They are often a neglected and underserved group but men who have sex with men need to be considered as part of prevention efforts. It is accepted-without a doubt – despite what useless people say on the net-that circumcision reduces the chances of getting HIV by up to 60 percent in heterosexual men (preventing HIV transmission from a woman to a man). Male circumcision also lowers the risk of heterosexual men getting sexually transmitted infections (STIs) such as genital ulcer disease, syphilis, herpes simplex virus type 2 (HSV), and human papillomavirus.
Gay and bisexual men could also benefit from voluntary male medical circumcision (VMMC) programmes, especially those living in low- and middle-income countries like Malawi! And, yes, we do have a cohort of men who have sex with men and they should be supported.
VMMC programmes had averted 230 000 new HIV infections by 2017 and are projected to avert one million by 2030. But the data is so far unclear as to whether this protective effect extends to gay men, and as such, these programmes are not actively promoted in this group.
An updated analysis found that the 23 percent decreased likelihood of acquiring HIV was highly significant among men living in low- and middle-income countries, compared to high-income countries, and most notably in South East Asia and Africa. The protective effect was also strongest among those who primarily engage in insertive anal sex, younger men who have sex with men, non-clinic-based studies, and studies in which the proportion of men who have sex with men self-reporting consistent condom use was lower.
They also found reduced likelihood of HSV infection among men who have sex with men overall and penile HPV infection among those living with HIV.
The researchers suggest that the more significant protective effect may be the result of higher rates of HIV and lower rates of circumcision. There is also higher stability in anal sex role segregation, that is, choosing to be exclusively receptive or insertive, which is important because circumcision would biologically be expected to protect during insertive but not receptive anal sex.
Bisexuality is also more common in these contexts. Studies suggest 40 percent to 70 percent of men who have sex with men have also had sex with women and up to 30 percent are married to a woman – which could present another explanatory factor.
Given that gay and bisexual men experience heavy stigma and poor access to HIV prevention services, the researchers note that they should not be excluded from VMMC programmes. Men who have sex with men could benefit from advances in cheap, safe and convenient circumcision surgical techniques.