title: Lower HIV Risk Among Circumcised Men Who Have Sex With Men in China: Interaction With Anal Sex Role in a Cross-Sectional Study.
abstract: BACKGROUND
  Voluntary medical male circumcision reduces the risk of HIV heterosexual transmission in men, but its effect on male-to-male sexual transmission is uncertain.
  
  
  METHODS
  Circumcision status of men who have sex with men (MSM) in China was evaluated by genital examination and self-report; anal sexual role was assessed by questionnaire interview. Serostatus for HIV and syphilis was confirmed.
  
  
  RESULTS
  Among 1155 participants (242 were seropositive and 913 with unknown HIV status at enrollment), the circumcision rate by self-report (10.4%) was higher than confirmed by genital examination (8.2%). Male circumcision (by examination) was associated with 47% lower odds of being HIV seropositive [adjusted odds ratio (aOR): 0.53; 95% confidence interval (CI): 0.27 to 1.02] after adjusting for demographic covariates, number of lifetime male sexual partners, and anal sex role. Among MSM who predominantly practiced insertive anal sex, circumcised men had 62% lower odds of HIV infection than those who were uncircumcised (aOR: 0.38; 95% CI: 0.09 to 1.64). Among those whose anal sex position was predominantly receptive or versatile, circumcised men have 46% lower odds of HIV infection than did men who were not circumcised (aOR: 0.54; 95% CI: 0.25 to 1.14). Compared to uncircumcised men reporting versatile or predominantly receptive anal sex positioning, those who were circumcised and reported practicing insertive sex had an 85% lower risk (aOR: 0.15; 95% CI: 0.04 to 0.65). Circumcision was not associated clearly with lower syphilis risk (aOR: 0.91; 95% CI: 0.51 to 1.61).
  
  
  CONCLUSIONS
  Circumcised MSM were less likely to have acquired HIV, most pronounced among men predominantly practicing insertive anal intercourse. A clinical trial is needed.
authors.affiliation: *Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, TN; †Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN; ‡Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China; §State Key Laboratory for Infectious Disease Prevention and Control, and National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China; ‖Department of Urology, Vanderbilt University School of Medicine, Nashville, TN; ¶HJF-DAIDS, a Division of The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Contractor to National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD; #Chaoyang District Center for Disease Control and Prevention, Beijing, China; Departments of **Biostatistics; and ††Pediatrics, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Han-Zhu
authors.initials: HZ
authors.lastname: Qian
authors.forename: Yuhua
authors.initials: Y
authors.lastname: Ruan
authors.forename: Yu
authors.initials: Y
authors.lastname: Liu
authors.forename: Douglas F
authors.initials: DF
authors.lastname: Milam
authors.forename: Hans M L
authors.initials: HM
authors.lastname: Spiegel
authors.forename: Lu
authors.initials: L
authors.lastname: Yin
authors.forename: Dongliang
authors.initials: D
authors.lastname: Li
authors.forename: Bryan E
authors.initials: BE
authors.lastname: Shepherd
authors.forename: Yiming
authors.initials: Y
authors.lastname: Shao
authors.forename: Sten H
authors.initials: SH
authors.lastname: Vermund
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002681:China; D002944:Circumcision, Male; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000635:transmission*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012725:Sexual Behavior; D055815:Young Adult