Sexual behaviors, condom use, and HIV/STI screening and diagnosis: A comparison of circumcised and non-circumcised MSM in the United States

BACKGROUND: Circumcision's potential link to HIV/STI prevention has been at the center of recent global public health debates. However, data related to circumcision and sexual health remains limited, with most research focused on heterosexual men. This study sought to assess behavioral differences among a large sample of circumcised and non-circumcised men who have sex with men (MSM) in the US. METHODS: Data were collected from 26,257 U.S. MSM, through an online survey. Measures included circumcision status, health indicators, HIV/STI screening and diagnosis, sexual behaviors, and condom use. RESULTS: Chi-square, Man-Whitney, and Logistic regressions analyses were conducted to determine differences between HIV/ STI status, sexual behaviors, and condom use among circumcised and non-circumcised men. Circumcision status did not significantly predict HIV testing (p>.05), or HIV positive status (p>.05), and there were no significant differences based on circumcision status for most STI diagnosis (syphilis, gonorrhea, Chlamydia, HPV). Being non-circumcised was predictive of Herpes-2 diagnosis, however being the insertive partner and wearing a condom when doing so, mediated this relationship, with men who were circumcised being likely to use a condom (p<.000). CONCLUSIONS: These data provide one of the first large national assessments of circumcision among MSM. While being non-circumcised did not increase the likelihood of HIV/STI infection, results indicated that circumcision was associated with higher rates of condom use, suggesting that those who promote condoms among MSM may need to better understand condom-related behaviors and attitudes among non-circumcised men to enhance the extent to which they are willing to use condoms consistently.