More than Foreskin: Circumcision Status, History of HIV/STI, and Sexual Risk in a Clinic-Based Sample of Men in Puerto Rico

Carlos E. Rodriguez-Diaz, Michael C. Clatts, Gerardo G. Jovet-Toledo, Ricardo L. Vargas-Molina, Lloyd Goldsamt, Hermes García

Research output: Contribution to journalArticle

Abstract

Introduction. Circumcision among adult men has been widely promoted as a strategy to reduce human immunodeficiency virus (HIV) transmission risk. However, much of the available data derive from studies conducted in Africa, and there is as yet little research in the Caribbean region where sexual transmission is also a primary contributor to rapidly escalating HIV incidence. Aim. In an effort to fill the void of data from the Caribbean, the objective of this article is to compare history of sexually transmitted infections (STI) and HIV diagnosis in relation to circumcision status in a clinic-based sample of men in Puerto Rico. Methods. Data derive from an ongoing epidemiological study being conducted in a large STI/HIV prevention and treatment center in San Juan in which 660 men were randomly selected from the clinic's waiting room. Main Outcome Measures. We assessed the association between circumcision status and self-reported history of STI/HIV infection using logistic regressions to explore whether circumcision conferred protective benefit. Results. Almost a third (32.4%) of the men were circumcised (CM). Compared with uncircumcised (UC) men, CM have accumulated larger numbers of STI in their lifetime (CM=73.4% vs. UC=65.7%; P=0.048), have higher rates of previous diagnosis of warts (CM=18.8% vs. UC=12.2%; P=0.024), and were more likely to have HIV infection (CM=43.0% vs. UC=33.9%; P=0.023). Results indicate that being CM predicted the likelihood of HIV infection (P value=0.027). Conclusions. These analyses represent the first assessment of the association between circumcision and STI/HIV among men in the Caribbean. While preliminary, the data indicate that in and of itself, circumcision did not confer significant protective benefit against STI/HIV infection. Findings suggest the need to apply caution in the use of circumcision as an HIV prevention strategy, particularly in settings where more effective combinations of interventions have yet to be fully implemented.

Original languageEnglish (US)
Pages (from-to)2933-2937
Number of pages5
JournalJournal of Sexual Medicine
Volume9
Issue number11
DOIs
StatePublished - Nov 2012

Fingerprint

Foreskin
Puerto Rico
Sexually Transmitted Diseases
HIV
Virus Diseases
Warts
Epidemiologic Studies
Logistic Models
Outcome Assessment (Health Care)

Keywords

  • Caribbean
  • Circumcision
  • Foreskin
  • HIV
  • Puerto rico
  • Transmission risk

ASJC Scopus subject areas

  • Urology
  • Obstetrics and Gynecology
  • Reproductive Medicine

Cite this

More than Foreskin : Circumcision Status, History of HIV/STI, and Sexual Risk in a Clinic-Based Sample of Men in Puerto Rico. / Rodriguez-Diaz, Carlos E.; Clatts, Michael C.; Jovet-Toledo, Gerardo G.; Vargas-Molina, Ricardo L.; Goldsamt, Lloyd; García, Hermes.

In: Journal of Sexual Medicine, Vol. 9, No. 11, 11.2012, p. 2933-2937.

Research output: Contribution to journalArticle

Rodriguez-Diaz, Carlos E. ; Clatts, Michael C. ; Jovet-Toledo, Gerardo G. ; Vargas-Molina, Ricardo L. ; Goldsamt, Lloyd ; García, Hermes. / More than Foreskin : Circumcision Status, History of HIV/STI, and Sexual Risk in a Clinic-Based Sample of Men in Puerto Rico. In: Journal of Sexual Medicine. 2012 ; Vol. 9, No. 11. pp. 2933-2937.
@article{266541857b4c4d32bce5a6c9c636a9ab,
title = "More than Foreskin: Circumcision Status, History of HIV/STI, and Sexual Risk in a Clinic-Based Sample of Men in Puerto Rico",
abstract = "Introduction. Circumcision among adult men has been widely promoted as a strategy to reduce human immunodeficiency virus (HIV) transmission risk. However, much of the available data derive from studies conducted in Africa, and there is as yet little research in the Caribbean region where sexual transmission is also a primary contributor to rapidly escalating HIV incidence. Aim. In an effort to fill the void of data from the Caribbean, the objective of this article is to compare history of sexually transmitted infections (STI) and HIV diagnosis in relation to circumcision status in a clinic-based sample of men in Puerto Rico. Methods. Data derive from an ongoing epidemiological study being conducted in a large STI/HIV prevention and treatment center in San Juan in which 660 men were randomly selected from the clinic's waiting room. Main Outcome Measures. We assessed the association between circumcision status and self-reported history of STI/HIV infection using logistic regressions to explore whether circumcision conferred protective benefit. Results. Almost a third (32.4{\%}) of the men were circumcised (CM). Compared with uncircumcised (UC) men, CM have accumulated larger numbers of STI in their lifetime (CM=73.4{\%} vs. UC=65.7{\%}; P=0.048), have higher rates of previous diagnosis of warts (CM=18.8{\%} vs. UC=12.2{\%}; P=0.024), and were more likely to have HIV infection (CM=43.0{\%} vs. UC=33.9{\%}; P=0.023). Results indicate that being CM predicted the likelihood of HIV infection (P value=0.027). Conclusions. These analyses represent the first assessment of the association between circumcision and STI/HIV among men in the Caribbean. While preliminary, the data indicate that in and of itself, circumcision did not confer significant protective benefit against STI/HIV infection. Findings suggest the need to apply caution in the use of circumcision as an HIV prevention strategy, particularly in settings where more effective combinations of interventions have yet to be fully implemented.",
keywords = "Caribbean, Circumcision, Foreskin, HIV, Puerto rico, Transmission risk",
author = "Rodriguez-Diaz, {Carlos E.} and Clatts, {Michael C.} and Jovet-Toledo, {Gerardo G.} and Vargas-Molina, {Ricardo L.} and Lloyd Goldsamt and Hermes Garc{\'i}a",
year = "2012",
month = "11",
doi = "10.1111/j.1743-6109.2012.02871.x",
language = "English (US)",
volume = "9",
pages = "2933--2937",
journal = "Journal of Sexual Medicine",
issn = "1743-6095",
publisher = "Wiley-Blackwell",
number = "11",

