Thursday, 10 May 2012

10 reasons to stop male circumcision in fight against AIDS

Unnecessary Male Circumcision is a serious problem in Africa with many young men being killed every year during ritual circumcisions and uncircumcised men being bullied, ostracized and forcibly circumcised.

While the international community condemns and campaigns against any type of female circumcision, far from working to end Unnecessary Male Circumcision, the international community is actively supporting, exporting and expanding the practice across the continent.

The key reason for giving international legitimacy to such a dangerous and barbaric practice is that the World Health Organization and UNAIDS are promoting Unnecessary Male Circumcision in the fight against HIV/AIDS as a result of 3 clinical trials which suggested that circumcision may reduce the number of heterosexual men contracting HIV.

Here we offer 10 reasons why we must stop the use of Unnecessary Male Circumcision in the fight against AIDS:
  1. It’s unethical
  2. It’s hypocritical
  3. It’s based on inconclusive evidence
  4. It ignores what’s happening in the real world
  5. It spreads dangerous myths about circumcision
  6. It puts women at greater risk
  7. It exposes men and boys to more risk
  8. It’s not as effective as other methods
  9. It's a waste of money
  10. It gives credibility to a dangerous practice that kills men and boys 

Most of the reasons listed above are addressed a report published in the American Journal of Preventative Health called : Male Circumcision and HIV Prevention (Insufficient Evidence and Neglected External Validity) by Green et al which you can read in full if you click here now.

It’s unethical because – as Green et al report “male circumcision constitutes the removal of healthy, functional and biologically unique tissue. For fully informed consent to occur, men must be educated about the risks and sensory losses from circumcision as well as made aware that circumcision does not offer full protection".

It’s hypocritical because condemning and seeking to eliminate female circumcision on the one hand whilst encouraging the increase of male circumcision on the other, deomstrates a distinct lack of equality, morality or integrity on behalf of the international community. 

It’s based on inconclusive evidence - according to Green et al, effectiveness levels found in controlled trials are rarely replicated in real-world settings. The three trials that the mass circumcision drive are based on were terminated early, many participants dropped out of the trial and a third of people who contracted HIV in one of the trials, caught it from a non-sexual source. Most importantly participants in the trials received continuous counseling, free condoms and monitoring for infection, which will not be available in real-world campaigns.

It ignores what actually happens in the real world and there is substantial evidence that contradicts the trial results and suggests that real-world population benefıts from male circumcision might be minimal. One analysis of HIV prevalence in sub-Saharan Africa concluded that male circumcision is not associated with reduced HIV prevalence. Another study in South Africa concluded  that “circumcision had no protective effect on HIV transmission.”

About 75% of U.S. men and about 70% of sub-Saharan African men are circumcised—higher percentages than in most other regions or countries with lower prevalence of HIV. In 10 out of 18 African countries surveyed circumcised men had higher rates of HIV than uncircumcised men. And while the trials did find 1.2 in a 100 circumcised men contracted AIDs compared with 2.5 in a 100 uncircumcised men – in Cameroon research has found that 5.1 in a 100 circumcised men have AIDS – three times more than uncircumcised men (1.5 in a hundred).

It spreads dangerous myths about circumcision ­– most notably that circumcision prevents HIV, which it does not. Reports from circumcision clinics have revealed that newly circumcised males are abandoning condoms or have a false sense of immunity from circumcision. Research in South Africa found that 15% of men and women now hold the mistaken belief that circumcision meant they did not need a condom. This belief has been further reinforced by public health officials recently distributing materials listing one advantage of circumcision as being “that men don’t have [to] use condoms”.

It puts women at greater risk – a recent trial has shown that male circumcision increases the risk to women of contracting AIDS – this is thought to because they resumed sex before their circumcised male partner’s open wound had healded. Women also are placed at greater risk from unsafe sex practices when they, or their circumcised male partners, wrongly believe that with circumcision they are immune to HIV and therefore they choose not to use condoms according to Green et al.

It exposes men and boys to more risk - A 2008 World Health Organization bulletin stated that more than 1 in 3 (35%) of traditional male circumcisions result in complications and nearly 1 in 5 (18%) clinical circumcisions result in complications. Men who participated in the HIV and Circumcision trial were 4 times more likely to suffer circumcision complications than they were to become infected with HIV/AIDS.

Most shockingly, circumcision can cause death and in South Africa 91 young men died in 2009 died as a result of Unnecessary Male Circumcision.

It’s not as effective as other methods – according to Green et al supplying free condoms is 95 times more cost effective than mass circumcision. A mathematical modeling analysis, presented at the 2009 International AIDS Society, revealed that in terms of cost effectiveness, the use of  condoms  and anti-retroviral treatments are way ahead of  male circumcision.

It’s a huge waste of money – as well as being less cost effective than giving our free condoms, from a public health perspective Green et al observe that it is diffıcult to justify promoting expenditures of scarce healthcare resources on a risky surgical procedure for HIV prevention in areas of the world that continue to lack clean water, adequate food supplies, and the most basic medical care, much less sanitary surgical conditions.

It gives credibility to a dangerous practice that kills men and boys – at a time when international opposition to female circumcision is growing stronger and louder, it seems only right that we should adopt a zero-tolerance approach to Unnecessary Male Circumcision.
Doing otherwise  - and worse still promoting the mass practice of male circumcision as a surgical prophylactic – gives credibility to a dangerous practice that damages and kills men and boys in Africa and can lead to those who choose to remain intact being brutally and forcibly circumcised.

1 comment:

  1. We have at least three papers that conclusively take the latest African "research" apart.

    How the circumcision solution in Africa will increase HIV infections

    Not a surgical vaccine: there is no case for boosting infant male circumcision to combat heterosexual transmission of HIV in Australia

    African clinical trials into male circumcision and HIV transmission: Methodological, ethical and legal concerns

    And we have an endless list of studies and surveys from countries where circumcision has failed to prevent HIV.

    We also have a long list of reports where clergy are actually endorsing circumcision in lieu of condoms, and men actually believe they are immune to HIV once they've been circumcised.

    Apart from promoting the deliberate violation of basic human rights, these campaigns are going to be directly responsible for more HIV transmissions.

    When this circumcision/HIV farce finally collapses, will the WHO be held accountable for their actions?

    The very idea that "research" is being used to endorse the deliberate destruction of the human body is outrageous. It boggles the mind how the WHO has endorsed what is essentially genital mutilation, based on research with glaringly obvious flaws.