Benefits of male circumcision for MSM: evidence for action

Voluntary medical male circumcision is a one-time, safe, highly cost-effective, biomedical, HIV prevention intervention supported by a robust evidence base of more than 40 observational studies and three randomised trials that showed circumcision reduces HIV acquisition in self-identified heterosexual men by approximately 60%, an effect that is sustained years after the procedure.1 Male circumcision also decreases the risk of heterosexual men acquiring other sexually transmitted infections (STIs), including genital ulcer disease, syphilis, herpes simplex virus type 2, and human papillomavirus (HPV).2 These STI prevention benefits extend to female partners, who have reduced rates of syphilis, HPV, bacterial vaginosis, and trichomoniasis.3 Between 2010 and 2017, more than 18·6 million men became circumcised in 14 priority African countries with generalised HIV epidemics and low rates of male circumcision.4 Voluntary medical male circumcision procedures averted an estimated 230 000 new HIV infections by 2017 and are projected to prevent more than 1 million HIV infections by 2030.4 Global goals are targeting 27 million more voluntary medical male circumcision procedures by 2021, translating to 90% of males aged 10–29 years being circumcised in priority settings.5

Gay, bisexual, and other men who have sex with men (MSM) have borne a disproportionate burden of the global HIV epidemic since its first recognition. In countries of low and middle income, MSM are 19 times more likely to be HIV infected compared with the general population, and HIV rates are rising among MSM in countries of low and middle income with high HIV burden, by contrast with global decreases in overall HIV incidence.6,  7 Homophobia and stigma, manifesting as criminalisation of homosexuality and neglect in national planning,8 constrain both the provision and uptake of HIV prevention services among MSM in many settings, further fuelling the HIV epidemic among MSM.

While the benefits of male circumcision against HIV and STIs among heterosexual men are clear, data for MSM have had conflicting results.  Read more via The Lancet

Benefits of male circumcision for MSM: evidence for action. The Lancet. Global health, ISSN: 2214-109X, Vol: 7, Issue: 4, Page: e388-e389. 2019