by Lillian Dell’Aquila Cannon
In the U.S. media, we have been seeing a lot of reports of how circumcision is being used to prevent the spread of HIV in Africa. These articles are used by circumcision supporters as reasons to encourage routine infant circumcision, but do their claims hold up?
In this excellent blog post, David Gissel Quist analyzes the results, methodology and ethics of those studies and finds they come up short. Some of the many flaws of these studies include:
- Not collecting data and/or not reporting on whether the men acquired HIV through non-sexual exposure. They just ASSUMED that the men who got HIV got it through sex.
- Not tracing and/or not reporting the sexual partners of the study participants.
In addition, there were huge ethical lapses in these studies. In the U.S., studies about HIV require that the subjects be told of their HIV status, and that their spouses also be told of their partners’ infection. This only makes sense – it is wrong to knowingly send HIV-positive people out to infect their spouses and others without warning them of the danger they face. This would not have passed an IRB in the U.S., so they went to Africa where they could get away with it. On top of all that, there is evidence that shows that male circumcision INCREASES a woman’s risk of contracting HIV, but of course, this is not being reported in the U.S. [Wawer M, Kigozi G, Serwadda D, et al. Trial of male circumcision in HIV+ men, Rakai, Uganda: effects in HIV+ men and in women partners. 15th Conference on Retroviruses and Opportunistic Infections. 3-6 February 2008. Boston. Abstract 33LB.]
We have run the circumcision/HIV experiment in the U.S. for 30 years – during the peak of the HIV epidemic, 85% of men in the U.S. were circumcised, and yet it didn’t stop the spread of HIV here. In Europe the circumcision rates are very low, yet they do not have higher HIV rates. Why do we not see the purported “protective effect of circumcision”outside of those three Africa studies? Maybe because it doesn’t exist.
Beyond all the scientific errors and faulty assumptions, there is the overarching issue of personal autonomy and decision-making. An adult man is the only one who deserves to make the choice to be circumcised to provide a theoretical protection against acquiring HIV. As Georgeanne Chapin said, addressing a typical composite male interlocutor, “You’re circumcised, right? Well, would you have unprotected sex with an HIV-positive woman, figuring that you’re protected from getting HIV?” Isn’t that the question? Would any parent send his child out into the world with this sage bit of advice: “You’re circumcised, so don’t worry about condoms – you’ll never get HIV?” Of course not. That would be ridiculous and dangerous, yet that is exactly what is happening in Africa. The men there already think that being circumcised is their invisible condom, and thus condom usage rates are falling. [Westercamp, W., et al., Male Circumcision in the General Population of Kisumu, Kenya: Beliefs about Protection, Risk Behaviors, HIV, and STIs, PLoS ONE 5(12): e15552. doi:10.1371/journal.pone.0015552] This is called a “moral hazard,” and yet the study designers aren’t even addressing it.
Then there’s the issue of colonialism – the white man goes to Africa, announces that circumcision will prevent African men from getting HIV, never telling them of all the caveats and unknowns, not treating them or their partners with the minimal level of human respect or ethical practices that would be accorded American study participants, while at the same time, telling them that their female circumcision practices are disgusting and must be stopped. No wonder the U.S. is so reviled abroad – we apparently don’t even consider Africans to be human and thus deserving of a minimal level of scientific integrity. Could they allow a human being to go out and infect his wife without warning him or her?
Imagine you’re a man who made it to adulthood with your penis intact. A scientist comes to you and says, “If you got circumcised, you might have a slightly lower chance of acquiring HIV, but you’d still have to wear condoms, it would increase the chance of giving HIV to your sexual partners, and it would dull your sexual sensation permanently.” Would you take that offer? Most informed men would not. In Africa, where HIV is a serious problem, circumcision is being touted as a silver bullet against HIV. Aid workers are so desperate to control the spread of HIV that they grasp at anything that might help, and these unethical scientists have preyed on their fears to promote circumcision as a cure. Africans are not being fully informed of the risks, nor are they being treated ethically.
The African circumcision and HIV studies are dangerous, immoral and futile, and only make sense if you see them in their historical context: yet another in a long string of diseases that circumcision was supposed to prevent. We laugh when people joke that masturbation causes blindness, but 150 years ago, doctors really did think that was true, and so promoted circumcision as a way to prevent masturbation which would lead to blindness, epilepsy, and so on. Today’s focus on HIV is no different, except that now, circumcising parents and circumcised men are latching onto the HIV argument to justify their increasingly attacked stances. Most parents who choose circumcision for their children do it for social reasons – they think that it is important to match Daddy or some future locker room companions – but these social reasons are crumbling under the dropping circumcision rates. Now they can latch onto HIV as an ex post facto justification, thinking that it will go without challenge, but it doesn’t. A few adult men might choose to be circumcised because they think it will lower their chances of acquiring HIV, but many more men would not take that bargain. If a man might say no to circumcision, then you have no right to force it onto him as an infant when he cannot refuse.