There seems to be a growing mis-guided pro-circumcision movement that have clung on to some reports that male circumcision seems to provide men some level protection against HIV infection.
I was a even more disturbed to see Bill Gates and the Gates Foundation giving this strategy increased credibility.
I remember groaning the first time I heard this, because it does seem there are a LOT of people who every few years seem to find new reasons to basically preach what I think is really just a form of mutilation.
I don’t want to turn this into a big “pro/anti circumcision” discussion. There are plenty of other sites that do that.
But instead – I’m worried that promoting circumcision as a credible anti-HIV strategy is very flawed and potentially dangerous.
Telling a man that he will have greater protection if he gets circumcised, could lead to greater amount of risky sexual behavior by creating a false impression of safety. Circumcised men are still getting HIV! If Health Workers start endorsing circumcision as an HIV prevention strategy, than it might lead to a reduced use of condoms, since circumcised men might feel like they don’t need it. And there doesn’t seem to be ANY study that indicates that it offers any level of greater protection over condom alone.
Circumcision offers NO protection for women. And over 60% of Africans living with HIV are woman. The partial protection is only seen for heterosexual men having vaginal intercourse. No studies show any protection for anal sex.
And it’s MORE EXPENSIVE – about 95 times more expensive than condoms.
In the Sept 2008 edition of the International Journal of Men’s Health, researchers McAllister, Travis, Bollinger,Rutiser, & Sundar wrote:
Our findings suggest that behavior change programs are more efficient and cost effective than surgical procedures. Providing free condoms is estimated to be significantly less costly, more effective in comparison to circumcising, and at least 95 times more cost effective at stopping the spread of HIV in sub-Saharan Africa. In addition, condom usage provides protection for women as well as men. This is significant in an area where almost 61% of adults living with AIDS are women.
Even one of the studies that “recommend” circumcision state that it will take 72 circumcisions to possibly prevent one HIV infection, and that
“Its impact on a population level will require consistently safe sexual practices to maintain the protective benefit.”
Translated: Circumcisized men will STILL need to practice safe sex to see any benefit. It’s like getting Lasik surgery – but you still have to wear glasses!
With cost estimates of $40-70 dollars for a single circumcision, that seems a very poor substitute for condoms that cost about $0.02 each.
The McAllister study estimated that agencies would have to spend about $5,844 in surgical costs to circumcise enough men to prevent ONE SIGNAL HIV infection. Meanwhile, it only takes $47 spent on condoms and education to prevent a single HIV infection.
Plus condoms prevent MUCH MORE than just HIV, they prevent a large number of other sexually transmitted diseases, and unwanted pregnancies.
It’s also not clear if the real link between STDs and uncircumsized men, is simply a lack of education about hygiene and sex. And much of Africa lacks access to the clean water they need to even maintain a healthy level of cleanliness.
I’m always a bit startled by how quick people are to move towards circumcision as a strategy to prevent disease. By that logic, I am sure that I can reliably prevent a large number of the 250,000-500,000 deaths from influeza that occur worldwide each year, buy simply chopping off people’s hands. People without hands will most likely see increased protection against getting the influenza, although it won’t be 100% (Does this sound familiar?).
But instead we actually recommend sane and reasonable preventions of the flu – washing hands and covering their mouths when they cough.
There is already tremendous health concern that a circumcision decree made by King Goodwill Zwelithini of the Zulu tribe in South Africa – will actually lead to more men mutilated and HIV infected. A nearby South African tribe, the Xhosa, have been performing ritualistic circumcision for centuries, but health officials saw 80 death last year among Xhosa boys, whose circumcision is performed by a “traditional surgeon”. Since the same knife is used on all the boys during the ceremony, HIV is often spread by the circumcision itself.
It’s very worrisome when institutions, with the reach and influence of the Gates Foundation, continue to give circumcision any level of credibility as a public HIV prevention strategy. It’s costly and unproven. It can be dangerous and deadly unless performed by skilled medical professionals. And it distracts from proven and inexpensive strategies that are saving lives now.