HIV, Circumcision, and Consent

During the last several years, adult male circumcision has become a highly promoted form of risk reduction when it comes to HIV. Some studies have shown that circumcision may reduce the chances of acquiring HIV by as much as 60%. So, in the places in Africa were HIV is the most prevalent, there are now many subsidized programs to encourage and implement adult male circumcision. There are many potential issues here – like that circumcision could be used as leverage to argue for sex without a barrier, and could mean that people who have sex with these men will be less able to get their partners to use condoms. (Check out our post Think Before You Snip for more.)

This week, The Times in Johannesburg published a piece about new conversations happening about the feasibility of circumcising baby’s penises to prevent HIV later in their lives. It’s a simple procedure that is done all over the world for religious and aesthetic reasons and here in the United States is not regarded as being a big deal.

Of course, it can be argued that we should take reasonable medical steps to prevent the transmission of HIV. However, a baby cannot consent to this procedure. And though circumcision of penises is accepted as a minor surgery, it is just as nonconsensual as genital cutting on the vulva and surgeries that intersex babies are subjected to at the recommendation of medical practitioners.

9 responses to “HIV, Circumcision, and Consent

    "There appears no clear pattern of association between male circumcision and HIV prevalence—in 8 of 18 countries with data, HIV prevalence is lower among circumcised men, while in the remaining 10 countries it is higher."

    The South African National Communication Survey on HIV/AIDS, 2009 found that 15% of adults across age groups "believe that circumcised men do not need to use condoms".

    From the committee of the South African Medical Association Human Rights, Law & Ethics Committee :
    "the Committee expressed serious concern that not enough scientifically-based evidence was available to confirm that circumcisions prevented HIV contraction and that the public at large was influenced by incorrect and misrepresented information. The Committee reiterated its view that it did not support circumcision to prevent HIV transmission."

    The one randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised btw:

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

  2. It may well be that IF adult circumcision has any effect on HIV transmission, it is indirectly, via the reinforcedment that a painful and marking operation has on the safe-sex messages the men were given at the time of the operation, or through some other effect. Since the trials were not placebo-controlled, any such effect can not be excluded. There is no evidence anywhere that circumcising babies (or cultural circumcision) has any effect on HIV transmssion.

    The issue of informed consent you raise on such an intimate matter is an important one.

  3. Thank you for this post. I am a male that was circumcised at birth. I feel that my body was dis-respected and violated by having a healthy part cut off. If I had the choice, I would never have consented to the surgery, no matter how minor.

    Our society must grow and mature. We must stop all genital surgery on all children unless there is a life-threatening medical condition. Genital surgery of a child should never be done for cosmetic or societal reasons.

  4. I wrote this in to Times Live. Let's hope somebody is listening…

    Dear Sirs,

    This e-mail is regarding the article: "Experts divided over baby circumcision plan"

    There are a few points that I believe should be addressed. First, why is there talk of babies being circumcised, when they are at absolute zero risk for sexually transmitted HIV? Wouldn't funds be better spent in mother-to-child prevention? Paediatrician Thahir Mitha claims "scientific evidence pointed to the benefits of neonatal circumcision," but where is this so-called "scientific evidence?" There have been absolutely ZERO studies in neonatal circumcision and HIV. So where is he drawing this conclusion from?

  5. Secondly, it sounds like promoters are more interested in spreading circumcision than they are in spreading HIV awareness, and the best ways to prevent it. Shouldn't young men be educated in HIV and conventional prevention methods first before they are offered circumcisions? It is rather sexist, if not racist, to assume that all South African boys will grow up to be irresponsible and promiscuous. Shouldn't authorities wait until the youth grow up to make a conscientous decision they might regret later on? Are there education packages for those youth who do not want to get circumcised? Or is getting circumcised to raised a specific quota the only option?

    Thirdly, is nobody thinking of informed consent? Circumcision is not a mere "snip." It is radical surgery that permanently alters the appearance and mechanics of the penis, and should not be taken lightly. Is nobody going to consider the ethics of coersing youth who haven't had their first sexual encounter yet to make a life-altering decision? Will these youth have the full mental capacity to make such a decision? What if these young men prefer to keep their foreskins? And won't circumcising newborns be taking away this choice?

  6. The media is doing a very bad job of publishing criticisms to the latest "studies" conducted in Africa, conducted by "researchers" that come from countries where people have a bias in favor of circumcision. Aside from many methodological flaws, the data from these "studies" does not seem to correlate with other situations in Africa and even the rest of the world. The most obvious smoking gun is the very United States of America who are funding all of this so-called "study," and where circumcision, particularly infant circumcision, is prevalent.

    Data shows that circumcision hasn't stopped HIV in America.

    And, it hasn't stopped other STDs either.

    In America, the majority of the male population is circumcised, approximately 80%, while in most countries in Europe, circumcision is uncommon. Despite these facts, America does poorly.

  7. In fact, AIDS rates in some US Cities rival hotspots in Africa. In some parts of the U.S., they're actually higher than those in sub-Saharan Africa. According to a 2010 study published in the New England Journal of Medicine, rates of HIV among adults in Washington, D.C. exceed 1 in 30; rates higher than those reported in Ethiopia, Nigeria or Rwanda.

    The Washington D.C. district report on HIV and AIDS reported an increase of 22% from 2006 in 2009. According to Shannon L. Hader of the Washington D.C. HIV/AIDS Administration, who once led the Federal Centers for Disease Control and Prevention's work in Zimbabwe, "[Washington D.C.'s] rates are higher than West Africa… they're on par with Uganda and some parts of Kenya."

  8. One would expect for there to be a lower transmission rates in the United States, and for HIV to be rampant in Europe; HIV transmission rates are in fact higher in the United States, where most men are circumcised from birth, than in various countries in Europe, where most men are not circumcised. It is telling that the HIV epidemic struck in America in the 1980s, was 90% of the male population was already circumcised. Somehow, we're supposed to believe that what didn't worked in our own country, or anywhere else, is going to start working miracles in Africa?

    Assuming that all of the latest research is "true," even the very "researchers" warn that circumcision FAILS. Circumcision is so ineffective at preventing HIV tranmission, that the authors of the latest studies cannot stress the use of condoms enough. If this is the case, why is circumcision even being considered? And why are "experts" eager to begin campaigns to circumcise newborns, when there hasn't even been a single study on the matter?

  9. Lastly, in light of the fact that the South African Medical Association (SAMA) has denounced the circumcision of male infants for HIV prevention as "unethical" and "illegal," how is it "experts" are even talking about the matter? According to the Children’s Act, children can only be circumcised for "medical reasons" directly related to problems with the foreskin. Circumcising children for HIV prevention is therefore illegal under the Children's Act, and children could sue their doctors as adults for the violation of their right to a complete body.

    Circumcision is no "vaccine." A circumcised man is still vulnerable to HIV transmission. Circumcision is so ineffective at preventing HIV that a man still has to wear a condom, rendering circumcision moot. Before "experts" continue any more talks of circumcising infants, even the youth, even rolling out further "mass circumcision campaigns," these facts need to be highlighted.

    Thank you for your time.

    Yours truly,

    Joseph Lewis

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