Circumcision for HIV Prevention in Men Who Have Sex With Men: An Updated Meta-Analysis

BACKGROUND: Circumcision reduces HIV risk for men who have sex with women, but for men who have sex with men (MSM), prior meta-analyses were ambiguous because of inconsistent, highly confounded data suggesting regional differences. This has left the weight of evidence unclear even after a small 2024 trial in primarily insertive MSM (PI-MSM) in China showed protection. Any protection would be for PI-MSM and could have substantial impact given high incidence. SETTING: No restrictions. METHODS: We performed an updated literature search on the association of male circumcision with HIV among MSM. We conducted descriptive analyses, and a random-effects meta-analysis among PI-MSM. To isolate the protective effect of circumcision from confounders, we then performed a confounder-adjusted meta-analysis, comparing the effect of circumcision on HIV status among PI-MSM versus other MSM, testing for publication bias (funnel plot asymmetry) and regional heterogeneity (United States/Canada/Europe/Australia vs. Asia/Africa/Latin America). RESULTS: Forty-nine studies were included in the descriptive analysis, 13 in the unadjusted meta-analysis, and 10 in the confounder-adjusted meta-analysis. In the unadjusted meta-analysis, circumcision was associated with a lower HIV risk among PI-MSM (odds ratio (OR) = 0.57, 95% CI: 0.33 to 0.98); publication bias and heterogeneity were present. In the confounder-adjusted analysis, the additional effect of circumcision in the PI-MSM group-a ratio of ORs-was 0.53 (95% CI: 0.34 to 0.83), a significant, substantial protective association. Regional heterogeneity ( P = 0.65) and publication bias ( P = 0.34) were not present. CONCLUSIONS: Among PI-MSM, circumcision was protective against HIV. Findings support male circumcision as an effective HIV prevention method for PI-MSM

• Population(s)
  • Men who have sex with men
  • General HIV- population
• Prevention, Engagement and Care Cascade
  • Prevention
• Prevention
  • Biomedical interventions