What Is the Potential Impact of Adult Circumcision on the HIV Epidemic Among Men Who Have Sex With Men in San Francisco?

摘要

With the help of a community-based survey, we assess the potential effect of circumcision on the HIV epidemic among men who have sex with men (MSM) in San Francisco. Only a small minority of MSM would both derive benefit from circumcision (i.e., were uncir-cumcised, HIV-negative, predominantly insertive, and reported unprotected insertive anal sex) and be willing to participate in circumcision trials (0.7%) or be circumcised if proven effective as a prevention strategy (0.9%). Circumcision would have limited public health significance for MSM in San Francisco. Men who have sex with men (MSM) continue to be disproportionately affected by human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) in the developed world and are becoming the center of HIV epidemics in some developing countries. However, evidence-based HIV prevention approaches have not been able to halt MSM epidemics, with HIV incidence resurgent in some countries and newly rising in others. A desire to consider adult male circumcision (MC) as a prevention strategy for MSM is driven by its demonstrated ability to reduce HIV incidence by as much as 60% in randomized controlled trials among heterosexual men.