title: Circumcision and risk of HIV infection in Australian homosexual men.
abstract: OBJECTIVE
  To assess circumcision status as a risk factor for HIV seroconversion in homosexual men.
  
  
  METHODS
  The Health in Men (HIM) study was a prospective cohort of homosexual men in Sydney, Australia. HIV-negative men (n = 1426) were recruited primarily from community-based sources between 2001 and 2004 and followed to mid-2007. Participants underwent annual HIV testing, and detailed information on sexual risk behaviour was collected every 6 months.
  
  
  METHODS
  HIV incidence in circumcised compared with uncircumcised participants, stratified by whether or not men predominantly practised the insertive role in anal intercourse.
  
  
  RESULTS
  There were 53 HIV seroconversions during follow-up; an incidence of 0.78 per 100 person-years. On multivariate analysis controlling for behavioural risk factors, being circumcised was associated with a nonsignificant reduction in risk of HIV seroconversion [hazard ratio 0.78, 95% confidence interval (CI) 0.42-1.45, P = 0.424]. Among one-third of study participants who reported a preference for the insertive role in anal intercourse, being circumcised was associated with a significant reduction in HIV incidence after controlling for age and unprotected anal intercourse (UAI) (hazard ratio 0.11, 95% CI 0.03-0.80, P = 0.041). Those who reported a preference for the insertive role overwhelmingly practised insertive rather than receptive UAI.
  
  
  CONCLUSIONS
  Overall, circumcision did not significantly reduce the risk of HIV infection in the HIM cohort. However, it was associated with a significant reduction in HIV incidence among those participants who reported a preference for the insertive role in anal intercourse. Circumcision may have a role as an HIV prevention intervention in this subset of homosexual men.
authors.affiliation: National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Level 2, 376 Victoria Street, Sydney NSW 2010, Australia. dtempleton@nchecr.unsw.edu.au
authors.forename: David J
authors.initials: DJ
authors.lastname: Templeton
authors.forename: Fengyi
authors.initials: F
authors.lastname: Jin
authors.forename: Limin
authors.initials: L
authors.lastname: Mao
authors.forename: Garrett P
authors.initials: GP
authors.lastname: Prestage
authors.forename: Basil
authors.initials: B
authors.lastname: Donovan
authors.forename: John
authors.initials: J
authors.lastname: Imrie
authors.forename: Susan
authors.initials: S
authors.lastname: Kippax
authors.forename: John M
authors.initials: JM
authors.lastname: Kaldor
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Grulich
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D002944:Circumcision, Male / Q000379:methods; D006679:HIV Seropositivity / Q000453:epidemiology* / Q000276:immunology / Q000523:psychology; D018451:Homosexuality, Male; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult