Circumspect Thoughts About Adult Circumcision

We're circumcised & proud of it!

Get circumsized & reap the benefits!

About a year ago, my colleague was in Swaziland and drove by this billboard promoting adult circumcision. Driving too quickly to do a double-take, 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.

Whitney Welshimer is a Program Assistant for Communications at the International Women’s Health Coalition. Read her full bio here.

2 responses to “Circumspect Thoughts About Adult Circumcision

  1. Circumcision to "prevent AIDS" is irrational. African men are being circumcised and given a false sense of security. Maria Warwer's study indicated that circumcising men to "prevent AIDS" actually increases women's risk of getting infected.

    Behind the campaign to circumcise African men to "prevent AIDS" are several men who are first and foremost intent on promoting circumcision, AIDS was a convenient disease to apply their favourite sexual mutilation to. The 140+ year history of medical circumcision is one of attempting to find medical justification for foreskin amputations.

    Many countries around the world (including 6 in Africa, Cameroon, Ghana, Lesotho, Malawi, Rwanda, and Swaziland) have higher rates of HIV infection among circumcised men. The USA with a large percentage of circumcised men has a high rate of HIV infection. Many countries around the world that don't circumcise have very low rates of HIV infection.

    This current push to circumcise Africa to "prevent AIDS" is a dangerous distraction from safer sex campaigns. Many men who were cut as infants need to justify this and promoting circumcision as a cure all is one of the ways of keeping from looking at what circumcision actually is.

    History will reveal this African circumcision campaign to be a medical fraud, just as all attempts to find medical justification for circumcision have been.

  2. You are more right than you know about the hype of "50-60%" reduction. That is a relative risk reduction, the ratio of the difference between two small figures. (From 3.37% to1.58% in Kenya, from 1.78% to 0.89% in Uganda). The absolute figures are that less than two years after circumcising 5,400 men in South Africa, Kenya and Uganda, 64 circumcised men contracted HIV and 137 non-circumcised men. The difference, 73 men, is the TOTAL basis of the claim that "circumcision could protect millions".

    327 circumcised men dropped out of the studies, their HIV status unknown, easily enough to conceal enough extra HIV+ men to make it statistically insignificant.

    And your question about transmission to women is a good one. A study by Maria Wawer et al in Uganda found 18% of the woman partners of circumcised HIV+ men became HIV+, compared with only 12% of the partners of non-circumcised HIV+ men. The study was stopped "for futility" before the figures could reach statistical significance. (There would have been no ethical objection to allowing the study to run, because they had established that circumcising the control group would not protect the women.)

    So encouraging men to have themselves circumcised may actually increase the risk of passing HIV on to their partners.

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