Circumcision to prevent HIV and other sexually transmitted infections in men who have sex with men: a systematic review and meta-analysis of global data.
Open accessAbstract
BACKGROUND: Men who have sex with men (MSM) are disproportionately affected by HIV and other sexually transmitted infections (STIs) worldwide. Previous reviews investigating the role of circumcision in preventing HIV and other STIs among MSM were inconclusive. Many new studies have emerged in the past decade. To inform global prevention strategies for HIV and other STIs among MSM, we reviewed all available evidence on the associations between circumcision and HIV and other STIs among MSM. METHODS: In this systematic review and meta-analysis, we searched PubMed, Web of Science, BioMed Central, Scopus, ResearchGate, Cochrane Library, Embase, PsycINFO, Google Scholar, and websites of international HIV and STI conferences for studies published before March 8, 2018. Interventional or observational studies containing original quantitative data describing associations between circumcision and incident or prevalent infection of HIV and other STIs among MSM were included. Studies were excluded if MSM could not be distinguished from men who have sex with women only. We calculated pooled odds ratios (ORs) and their 95% CIs using random-effect models. We assessed risk of bias using the Newcastle-Ottawa scale. FINDINGS: =0%). INTERPRETATION: We found evidence that circumcision is likely to protect MSM from HIV infection, particularly in countries of low and middle income. Circumcision might also protect MSM from HSV and penile HPV infection. MSM should be included in campaigns promoting circumcision among men in countries of low and middle income. In view of the substantial proportion of MSM in countries of low and middle income who also have sex with women, well designed longitudinal studies differentiating MSM only and bisexual men are needed to clarify the effect of circumcision on male-to-male transmission of HIV and other STIs. FUNDING: National Natural Science Foundation of China, National Science and Technology Major Project of China, Australian National Health and Medical Research Council Early Career Fellowship, Sanming Project of Medicine in Shenzhen, National Institutes of Health, Mega Projects of National Science Research for the 13th Five-Year Plan, Doris Duke Charitable Foundation.
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One meta-analysis of 62 observational studies reported that circumcision was protective against HIV acquisition in low- to middle-income countries but not in high-income countries.
“No definitive data exist to determine whether male circumcision reduces HIV acquisition among MSM, although one meta-analysis of 62 observational studies reported that circumcision was protective against HIV acquisition in low- to middle-income countries but not in high-income countries (73).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [73]
The Findings and Results report 62 observational studies and a protective association with HIV infection among MSM in low- and middle-income countries, but not in high-income countries. The claim calls this protection against HIV acquisition; the pooled outcome was HIV infection, and the Discussion notes that more than half the studies were cross-sectional, so the analysis does not establish reduced acquisition. (LLM, conf=0.84)
Experimental — accuracy not yet measuredNo definitive data exist to determine whether male circumcision reduces HIV acquisition among MSM.
“No definitive data exist to determine whether male circumcision reduces HIV acquisition among MSM, although one meta-analysis of 62 observational studies reported that circumcision was protective against HIV acquisition in low- to middle-income countries but not in high-income countries (73).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [73]
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- Authors
- Yuan, T., Fitzpatrick, T., Ko, N.-Y., Cai, Y., Chen, Y., Zhao, J., Li, L., Xu, J., Gu, J., Li, J., Hao, C., Yang, Z., Cai, W., Cheng, C.-Y., Luo, Z., Zhang, K., Wu, G., Meng, X., Grulich, A. E., Hao, Y., & Zou, H.
- Affiliations
- Sun Yat-sen University (CN)
- University of Washington (US)
- National Cheng Kung University Hospital (TW)
- Shanghai Jiao Tong University (CN)
- Shenzhen Center for Disease Control and Prevention (CN)
- Guangzhou Eighth People's Hospital (CN)
- National Health and Family Planning Commission (CN)
- Tao Yuan General Hospital (TW)
- Shenzhen Nanshan Center for Chronic Disease Control (CN)
- Chongqing Municipal Government (CN)
- UNSW Sydney (AU)
- Corresponding author
- Zou, Huachun
- ORCID
- Venue
- The Lancet Global Health
- Publisher
- Elsevier BV
- Published
- 2019-04
- Volume
- 7
- Issue
- 4
- Pages
- e436-e447
- ISSN
- 2214-109X (ISSN-L)
- PMC
- PMC7779827
- OpenAlex
- W2921398057
- Cited by
- 114
- References
- 94
- Citations by year
- 2026: 7 · 2025: 9 · 2024: 17 · 2023: 26 · 2022: 18 · 2021: 16 · 2020: 13 · 2019: 7
- FWCI
- 2.78
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- The Lancet Global Health (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- UNSWorks (UNSW Sydney) (submittedVersion, cc-by-nc-nd)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Natural Science Foundation of China (ID 81703278)
- Sanming Project of Medicine in Shenzhen (ID SZSM201811071)
- National Institutes of Health (ID 71673187, 2018ZX10715004, R01 MH105857, R01 AI121259, 81803334, ID 2017ZX10201101-002-007, ID 81573211)
- National Major Science and Technology Projects of China (2018ZX10721102)
- Doris Duke Charitable Foundation
- Topics
- Health Sciences › Medicine › Surgery › Genital Health and Disease
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
- Keywords
- male circumcision, HIV prevention, sexually transmitted infections, men who have sex with men, herpes simplex virus, low- and middle-income countries, HIV prevention campaigns
- MeSH terms
- Circumcision, Male, Herpes Simplex, Humans, Male, Sexual Behavior, Sexually Transmitted Diseases, HIV Infections, Homosexuality, Male
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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