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Can Male Circumcision Have an Impact on the HIV Epidemic in Men Who Have Sex with Men?

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  • Steven M Goodreau
  • Nicole B Carnegie
  • Eric Vittinghoff
  • Javier R Lama
  • Jonathan D Fuchs
  • Jorge Sanchez
  • Susan P Buchbinder

Abstract

Background: Three trials have demonstrated the prophylactic effect of male circumcision (MC) for HIV acquisition among heterosexuals, and MC interventions are underway throughout sub-Saharan Africa. Similar efforts for men who have sex with men (MSM) are stymied by the potential for circumcised MSM to acquire HIV easily through receptive sex and transmit easily through insertive sex. Existing work suggests that MC for MSM should reach its maximum potential in settings where sexual role segregation is historically high and relatively stable across the lifecourse; HIV incidence among MSM is high; reported willingness for prophylactic circumcision is high; and pre-existing circumcision rates are low. We aim to identify the likely public health impact that MC interventions among MSM would have in one setting that fulfills these conditions—Peru—as a theoretical upper bound for their effectiveness among MSM generally. Methods and Findings: We use a dynamic, stochastic sexual network model based in exponential-family random graph modeling and parameterized from multiple behavioral surveys of Peruvian MSM. We consider three enrollment criteria (insertive during 100%, >80% or >60% of UAI) and two levels of uptake (25% and 50% of eligible men); we explore sexual role proportions from two studies and different frequencies of switching among role categories. Each scenario is simulated 10 times. We estimate that efficiency could reach one case averted per 6 circumcisions. However, the population-level impact of an optimistic MSM-MC intervention in this setting would likely be at most ∼5–10% incidence and prevalence reductions over 25 years. Conclusions: Roll-out of MC for MSM in Peru would not result in a substantial reduction in new HIV infections, despite characteristics in this population that could maximize such effects. Additional studies are needed to confirm these results for other MSM populations, and providers may consider the individual health benefits of offering MC to their MSM patients.

Suggested Citation

  • Steven M Goodreau & Nicole B Carnegie & Eric Vittinghoff & Javier R Lama & Jonathan D Fuchs & Jorge Sanchez & Susan P Buchbinder, 2014. "Can Male Circumcision Have an Impact on the HIV Epidemic in Men Who Have Sex with Men?," PLOS ONE, Public Library of Science, vol. 9(7), pages 1-9, July.
    • Handle: RePEc:plo:pone00:0102960
    DOI: 10.1371/journal.pone.0102960
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    References listed on IDEAS

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    1. Hunter, David R. & Handcock, Mark S. & Butts, Carter T. & Goodreau, Steven M. & Morris, Martina, 2008. "ergm: A Package to Fit, Simulate and Diagnose Exponential-Family Models for Networks," Journal of Statistical Software, Foundation for Open Access Statistics, vol. 24(i03).
    2. Stanley Wasserman & Philippa Pattison, 1996. "Logit models and logistic regressions for social networks: I. An introduction to Markov graphs andp," Psychometrika, Springer;The Psychometric Society, vol. 61(3), pages 401-425, September.
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    Cited by:

    1. Wouter Vermeer & Arthur Hjorth & Samuel M. Jenness & C Hendrick Brown & Uri Wilensky, 2020. "Leveraging Modularity During Replication of High-Fidelity Models: Lessons from Replicating an Agent-Based Model for HIV Prevention," Journal of Artificial Societies and Social Simulation, Journal of Artificial Societies and Social Simulation, vol. 23(4), pages 1-7.
    2. Maria Ganczak & Marcin Korzeń & Maciej Olszewski, 2017. "Attitudes, Beliefs and Predictors of Male Circumcision Promotion among Medical University Students in a Traditionally Non-Circumcising Region," IJERPH, MDPI, vol. 14(10), pages 1-14, September.

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