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KRETSINGER ON CIRCUMCISION

Wednesday, 14th of May 2014

KRETSINGER ON CIRCUMCISION

Please find below abstracts of five publications on male circumcision in the US, all co-authored by Dr. Katrina Kretsinger, US Centers for Disease Control.

Good reading.

 

NEED FOR PHYSICIAN EDUCATION ON THE BENEFITS AND RISKS OF MALE CIRCUMCISION IN THE UNITED STATES

AIDS Educ Prev. 2012 Aug;24(4):377-87. doi: 10.1521/aeap.2012.24.4.377.

 

Carbery B¹, Zhu J, Gust DA, Chen RT, Kretsinger K, Kilmarx PH¹Emory University, Atlanta, Georgia, USA.

Abstract below; full text available to journal subscribers

Physicians may be called upon to counsel male patients or parents of newborn males regarding their decision to circumcise their newborn sons. The purpose of the present study was to describe physicians who do not understand the benefits and risks associated with male circumcision well enough to counsel parents of newborn male infants and adult men. A self-administered, cross-sectional electronic survey of physicians was conducted in 2008. We analyzed responses from 1,500 physicians (510 family practitioners, 490 internists, 250 pediatricians, and 250 obstetricians/gynecologists). Nearly 22% (n = 327/1500) reported they did not understand the risks and benefits of newborn male circumcision well enough to counsel parents and 40.3% (n = 504/1250) reported not understanding the risks and benefits well enough to counsel adult men. A substantial minority of physicians may need additional training and/or information about current male circumcision research to feel comfortable counseling parents of newborn male infants or adult men.

ACCEPTABILITY OF NEWBORN CIRCUMCISION TO PREVENT HIV INFECTION IN THE UNITED STATES

Sex Transm Dis. 2011 Jun;38(6):536-42. doi: 10.1097/OLQ.0b013e318207f5b0.

 

Gust DA¹, Kretsinger K, Gaul Z, Pals S, Heffelfinger JD, Begley E, Chen RT, Kilmarx PH.

• ¹Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA. dgust@cdc.gov

Abstract below; full text is available to journal subscribers.

BACKGROUND/PURPOSE:

To understand whether information from the African clinical trials about the partially protective effect of male circumcision against human immunodeficiency virus (HIV) infection could influence adults to circumcise a newborn son.

METHODS:

Using the 2008 ConsumerStyles panel survey data, multiple regression analysis was performed to identify correlates of (1) inclination toward circumcising a newborn son and (2) being influenced to have a newborn son circumcised if it would reduce the chance of becoming HIV infected later in life.

RESULTS:

Response rate was 50.6% (10,108/19,996). Approximately 12% reported not being inclined to circumcise a newborn son. Higher odds of not being inclined to circumcise a newborn son were associated with Hispanic and "other" race/ethnicity, being an uncircumcised man and a man not reporting circumcision status, postgraduate education, region, and negative health-related attitudes. Lower odds were associated with black race and less number of household members. Fifty-three percent of respondents reported that information about the protective effect of circumcision would make them more likely to have a newborn son circumcised. Higher odds of being influenced to have a newborn son circumcised were associated with being ≥45 years of age, black race, living in a household with fewer than 5 members, having high school or some college education, region, and positive health-related attitudes; lower odds were associated with being an uncircumcised man and lower income.

CONCLUSIONS:

Our findings suggest that providing educational information about the HIV prevention and benefit of circumcision may increase the inclination to circumcise a newborn son for some people.

 

COVERAGE OF NEWBORN AND ADULT MALE CIRCUMCISION VARIES AMONG PUBLIC AND PRIVATE US PAYERS DESPITE HEALTH BENEFITS.

Health Aff (Millwood). 2011 Dec;30(12):2355-61. doi: 10.1377/hlthaff.2011.0776.

 

Clark SJ¹, Kilmarx PH, Kretsinger K.

• ¹Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan, USA. saclark@med.umich.edu

Abstract below; full text available to journal subscribers

Studies have shown that male circumcision greatly reduces the risk for heterosexual transmission of HIV, other sexually transmitted infections, infant urinary tract infections, penile cancer, and other adverse health outcomes. Given recent data regarding these health benefits and the cost-effectiveness of newborn male circumcision, national policy makers are developing new recommendations regarding circumcision for newborn, adolescent, and adult males. To investigate the implications, this study assessed insurance coverage and reimbursement for routine newborn and adult male circumcision in private and public health plans in 2009. We found that coverage varies across private and public payers. Private insurance provides far broader coverage than state Medicaid programs for routine newborn male circumcision. Specifically, Medicaid programs in seventeen states do not cover it, even though low-income populations have a higher risk of HIV and other sexually transmitted diseases compared to higher-income groups. For adult male circumcision, coverage is generally sparse across public and private plans. Presentation of evidence-based recommendations--for example, from the Centers for Disease Control and Prevention--may be necessary if coverage for newborn and adult male circumcision is to be expanded.

