School of Health Sciences, City University London, 20 Bartholomew Close, London, EC1A 7QN, UK.
Arch Sex Behav. 2013 Oct;42(7):1319-26. doi: 10.1007/s10508-012-0061-1. Epub 2013 Jan 29.
The objective was to examine the association between circumcision status and self-reported HIV infection among men who have sex with men (MSM) in Britain who predominantly or exclusively engaged in insertive anal intercourse. In 2007-2008, a convenience sample of MSM living in Britain was recruited through websites, in sexual health clinics, bars, clubs, and other venues. Men completed an online survey which included questions on circumcision status, HIV testing, HIV status, sexual risk behavior, and sexual role for anal sex. The analysis was restricted to 1,521 white British MSM who reported unprotected anal intercourse in the previous 3 months and who said they only or mostly took the insertive role during anal sex. Of these men, 254 (16.7 %) were circumcised. Among men who had had a previous HIV test (n = 1,097), self-reported HIV seropositivity was 8.6 % for circumcised men (17/197) and 8.9 % for uncircumcised men (80/900) (unadjusted odds ratio [OR], 0.97; 95 % confidence interval [95 % CI], 0.56, 1.67). In a multivariable logistic model adjusted for known risk factors for HIV infection, there was no evidence of an association between HIV seropositivity and circumcision status (adjusted OR, 0.79; 95 % CI, 0.43, 1.44), even among the 400 MSM who engaged exclusively in insertive anal sex (adjusted OR, 0.84; 95 % CI, 0.25, 2.81). Our study provides further evidence that circumcision is unlikely to be an effective strategy for HIV prevention among MSM in Britain.
本研究旨在探究英国男男性行为者(MSM)中,以插入性肛交为主或完全以插入性肛交为性行为方式的人群中,包皮环切与自我报告 HIV 感染之间的相关性。2007-2008 年,通过网站、性健康诊所、酒吧、俱乐部和其他场所,对居住在英国的 MSM 进行了便利抽样调查。男性完成了一项在线调查,内容包括包皮环切状态、HIV 检测、HIV 状态、性行为风险和肛交中的性角色。分析仅限于 1521 名报告在过去 3 个月中进行过无保护肛交且表示在肛交中仅或主要处于插入方的白种英国 MSM。在这些男性中,254 名(16.7%)接受了包皮环切。在曾接受过 HIV 检测的男性中(n=1097),自我报告的 HIV 血清阳性率为包皮环切男性(17/197)的 8.6%,未行包皮环切男性(80/900)的 8.9%(未调整的优势比[OR],0.97;95%置信区间[95%CI],0.56,1.67)。在调整已知 HIV 感染风险因素的多变量逻辑回归模型中,HIV 血清阳性率与包皮环切状态之间无关联(调整后的 OR,0.79;95%CI,0.43,1.44),即使在仅进行插入性肛交的 400 名 MSM 中(调整后的 OR,0.84;95%CI,0.25,2.81)。本研究进一步证明,在英国的 MSM 中,包皮环切不太可能成为预防 HIV 的有效策略。
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