Demographic Network Models of Circumcision Interventions for HIV Prevention among Men Who Have Sex with Men in Peru

Steven M. Goodreau, University of Washington
Nicole Bohme Carnegie, Harvard University
Eric Vittinghoff, University of California, San Francisco
Javier Lama, Asociación Civil Impacta Salud y Educación
Jorge Sanchez, Asociación Civil Impacta Salud y Educación
Jonathan Fuchs, San Francisco Department of Public Health
Susan Buchbinder, University of California, San Francisco

Three trials have demonstrated the prophylactic effect of male circumcision (MC) for HIV acquisition among heterosexuals, and MC interventions are underway throughout sub-Saharan Africa. Similar efforts for men who have sex with men (MSM) are stymied by the potential for circumcized MSM to acquire HIV easily through receptive sex and transmit easily through insertive sex. Existing work suggests that MSM-MC should reach its maximum potential in settings like Peru where role segregation is historically high and perhaps relatively stable across the lifecourse. We use a dynamic sexual network model parameterized from multiple behavioral surveys to simulate Peruvian MSM-MC interventions. Although MSM-MC may have powerful protective effects for individual men who are predominantly insertive, and comparisons to other work suggest that an intervention would be cost-effective, we find the population-level impact of a realistic MSM-MC intervention in Peru to be quite modest: ~5-10% reduction in incidence and prevalence over 25 years.