}

TY - JOUR

T1 - More than Foreskin

T2 - Circumcision Status, History of HIV/STI, and Sexual Risk in a Clinic-Based Sample of Men in Puerto Rico

AU - Rodriguez-Diaz, Carlos E.

AU - Clatts, Michael C.

AU - Jovet-Toledo, Gerardo G.

AU - Vargas-Molina, Ricardo L.

AU - Goldsamt, Lloyd

AU - García, Hermes

PY - 2012/11

Y1 - 2012/11

N2 - Introduction. Circumcision among adult men has been widely promoted as a strategy to reduce human immunodeficiency virus (HIV) transmission risk. However, much of the available data derive from studies conducted in Africa, and there is as yet little research in the Caribbean region where sexual transmission is also a primary contributor to rapidly escalating HIV incidence. Aim. In an effort to fill the void of data from the Caribbean, the objective of this article is to compare history of sexually transmitted infections (STI) and HIV diagnosis in relation to circumcision status in a clinic-based sample of men in Puerto Rico. Methods. Data derive from an ongoing epidemiological study being conducted in a large STI/HIV prevention and treatment center in San Juan in which 660 men were randomly selected from the clinic's waiting room. Main Outcome Measures. We assessed the association between circumcision status and self-reported history of STI/HIV infection using logistic regressions to explore whether circumcision conferred protective benefit. Results. Almost a third (32.4%) of the men were circumcised (CM). Compared with uncircumcised (UC) men, CM have accumulated larger numbers of STI in their lifetime (CM=73.4% vs. UC=65.7%; P=0.048), have higher rates of previous diagnosis of warts (CM=18.8% vs. UC=12.2%; P=0.024), and were more likely to have HIV infection (CM=43.0% vs. UC=33.9%; P=0.023). Results indicate that being CM predicted the likelihood of HIV infection (P value=0.027). Conclusions. These analyses represent the first assessment of the association between circumcision and STI/HIV among men in the Caribbean. While preliminary, the data indicate that in and of itself, circumcision did not confer significant protective benefit against STI/HIV infection. Findings suggest the need to apply caution in the use of circumcision as an HIV prevention strategy, particularly in settings where more effective combinations of interventions have yet to be fully implemented.

AB - Introduction. Circumcision among adult men has been widely promoted as a strategy to reduce human immunodeficiency virus (HIV) transmission risk. However, much of the available data derive from studies conducted in Africa, and there is as yet little research in the Caribbean region where sexual transmission is also a primary contributor to rapidly escalating HIV incidence. Aim. In an effort to fill the void of data from the Caribbean, the objective of this article is to compare history of sexually transmitted infections (STI) and HIV diagnosis in relation to circumcision status in a clinic-based sample of men in Puerto Rico. Methods. Data derive from an ongoing epidemiological study being conducted in a large STI/HIV prevention and treatment center in San Juan in which 660 men were randomly selected from the clinic's waiting room. Main Outcome Measures. We assessed the association between circumcision status and self-reported history of STI/HIV infection using logistic regressions to explore whether circumcision conferred protective benefit. Results. Almost a third (32.4%) of the men were circumcised (CM). Compared with uncircumcised (UC) men, CM have accumulated larger numbers of STI in their lifetime (CM=73.4% vs. UC=65.7%; P=0.048), have higher rates of previous diagnosis of warts (CM=18.8% vs. UC=12.2%; P=0.024), and were more likely to have HIV infection (CM=43.0% vs. UC=33.9%; P=0.023). Results indicate that being CM predicted the likelihood of HIV infection (P value=0.027). Conclusions. These analyses represent the first assessment of the association between circumcision and STI/HIV among men in the Caribbean. While preliminary, the data indicate that in and of itself, circumcision did not confer significant protective benefit against STI/HIV infection. Findings suggest the need to apply caution in the use of circumcision as an HIV prevention strategy, particularly in settings where more effective combinations of interventions have yet to be fully implemented.

KW - Caribbean

KW - Circumcision

KW - Foreskin

KW - HIV

KW - Puerto rico

KW - Transmission risk

UR - http://www.scopus.com/inward/record.url?scp=84868199211&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84868199211&partnerID=8YFLogxK

U2 - 10.1111/j.1743-6109.2012.02871.x

DO - 10.1111/j.1743-6109.2012.02871.x

M3 - Article

C2 - 22897699

AN - SCOPUS:84868199211

VL - 9

SP - 2933

EP - 2937

JO - Journal of Sexual Medicine

JF - Journal of Sexual Medicine

SN - 1743-6095

IS - 11

ER -