 

MALE CIRCUMCISION AS AN HIV PREVENTION INTERVENTION IN THE U.S.: INFLUENCE OF HEALTH CARE PROVIDERS AND POTENTIAL FOR RISK COMPENSATION.

Prev Med. 2011 Mar-Apr;52(3-4):270-3. doi: 10.1016/j.ypmed.2011.01.015. Epub 2011 Feb 2.

 

Gust DA¹, Kretsinger K, Pals SL, Gaul ZJ, Hefflefinger JD, Begley EB, Chen RT, Kilmarx PH.

• ¹Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. dgust@cdc.gov

Abstract below; full text available to journal subscribers

OBJECTIVE:

The study aims to assess the acceptability of male circumcision as an HIV prevention intervention and the potential for risk compensation in the continental U.S.

METHODS: ConsumerStyles 2008 survey was used to identify correlates of 1) a "likely" or "very likely" response among uncircumcised men to "How likely are you to get circumcised if your health care provider told you that circumcision would reduce your chance of becoming HIV infected?" and 2) agreement or neutrality with a statement indicating that given the protective effects of circumcision for heterosexual men shown by research, men do not have to worry about risks like not wearing condoms during sex or having more sex partners (assessed potential for risk compensation).

RESULTS:

Response rate was 50.6% (10,108/19,996). Overall, 13.1% of uncircumcised men reported they would be likely to get circumcised if their health care provider told them it would reduce the risk of HIV infection through sex with infected women. Nearly 18% of all men responded in a way indicating a potential for risk compensation if circumcised.

CONCLUSIONS:

Tailored educational materials about the benefits and risks, including risk compensation, associated with male circumcision as an HIV prevention intervention should be made available to health care providers and specific groups.

Published by Elsevier Inc.

 

CIRCUMCISION STATUS AND HIV INFECTION AMONG MSM: REANALYSIS OF A PHASE III HIV VACCINE CLINICAL TRIAL

AIDS. 2010 May 15;24(8):1135-43. doi: 10.1097/QAD.0b013e328337b8bd.

 

Gust DA¹, Wiegand RE, Kretsinger K, Sansom S, Kilmarx PH, Bartholow BN, Chen RT.

Abstract below; full text is available to journal subscribers.

OBJECTIVE:

Determine whether male circumcision would be effective in reducing HIV transmission among men who have sex with men (MSM).

DESIGN:

Retrospective analysis of the VAXGen VAX004 HIV vaccine clinical trial data.

METHODS:

Survival analysis was used to associate time to HIV infection with multiple predictors. Unprotected insertive and receptive anal sex predictors were highly correlated, thus separate models were run.

RESULTS:

Four thousand eight hundred and eighty-nine participants were included in this reanalysis; 86.1% were circumcised. Three hundred and forty-two (7.0%) men became infected during the study; 87.4% were circumcised. Controlling for demographic characteristics and risk behaviors, in the model that included unprotected insertive anal sex, being uncircumcised was not associated with incident HIV infection [adjusted hazards ratio (AHR) = 0.97, confidence interval (CI) = 0.56-1.68]. Furthermore, while having unprotected insertive (AHR = 2.25, CI = 1.72-2.93) or receptive (AHR = 3.45, CI = 2.58-4.61) anal sex with an HIV-positive partner were associated with HIV infection, the associations between HIV incidence and the interaction between being uncircumcised and reporting unprotected insertive (AHR = 1.78, CI = 0.90-3.53) or receptive (AHR = 1.26, CI = 0.62-2.57) anal sex with an HIV-positive partner were not statistically significant. Of the study visits when a participant reported unprotected insertive anal sex with an HIV-positive partner, HIV infection among circumcised men was reported in 3.16% of the visits (80/2532) and among uncircumcised men in 3.93% of the visits (14/356) [relative risk (RR) = 0.80, CI = 0.46-1.39].

CONCLUSIONS:

Among men who reported unprotected insertive anal sex with HIV-positive partners, being uncircumcised did not confer a statistically significant increase in HIV infection risk. Additional studies with more incident HIV infections or that include a larger proportion of uncircumcised men may provide a more definitive result.