Review

. 2025 Aug 7.

doi: 10.1007/s10461-025-04850-4. Online ahead of print.

Male Circumcision and HIV Risk Compensation Among Men Who Have Sex with Men: A Systematic Review and Meta-Analysis

Xinsheng Wu^#¹, Zhongwen Wang^#¹, Yongjian Shi¹, Thomas Fitzpatrick², Weijie Zhang³, Zixin Wang⁴, Phoenix K H Mo⁵, Luyao Xie⁵, Yu Liu⁶, Domingo Fernández Vecilla⁷, Qianqian Luo⁸, Aidi Zhang⁹, Ana Claudia Ossa-Giraldo¹⁰, Kate M Mitchell¹¹, Sten H Vermund¹², Huachun Zou^{13

14

15

16}

Affiliations

¹ School of Public Health, Fudan University, Shanghai, China.
² School of Medicine, University of Washington, Seattle, WA, USA.
³ School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China.
⁴ JC School of Public Health and Primary Care, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China.
⁵ Centre for Health Behaviours Research, School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong SAR, China.
⁶ Division of Epidemiology, Department of Public Health Sciences (SRB 3305), University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
⁷ Marques de Valdecilla University Hospital, School of Medicine, University of Cantabria, Av. Valdecilla, 25, 39008, Santander, Cantabria, Spain.
⁸ School of Nursing, Binzhou Medical University, Yantai, China.
⁹ The Third, Xiangya Hospital of Central South University, Changsha, China.
¹⁰ Infettare Research Group, School of Medicine, Universidad Cooperativa de Colombia, Medellín, Colombia.
¹¹ Department of Nursing and Community Health, Glasgow Caledonian University London, London, UK.
¹² College of Public Health, University of South Florida, Tampa, FL, USA.
¹³ School of Public Health, Fudan University, Shanghai, China. zouhuachun@fudan.edu.cn.
¹⁴ School of Public Health, Southwest Medical University, Luzhou, China. zouhuachun@fudan.edu.cn.
¹⁵ Melbourne Sexual Health Centre, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia. zouhuachun@fudan.edu.cn.
¹⁶ Xuhui District, Room 435, Bld #8, 130 Dongan Road, Shanghai, 200032, China. zouhuachun@fudan.edu.cn.

^# Contributed equally.

PMID: 40773103
DOI: 10.1007/s10461-025-04850-4

Review

Male Circumcision and HIV Risk Compensation Among Men Who Have Sex with Men: A Systematic Review and Meta-Analysis

Xinsheng Wu et al. AIDS Behav. 2025.

. 2025 Aug 7.

doi: 10.1007/s10461-025-04850-4. Online ahead of print.

Authors

Affiliations

¹ School of Public Health, Fudan University, Shanghai, China.
² School of Medicine, University of Washington, Seattle, WA, USA.
³ School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China.
⁴ JC School of Public Health and Primary Care, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China.
⁵ Centre for Health Behaviours Research, School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong SAR, China.
⁶ Division of Epidemiology, Department of Public Health Sciences (SRB 3305), University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
⁷ Marques de Valdecilla University Hospital, School of Medicine, University of Cantabria, Av. Valdecilla, 25, 39008, Santander, Cantabria, Spain.
⁸ School of Nursing, Binzhou Medical University, Yantai, China.
⁹ The Third, Xiangya Hospital of Central South University, Changsha, China.
¹⁰ Infettare Research Group, School of Medicine, Universidad Cooperativa de Colombia, Medellín, Colombia.
¹¹ Department of Nursing and Community Health, Glasgow Caledonian University London, London, UK.
¹² College of Public Health, University of South Florida, Tampa, FL, USA.
¹³ School of Public Health, Fudan University, Shanghai, China. zouhuachun@fudan.edu.cn.
¹⁴ School of Public Health, Southwest Medical University, Luzhou, China. zouhuachun@fudan.edu.cn.
¹⁵ Melbourne Sexual Health Centre, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia. zouhuachun@fudan.edu.cn.
¹⁶ Xuhui District, Room 435, Bld #8, 130 Dongan Road, Shanghai, 200032, China. zouhuachun@fudan.edu.cn.

^# Contributed equally.

