Are circumcised (surgically altered to remove the foreskin) men at risk of acquiring Human Immunodeficiency Virus (HIV) through vaginal intercourse?

From the Guidelines

Circumcised men are at a significantly lower risk of acquiring Human Immunodeficiency Virus (HIV) through vaginal intercourse, with a reduction in risk of 53% to 60%, as reported in the 2014 recommendations of the international antiviral society-usa panel 1. The reduced risk is due to several factors, including:

• Removal of foreskin cells that are more susceptible to HIV infection
• Keratinization of the glans, making it less permeable to the virus
• Reduction in micro-tears during intercourse However, it is essential to note that circumcision does not eliminate the risk of HIV acquisition entirely, and circumcised men should still practice safe sex, including:
• Consistent condom use
• Regular HIV testing
• Limiting sexual partners
• Considering PrEP (pre-exposure prophylaxis) if at high risk As stated in the study by Marrazzo et al. 1, voluntary male circumcision has been shown to be a durable and cost-effective method for reducing the risk of HIV acquisition, and its implementation has been recommended by the WHO and UNAIDS for HIV prevention in priority countries. It is crucial to emphasize that circumcision only partially protects against HIV, and other STIs and pregnancy risks remain unchanged, highlighting the need for a comprehensive approach to sexual health for all men, regardless of circumcision status.

From the Research

Risk of HIV Infection in Circumcised Men

• The risk of HIV infection in circumcised men is a topic of ongoing research, with studies suggesting that male circumcision can reduce the risk of HIV infection in high-risk heterosexual populations 2.
• A review of the scientific evidence on male circumcision and HIV infection risk found that level 1 evidence supports the concept that male circumcision substantially reduces the risk of HIV infection 2.
• Three major lines of evidence support this conclusion: biological data, observational studies, and randomized clinical trials 2.

Biological and Observational Evidence

• Biological studies suggest that male circumcision can reduce the risk of HIV infection by removing the foreskin, which is a potential site of HIV entry 3.
• Observational studies have found that circumcised men are at lower risk of HIV infection than uncircumcised men, particularly in high-risk populations 4.
• A cross-sectional study in Rwanda found that uncircumcised men had a higher prevalence of HIV infection than circumcised men, despite having a lower-risk profile 4.

Randomized Clinical Trials

• Three randomized controlled trials in sub-Saharan Africa have shown that circumcision reduces the risk of acquiring HIV infection in men by approximately 60% 3.
• A review of these trials found that circumcision may be protective against genital ulcer disease, Herpes simplex type 2, Trichomonas vaginalis, and human papillomavirus infection in men 3.

Risk Factors for HIV Infection in Circumcised Men

• A case-control study in Uganda found that risk factors for HIV infection among circumcised men included being circumcised at adulthood, resuming sexual intercourse before wound healing, inconsistent condom use, and having sex under the influence of peers 5.
• The study also found that men who had religious circumcision were less likely to have HIV infection than those who were traditionally circumcised 5.