Willingness of Men Who Have Sex with Men in the US to Be Circumcised as Adults to Reduce Risk of HIV Infection
Elin Begley*, K Jafa, A Voetsch, J Heffelfinger, and P Sullivan
CDC, Atlanta, GA, US
Background: A recent clinical trial in South Africa
demonstrated that circumcision reduced the risk of HIV acquisition by 61% among
heterosexual men; and 1 longitudinal US cohort study documented decreased risk
of HIV infection among circumcised MSM. We examined the prevalence of
circumcision, willingness to be circumcised, and
perceived benefits of and concerns about adult circumcision among MSM in the United States.
Methods: We analyzed survey data from 415 MSM
respondents not known to be HIV+ who were interviewed at 5 Gay Pride
events in 2006 (182 at minority Gay Pride events in Chicago, Illinois,
Charlotte, North Carolina, and St Louis, Missouri, and 233 at Gay Pride events
in Birmingham, Alabama and Anchorage, Alaska). We asked uncircumcised men if they
would be willing to be circumcised if scientific studies showed that
circumcision reduced risk of HIV infection for MSM, and about potential
benefits of and concerns about circumcision. Among uncircumcised MSM, we used a
χ2 test to determine if significant differences (p <0.05) existed in demographic
characteristics and sexual orientation, and the Wilcoxon-Mann-Whitney
test to compare median Likert scale values (1 =
strongly disagree, 5 = strongly agree) of perceived benefits of and concerns
about circumcision, by willingness to be circumcised.
Results: Of 415 MSM respondents, 331 (80%) were
circumcised. Of 84 uncircumcised men, 59 (70%) belonged to a racial minority;
45 (54%) indicated that they would be willing to be circumcised if it were
shown to reduce risk of HIV infection and 13 (15%) were uncertain. There were
no significant differences between MSM willing and unwilling to be circumcised
by age, ethnicity, race, education level, health insurance status, or sexual orientation.
Compared to MSM unwilling to be circumcised, MSM willing to be circumcised were
more likely to agree that increased sexual pleasure (p = 0.03) and reduced risk of penile cancer (p <0.01), sexually transmitted diseases (p = 0.03), and HIV (p = 0.03)
were benefits to circumcision and that post-operative penile bleeding was a
concern (p = 0.01).
Conclusions: Only 20% of MSM respondents were
uncircumcised, and over half of uncircumcised MSM reported they would be
willing to be circumcised if it were scientifically proven to reduce risk of
HIV infection. If circumcision is shown to be an effective intervention to
reduce risk of HIV infection among MSM in the United States, data on perceived
benefits of and concerns about circumcision should be used to develop
circumcision education programs.