PMID: 40773103
DOI: 10.1007/s10461-025-04850-4

Abstract
in English, Spanish

Male circumcision (MC) has been shown to reduce the risk of HIV infection among men who have sex with men (MSM) in a recent randomised controlled trial. A question that remains unanswered is whether MC in MSM implies HIV compensation, i.e. condomless sex and/or multiple sex partners. We searched PubMed, Embase, and the Cochrane Library for relevant studies published before November 5, 2024 and reviewed references of included studies. We included interventional and observational studies reporting original quantitative data on the association between MC and condom use or the number of sex partners among MSM. Odds ratios (ORs) and 95% confidence intervals (CIs) were extracted directly from the studies or calculated from available data when necessary. A Mantel-Haenszel random effects model was used to calculate pooled ORs and CIs. The final analysis included 41,694 MSM from 15 eligible studies. No statistically significant association was found between MC and condomless sex (OR 1.02, 95% CI 0.91-1.14; k = 13; I² = 18%) or multiple sex partners (OR 1.03, 95% CI 0.94-1.12; k = 10; I² = 12%) among MSM. The lack of association persisted in the great majority of subgroup analyses, encompassing country income, age, recruitment setting, time length, year of recruitment, circumcision assessment, proportion circumcised, or risk of bias. In conclusion, MC among MSM was not found to be associated with either condomless sex or multiple sex partners. Nonetheless, standard minimum service packages, as per WHO guidelines, should be integrated and consistently provided within MC programs to better protect MSM from HIV infection.

La circuncisión masculina (CM) ha demostrado reducir el riesgo de infección por VIH entre hombres que tienen sexo con hombres (HSH) en un reciente ensayo clínico aleatorizado. Una cuestión que permanece sin respuesta es si la CM en HSH conlleva compensación de riesgo para el VIH, es decir, sexo sin preservativo y/o múltiples parejas sexuales. Buscamos en PubMed, Embase y la Biblioteca Cochrane estudios relevantes publicados antes del 5 de noviembre de 2024 y revisamos las referencias de los estudios incluidos. Incluimos estudios de intervención y observacionales que reportaron datos cuantitativos originales sobre la asociación entre la CM y el uso de preservativo o el número de parejas sexuales entre HSH. Las razones de probabilidades (OR) y sus intervalos de confianza al 95 % (IC) se extrajeron directamente de los estudios o se calcularon a partir de los datos disponibles cuando fue necesario. Se utilizó un modelo de efectos aleatorios de Mantel–Haenszel para calcular las OR e IC agrupadas. El análisis final incluyó a 41 694 HSH procedentes de 15 estudios elegibles. No se encontró una asociación estadísticamente significativa entre la CM y el sexo sin preservativo (OR 1,02; IC 95 %: 0,91–1,14; k = 13; I² = 18 %) ni con múltiples parejas sexuales (OR 1,03; IC 95 %: 0,94–1,12; k = 10; I² = 12 %) entre HSH. La ausencia de asociación persistió en la gran mayoría de los análisis de subgrupos, que abarcaron nivel de ingresos del país, edad, contexto de reclutamiento, duración del estudio, año de reclutamiento, método de evaluación de la circuncisión, proporción circuncidada y riesgo de sesgo. En conclusión, no se encontró que la CM entre HSH estuviera asociada ni con sexo sin preservativo ni con múltiples parejas sexuales. No obstante, los paquetes de servicios mínimos estándar, según las directrices de la OMS, deberían integrarse y proporcionarse de forma continua en los programas de CM para proteger mejor a los HSH de la infección por VIH.

Keywords: Condomless sex; HIV/AIDS; Male circumcision (MC); Men who have sex with men (MSM); Multiple sex partners; Risk compensation.

PubMed Disclaimer

Conflict of interest statement

Declarations. Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References

1. Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, Puren A. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med. 2005;2(11):e298. - PubMed - PMC
1. Bailey RC, Moses S, Parker CB, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet. 2007;369(9562):643–56. - PubMed
1. Gray RH, Kigozi G, Serwadda D, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet. 2007;369(9562):657–66. - PubMed
1. Gao Y, Yuan T, Zhan Y, et al. Association between medical male circumcision and HIV risk compensation among heterosexual men: a systematic review and meta-analysis. Lancet Glob Health. 2021;9(7):e932–41. - PubMed - PMC
1. Paul Poteat V, Russell ST, Dewaele A. Sexual health risk behavior disparities among male and female adolescents using identity and behavior indicators of sexual orientation. Arch Sex Behav. 2019;48(4):1087–97. - PubMed

Publication types

Actions

Grants and funding

2023YFC2306700/National Key Technologies R&D Program

LinkOut - more resources

Full Text Sources
- Springer

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Male Circumcision and HIV Risk Compensation Among Men Who Have Sex with Men: A Systematic Review and Meta-Analysis

Affiliations

Male Circumcision and HIV Risk Compensation Among Men Who Have Sex with Men: A Systematic Review and Meta-Analysis

Authors

Affiliations

Abstract
in English, Spanish

Conflict of interest statement

Similar articles

References

Publication types

Grants and funding

LinkOut - more resources

Full Text Sources

Abstract in English, Spanish

Conflict of interest statement

Similar articles

References

Publication types

Related information

Grants and funding

LinkOut - more resources

Full Text Sources

Abstract
in English, Spanish