More than foreskin: circumcision status, history of HIV/STI, and sexual risk in a clinic-based sample of men in Puerto Rico.
BACKGROUND
Circumcision among adult men has been widely promoted as a strategy to reduce human immunodeficiency virus (HIV) transmission risk. However, much of the available data derive from studies conducted in Africa, and there is as yet little research in the Caribbean region where sexual transmission is also a primary contributor to rapidly escalating HIV incidence.


OBJECTIVE
In an effort to fill the void of data from the Caribbean, the objective of this article is to compare history of sexually transmitted infections (STI) and HIV diagnosis in relation to circumcision status in a clinic-based sample of men in Puerto Rico.


METHODS
Data derive from an ongoing epidemiological study being conducted in a large STI/HIV prevention and treatment center in San Juan in which 660 men were randomly selected from the clinic's waiting room.


METHODS
We assessed the association between circumcision status and self-reported history of STI/HIV infection using logistic regressions to explore whether circumcision conferred protective benefit.


RESULTS
Almost a third (32.4%) of the men were circumcised (CM). Compared with uncircumcised (UC) men, CM have accumulated larger numbers of STI in their lifetime (CM = 73.4% vs. UC = 65.7%; P = 0.048), have higher rates of previous diagnosis of warts (CM = 18.8% vs. UC = 12.2%; P = 0.024), and were more likely to have HIV infection (CM = 43.0% vs. UC = 33.9%; P = 0.023). Results indicate that being CM predicted the likelihood of HIV infection (P value = 0.027).


CONCLUSIONS
These analyses represent the first assessment of the association between circumcision and STI/HIV among men in the Caribbean. While preliminary, the data indicate that in and of itself, circumcision did not confer significant protective benefit against STI/HIV infection. Findings suggest the need to apply caution in the use of circumcision as an HIV prevention strategy, particularly in settings where more effective combinations of interventions have yet to be fully implemented.
Medical Sciences Campus-School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. carlos.rodriguez64@upr.edu
Carlos E
CE
Rodriguez-Diaz
Michael C
MC
Clatts
Gerardo G
GG
Jovet-Toledo
Ricardo L
RL
Vargas-Molina
Lloyd A
LA
Goldsamt
Hermes
H
García
D000328:Adult; D002944:Circumcision, Male; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission*; D006306:Health Surveys; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D011647:Puerto Rico; D012749:Sexually Transmitted Diseases / Q000517:prevention & control* / Q000635:transmission*; D047568:Unsafe Sex