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Friday, March 6, 2009

Male Circumcision Is No Silver Bullet in Combating HIV


(Click here also for Original Article)

(The author's friend was driving too quickly in Cameroun and had to do a double-take after passing the sign above, she returned to the site later to confirm that she had read the the billboard correctly.)

Three African studies in 2006 showed that male circumcision could significantly reduce a man's risk of contracting HIV from vaginal intercourse. "Significantly" in health study-speak might not mean what you think it means though. The studies, which examined nearly 8,000 men ages 18-24 in Kisumu, Kenya and Rakai, Uganda, found that male circumcision reduced men's risk of contracting HIV from vaginal intercourse by as much as 53 percent. These studies corroborated findings from an earlier study in South Africa, which reported reductions as high as 60 percent. A 50-60% reduction is not 100%. Not by a long shot.

But since these studies were published, sliced foreskins have replaced sliced bread as the next best thing. Bad puns and gory images aside, the avid support for male circumcision among public health professionals, funders, and the public alike has often failed to ask the simple question: What does this mean for women?

Circumcision itself does not offer a man's current partner(s) (female or male) any protection from contracting HIV. Many men -- newly or previously circumcised -- assume that circumcision will fully protect them from HIV, so they feel inclined to "reap the benefits" by pushing for sex without condoms, jeopardizing their own health and that of their partner(s). Moreover, after the operation, many men do not wait the requisite six weeks to let the wound heal before having sex – again, putting their lives and that of their partner at risk. Surely, there may be some indirect benefits to women. For example, expectations of the surgery may bring men into local clinics that would not otherwise visit health services, and this can provide an opportunity to educate men on safe sex and provide access to male and female condoms.

But we all need to get our facts straight. This week, the World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the AIDS Vaccine Advocacy Coalition (AVAC), and Family Health International (FHI) launched a website -- the Clearinghouse on Male Circumcision - to do just that. Their page about the effects of adult male circumcision on women's health includes some useful resources. Also check out Straight Talk About Male Circumcision - a post by Kate Bourne, the Vice President of International Policy & Regional Programs at IWHC, to learn more about what male circumcision means for women.


2 comments:

  1. The website you mention is only really interested in promoting male circumcision is only interested in promoting male circumcision for its own sake (or anything-but-condoms), rather than in fighting AIDS.

    You won't find any mention of it at the website, but there are seven African countries where men are more likely to be HIV+ if they've been circumcised: Rwanda, Cameroon, Ghana, Lesotho, Malawi, Swaziland, and Tanzania. If circumcision really worked against AIDS, this just wouldn't happen. We now have people calling circumcision a "vaccine" or "invisible condom", and viewing circumcision as an alternative to condoms.

    ABC (Abstinence, Being faithful, Condoms) is the way forward. Promoting genital surgery will cost African lives, not save them.

    It's not like we've actually tried the things that do work. In Malawi for instance, only 57% know that condoms protect against HIV/AIDS, and only 68% know that limiting sexual partners protects against HIV/AIDS. There are people who haven't even heard of condoms. It just seems really misguided to be hailing male circumcision as the way forward. It would help if some of the aid donors didn't refuse to fund condom education, or work that involves talking to prostitutes. There are African prostitutes that sleep with 20-50 men a day, and some of them say that hardly any of the men use a condom. If anyone really cares about men, women, and children dying in Africa, surely they'd be focussing on education about safe sex rather than surgery that offers limited protection at best, and runs a high risk of risk compensatory behaviour.

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  2. Most of US men who have died of AIDS were circumcised at birth. AIDS is as rare in Japan as it is in 95%-cut Israel.

    Foreskin feels REALLY Good. HIS body HIS decision.

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