School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China.
Xiangya Nursing School, Central South University, Changsha, China; Yale School of Public Health, Yale University, New Haven, CT, USA.
Lancet Glob Health. 2021 Jul;9(7):e932-e941. doi: 10.1016/S2214-109X(21)00102-9. Epub 2021 Apr 30.
Medical male circumcision (MMC) reduces HIV infection among heterosexual men. There are concerns MMC might prompt higher-risk sexual behaviours because of lower self-perceived risk of HIV infection. We reviewed the published literature to examine associations between MMC and both condom use and number of sex partners among heterosexual men.
In this systematic review and meta-analysis, we searched PubMed, Embase, and the Cochrane Library for studies published before Nov 15, 2020. Interventional and observational studies were included if they contained original quantitative data describing the association between MMC and condom use or number of sex partners among heterosexual men. We excluded data from men whose circumcisions were ritual or religious and data from men who have sex with men. We extracted odds ratios (ORs) and 95% CIs for the associations between MMC and condomless sex and MMC and multiple sex partners directly from the publications if available, selecting adjusted ORs when provided; when necessary, we calculated ORs and 95% CIs using original study data provided in the publication. We used the Mantel-Haenszel random effects model to calculate pooled ORs and 95% CIs.
Our search yielded 3035 results, of which 471 were duplicates and 2537 did not meet the inclusion criteria. From the remaining 27 eligible studies, we identified 99 292 men from 31 independent population samples. 24 studies were done in Africa. We found no statistically significant associations between MMC and condomless sex (OR 0·91, 95% CI 0·80-1·05; k=30; I=88·7%) or multiple sex partners (1·02, 0·88-1·18; k=27; I=90·1%). No associations between MMC and condomless sex or multiple sexual partners were found in any subgroup analyses by study design, income of country, age, recruitment setting, circumcision assessment, circumcision prevalence, and risk of publication bias.
The promotion of circumcision as an HIV preventive measure does not appear to increase higher-risk sexual behaviours in heterosexual men. Ongoing sexual health education should be maintained as a vital component of effective MMC programmes.
National Science and Technology Major Project of China, the Fundamental Research Funds for the Central Universities, and the Shenzhen Science and Technology Innovation Commission Basic Research Program.
医学男性包皮环切术（MMC）可降低异性恋男性中的 HIV 感染率。有人担心 MMC 可能会因为自我感知的 HIV 感染风险降低而促使更高风险的性行为。我们回顾了已发表的文献，以检查 MMC 与异性恋男性使用避孕套和性伴侣数量之间的关系。
在这项系统评价和荟萃分析中，我们在 2020 年 11 月 15 日之前在 PubMed、Embase 和 Cochrane 图书馆中搜索了已发表的研究。如果研究包含描述 MMC 与异性恋男性使用避孕套或性伴侣数量之间关联的原始定量数据，则将纳入干预性和观察性研究。我们排除了仪式或宗教性质的包皮环切术和男男性行为者的数据。如果有可用数据，我们直接从出版物中提取 MMC 与无保护性行为和 MMC 与多个性伴侣之间的关联的比值比（OR）和 95%置信区间（CI），如果提供了调整后的 OR，则选择调整后的 OR；在必要时，我们使用出版物中提供的原始研究数据计算 OR 和 95%CI。我们使用 Mantel-Haenszel 随机效应模型计算汇总 OR 和 95%CI。
我们的搜索产生了 3035 个结果，其中 471 个是重复的，2537 个不符合纳入标准。在剩下的 27 项符合条件的研究中，我们从 31 个独立的人群样本中确定了 99292 名男性。24 项研究在非洲进行。我们没有发现 MMC 与无保护性行为（OR 0.91，95%CI 0.80-1.05；k=30；I=88.7%）或多个性伴侣（1.02，0.88-1.18；k=27；I=90.1%）之间存在统计学上的显著关联。在按研究设计、国家收入、年龄、招募地点、包皮环切评估、包皮环切流行率和发表偏倚风险进行的任何亚组分析中，都没有发现 MMC 与无保护性行为或多个性伴侣之间存在关联。
推广包皮环切术作为一种 HIV 预防措施似乎不会增加异性恋男性的高风险性行为。应继续开展性健康教育，作为有效 MMC 计划的重要组成部分。
中国国家科技重大专项、中央高校基本科研业务费和深圳市科技创新委员会基础研究项目。
