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Kigozi, Uganda presented on a study to assess if there was any differences in MC safety and adverse effects according to HIV status.  Side effects were infrequent and wound healing appeared to be similar according to HIV status. These findings have implications for health care workers knowing HIV status prior to circumcision and suggest it may not be required, although further analysis according to CD4 count is planned.

Makumbi, presented data from a study examining male post coital cleansing and the risk of HIV acquisition in rural Rakai (Male circumcision trial) as use of water with/without soap following coitus is quite common in Africa and no prospective studies have assesses the impact of this practice on HIV acquisition in uncircumcised men. The study showed consistent washing was not associated with a reduction in HIV incidence however HIV incidence was significantly lower if washing was delayed to >10 minutes after sexual intercourse (AIRR=0.13, 95% CI=0.03-0.54) or conversely washing less than ten minutes after intercourse increased HIV risk – possible confounders such as HIV status of partners and the individuals perceived HICV status were adjusted for. The latter finding was surprising and resulted in much interest from the audience. It was suggested that a larger sample size and longitudinal data would be beneficial confirm these findings.

Guanira, Ecuador presented on a study to assess circumcision rates and the willingness of men who have sex with men (MSM) in Peru to participate in circumcision trials. HIV in the Andean region is concentrated among MSM. The study was of cross sectional design where MSM were recruited from an existing HIV sentinel surveillance program in five Andean cities; 75 circumcised MSM and 1932 uncircumcised MSM were recruited, 41 refused.  One city was not included in the study as the MC status was not assessed adequately – some study staff considered people with phimosis as being circumcised. Lima and Guayaquil had the highest rates of HIV and syphilis. Circumcision rates were consistency low across cities - mean 3.7%.  Concerns reported by MSM about circumcision related to side effects and their partner would insist on having sex without condoms. There was no association between circumcision and HIV infections BUT a higher odds ratio when the analysis was restricted to insertive anal intercourse, not statistically significant. Higher education and living in larger cities were associated with willingness to participate in MC trials. Guanira commented that the low rates of MC limited the power to find any associations and a subsequent study, data not shown, was conducted in Lima involving 900 MSM showed the association between MC and HIV infection was closer to significance. These data suggest that a MC RCT study may be warranted in Peru to further assess its efficacy in the prevention of HIV.

Templeton, Sydney, presented on the circumcision status and risk of HIV seroconversion among MSM in Sydney (health in men cohort study). There are relatively few studies assessing the association of circumcision and HIV among MSM; the most recent (2005) conducted in the US showed an AOR of 2.0 (95% CI 1.1-3.7), other studies have shown no association.  Fifty five percent of participants were recruited from gay community events – over 1400 MSM were enrolled. The median age was 35 years and two thirds of MSM were circumcised. Older age was strongly associated with MSM as well as ethnicity and country of birth. There was 100% concordance between baseline self-report of MC and examination. To the end of 2006, 48 seroconversion (HIV incidence=0.9 per 100 PY) occurred. No association was seen between MC and HIV seroconversion. Templeton suggested that based on these data it would be premature to promote circumcision as HIV prevention intervention among MSM in Australia. These result different from the 2005 US study among MSM – however the US study had a much larger sample size and the two studies had different demographic and circumcision rates.

Londish, Australia presented on modelling data which explore MC in sub-Saharan Africa. These data showed MC predicts a significant reduction in HIV prevalence even when it is limited to certain age groups - 20-30 year olds and men who have a high number of sexual partners. The model explored the impact on HIV incidence also, but data is not available yet.