Kankaka Edward Nelson, Ssekasanvu Joseph, Prodger Jessica, Nabukalu Dorean, Nakawooya Hadijja, Ndyanabo Anthony, Kigozi Godfrey, Gray Ronald
a Rakai Health Sciences Program , Rakai , Uganda.
b Department of Epidemiology, Bloomberg School of Public Health , Johns Hopkins University , Baltimore , MD , USA.
AIDS Care. 2018 Aug;30(8):990-996. doi: 10.1080/09540121.2018.1437253. Epub 2018 Feb 13.
To determine whether circumcision of HIV-positive men is associated with increased subsequent sexual risk behaviors which may place their female partners at risk.
Newly circumcised and uncircumcised HIV-positive men in the Rakai Community Cohort Study were followed from baseline (July 2013-January 2015) to determine trend in sexual risk behaviors and association of circumcision with subsequent sexual risk behaviors at follow up (February 2015-September 2016). Risk behaviors included sexual activity, alcohol before sex, transactional sex, multiple sex partners, casual sex partners, and inconsistent condom use with casual partners. The association was evaluated using modified Poisson regression, and sensitivity analyses were performed after multiple imputation with chained equations for missing data.
We identified 538 eligible men, of whom 113(21.0%) were circumcised at baseline and 425(79.0%) were uncircumcised. Men in fishing communities were more likely to be circumcised (p = 0.032) as well as those exposed to targeted HIV messaging (p < 0.001). Overall, 188(34.9%) men were lost to follow up and most were uncircumcised (p = 0.020). Among those followed up, behaviors remained largely unchanged with no differences by circumcision status. Transactional sex appeared to be associated with circumcision in unadjusted analyses (PR = 1.58, 95%CI = 1.01,2.48; p = 0.045, p = 0.05) and adjusted analyses (adj.PR = 1.54, 95%CI = 1.06,2.23; p = 0.022). However, the association was no longer significant in sensitivity analyses after accounting for loss to follow up (adj.PR = 1.43, 95%CI = 0.98,2.08; p = 0.066). No association with circumcision was observed for other sexual risk behaviors.
We found no association between circumcision of HIV-positive men and subsequent sexual risk behavior.
确定HIV阳性男性行包皮环切术是否与随后增加的性风险行为相关，而这些行为可能会使其女性伴侣处于危险之中。
在拉凯社区队列研究中，对新接受包皮环切术和未接受包皮环切术的HIV阳性男性从基线期（2013年7月至2015年1月）开始进行随访，以确定性风险行为的趋势以及包皮环切术与随访期（2015年2月至2016年9月）随后的性风险行为之间的关联。风险行为包括性活动、性行为前饮酒、交易性性行为、多个性伴侣、临时性伴侣以及与临时性伴侣使用避孕套不一致。使用修正的泊松回归评估这种关联，并在对缺失数据采用链式方程进行多次插补后进行敏感性分析。
我们确定了538名符合条件的男性，其中113名（21.0%）在基线期接受了包皮环切术，425名（79.0%）未接受包皮环切术。渔业社区的男性更有可能接受包皮环切术（p = 0.032），接触过针对性HIV信息的男性也是如此（p < 0.001）。总体而言，188名（34.9%）男性失访，且大多数未接受包皮环切术（p = 0.020）。在接受随访的男性中，行为在很大程度上保持不变，无论包皮环切术状态如何均无差异。在未调整分析中，交易性性行为似乎与包皮环切术有关（PR = 1.58，95%CI = 1.01，2.48；p = 0.045，p = 0.05），在调整分析中也是如此（调整后PR = 1.54，95%CI = 1.06，2.23；p = 0.022）。然而，在考虑失访情况后的敏感性分析中，这种关联不再显著（调整后PR = 1.43，95%CI = 0.98，2.08；p = 0.066）。对于其他性风险行为，未观察到与包皮环切术有关联。
我们发现HIV阳性男性的包皮环切术与随后的性风险行为之间没有关联。
