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We addressed gaps in current HIV prevention research by examining the differences between 2 groups of young men: men who have sex with men only (MSM/O) and men who have sex with men and women (MSM/W). We examined patterns and correlates of sexual risk, and considered how race/ethnicity may affect these relationships.Cross-sectional self-report data were collected from a racially diverse sample of 10,295 young MSM from 1999 to 2002. The sample comprised data from 13 urban locations across the US.MSM/W reported less unprotected anal intercourse (UAI) than MSM/O, despite reporting less exposure to HIV prevention interventions, lower social support, and less awareness of antiretroviral therapies. African American men were more likely to be MSM/W and less likely to report UAI. Ever getting an HIV test was associated with less UAI only among African American participants (MSM/W or MSM/O) in racial/ethnic group-specific analyses.HIV prevention interventions for MSM should address differences between MSM/W and MSM/O. An important component of HIV prevention efforts designed for African American MSM/W and MSM/O should be HIV testing.

Context Randomized controlled trials and meta-analyses have demonstrated that male circumcision reduces men's risk of contracting human immunodeficiency virus (HIV) infection during heterosexual intercourse. Less is known about whether male circumcision provides protection against HIV infection among men who have sex with men (MSM). Objectives To quantitatively summarize the strength of the association between male circumcision and HIV infection and other sexually transmitted infections (STIs) across observational studies of MSM. Data Sources Comprehensive search of databases, including MEDLINE, EMBASE, ERIC, Sociofile, PsycINFO, Web of Science, and Google Scholar, and correspondence with researchers, to find published articles, conference proceedings, and unpublished reports through February 2008. Study Selection Of 18 studies that quantitatively examined the association between male circumcision and HIV/STI among MSM, 15 (83%) met the selection criteria for the meta-analysis. Data Extraction Independent abstraction was conducted by pairs of reviewers using a standardized abstraction form. Study quality was assessed using the Newcastle-Ottawa Scale. Data Synthesis A total of 53 567 MSM participants (52% circumcised) were included in the meta-analysis. The odds of being HIV-positive were nonsignificantly lower among MSM who were circumcised than uncircumcised (odds ratio, 0.86; 95% confidence interval, 0.65-1.13; number of independent effect sizes [k] = 15). Higher study quality was associated with a reduced odds of HIV infection among circumcised MSM (β, −0.415; P = .01). Among MSM who primarily engaged in insertive anal sex, the association between male circumcision and HIV was protective but not statistically significant (odds ratio, 0.71; 95% confidence interval, 0.23-2.22; k = 4). Male circumcision had a protective association with HIV in studies of MSM conducted before the introduction of highly active antiretroviral therapy (odds ratio, 0.47; 95% confidence interval, 0.32-0.69; k = 3). Neither the association between male circumcision and other STIs (odds ratio, 1.02; 95% confidence interval, 0.83-1.26; k = 8), nor its relationship with study quality was statistically significant (β, 0.265; P = .47). Conclusions Pooled analyses of available observational studies of MSM revealed insufficient evidence that male circumcision protects against HIV infection or other STIs. However, the comparable protective effect of male circumcision in MSM studies conducted before the era of highly active antiretroviral therapy, as in the recent male circumcision trials of heterosexual African men, supports further investigation of male circumcision for HIV prevention among MSM.

Objective: To examine characteristics of circumcised and uncircumcised Latino and black men who have sex with men (MSM) in the United States and assess the association between circumcision and HIV infection. Methods: Using respondent-driven sampling, 1154 black MSM and 1091 Latino MSM were recruited from New York City, Philadelphia, and Los Angeles. A 45-minute computer-assisted interview and a rapid oral fluid HIV antibody test (OraSure Technologies, Bethlehem, PA) were administered to participants. Results: Circumcision prevalence was higher among black MSM than among Latino MSM (74% vs. 33%; P < 0.0001). Circumcised MSM in both racial/ethnic groups were more likely than uncircumcised MSM to be born in the United States or to have a US-born parent. Circumcision status was not associated with prevalent HIV infection among Latino MSM, black MSM, black bisexual men, or black or Latino men who reported being HIV-negative based on their last HIV test. Further, circumcision was not associated with a reduced likelihood of HIV infection among men who had engaged in unprotected insertive and not unprotected receptive anal sex. Conclusions: In these cross-sectional data, there was no evidence that being circumcised was protective against HIV infection among black MSM or Latino MSM.

The social demography of the human immunodeficiency virus (HIV) epidemic among Black men in the United States has changed over the last two decades. Black men who have sex with men (MSM) now account for the largest proportion (30%) of all Black men diagnosed with HIV (CDC, 2004a). Moreover, Black men constitute a sizable proportion (27%) of all MSM diagnosed with HIV (CDC, 2004a,b). Similarly, most studies of MSM have reported that rates of HIV infection are higher among Black MSM than all other racial or ethnic MSM groups (Easterbrook et al., 1993; Lemp et al., 1994; Valleroy et al., 2000; CDC, 2001; Mansergh et al., 2002; Harawa et al., 2004).