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  • Male Circumcision and HIV provides a place for a public health policy debate on the linking of male circumcision and HIV/AIDS. It seeks to address questions of cost versus benefit, the effectiveness of circumcision in the fight against HIV/AIDS in real world settings, and the differing points of view of researchers, the media, and all contributors to the policy discussion.

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  • David Wilton

    David Wilton is a lawyer by training. He has a long-standing interest in issues of body integrity and HIV/AIDS. He maintains this site and blogs from San Francisco, California. His primary interests outside of nurturing a debate on the controversial measure of removing sexual tissue to reduce the spread of HIV are in the areas of international relations, languages, and journalism.
  • Adrienne Soti
    Adrienne Soti has provided research and monitoring of the media for Male Circumcision and HIV. A native of Hungary who came to the US in 1990, she lives with her husband and two small children in New Jersey. She has a B.A. in Psychology and Philosophy from Rutgers University. She lists biology and medicine among her many interests and is particularly interested in bio-ethical issues. The circumcision controversy came to her attention after the birth of her son in 2005.

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    PO Box 40312
    San Francisco, CA 94140
    wilt31@gmail.com
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« Quickpost: Zambia, unprepared and undeterred | Main | "Risk reduction" strategies no substitute for consistent condom use, study shows »

Thursday, September 20, 2007

Quickpost: Rwanda, desperate and vulnerable, succumbs to circumcision hysteria; US promotes genital mutilation

Rwanda is the latest country to succumb to circumcision hysteria in the face of failed efforts at behavior modification, condom distribution, and international indifference to the poor implementation of ARV therapies.

The United States will provide funds to promote the genital mutilation even as its own rates fall.

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"...said the program initially would target the army, police and higher education students (Musoni, New Times/AllAfrica.com, 9/20)."
Read: Men in the Army, Police, and College students will most likely lose their advancement opportunities, or scholarship if they don't submit to be circumcised. This is coersion, something circ promoters supposedly said would be disallowed.
Africa is lost. Circumcision, and new HIV cases, will soar. It didn't have to be this way; we have, however, a President and Congress that practice "Faith-based medicine". From where I sit, we have five goals:

1. Continue to educate the public. This is best done by exposing the wild claims the promoters of circ make in this country and especially abroad. Most of the public won't understand the "science" behind circumcision as an HIV prevention tool, but a couple of outrageous statements tend to get burned into people's minds.
2. Curtail the promotion of circ in countries with low HIV prevalence. A spanish language version of this site and ones like it is needed, pronto!
3. Push for criminal prosecutions of the men promoting this surgery. I have little doubt that false confidence will cause millions to go to an early grave. Make it clear to those charlatans touting circ that there are going to be legal consequences for their actions.
4. All out push to shame big pharma into a vaccine for HIV. They have thousands of ARVs, why no vaccine or cure? Makes one wonder, doesn't it?
5. After the storm: any way we can, help these countries where circ is being done now to NOT pass it on to their boys. Mothers are bring their little sons into clinics to have it done now. What does that say about the fight we are facing?

It will be difficult, I think, to curtail the barrage and misinformation campaign being directed towards the Africans. Remember that we are dealing, essentially, uneducated people who have little access to factual information. Unfortunately, access to a site like this would be difficult for many Africans and in general they must rely on government propaganda and other forms of hearsay.

Although I can't seem to wrap my head around most of this crap, the most obvious fallacy I see is simply the cost factor. As I've mentioned in previous comments a circumcision will cost enough condoms to last a man about six years how is that good policy? Then it occurred to me that circumcision fits very nicely into the so called 'faith-based' HIV prevention programs currently promoted by the administration. I mean here is a way they can attempt to curtail the spread of HIV, though we know it will have no impact, in such a way that it does not promote sex. I mean if someone comes in asking for a condom I pretty much know what his, or her, next stop will be. Conversely, if a guy comes in for a circumcision well at least we know he may be out of business for at least a month. It's what is known in the business as "plausible deniability". The agencies can look like they are doing something without the appearance of promoting promiscuity, which many constituents believe condoms essentially do. That plus the fact that the those in the US are always looking for a justification to circumcise makes it an easy sell. I know that does sound insane but so does circumcision.

I think others have grudgingly gone along with this in part because the US wields a significant influence on most world organizations and many are frustrated with the HIV problem in Africa and have essentially capitulated to the fact that 'these people can't be educated' and have broken down to grasping at anything. The people of Africa most affected by this are also frustrated and again will grasp at anything. The problem with that is I can't fathom the conversation; don't get circumcised but you need a condom or get circumcised and you need a condom. How does this produce a yes? It only makes sense if a person does not believe they need a condom after the fact because in either state my best, and required, means of self protection simply do not change. It reminds me of a passage I recently read:

"The ultimate factor in choosing is common sense, and it is common sense that men under pressure lose fastest..."

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Elsewhere on the Web

  • Circumcision and AIDS at MGMbill.org
    A decidedly anti-circumcision site with a calm approach to addressing the human rights issues likely to become problematic in the rush to roll out circumcision as an HIV prophylactic.
  • Circumcision and HIV at circumstitions.com
    One of the most thorough reviews anywhere of circumcision and the history behind the HIV prevention community's study of it. The science behind this prophylactic tool is much more equivocal than the most recent researchers would have you believe. New Zealand based.
  • Circumcision and HIV: Harm Outweighs Benefits from circumcision.org
    From the Circumcision Resource Center, Boston, Massachusetts. This human rights organization has published such books as Questioning Circumcision: A Jewish Perspective and Circumcision: The Hidden Trauma. Sitting on its board are a number of individuals affiliated with Harvard and other Ivy League institutions.
  • Circumcision and HIV infection from CIRP.org
    From the Circumcision Information Resource Pages. Not as up-to-date, but an excellent primer on the issue.
  • Doctors Opposing Circumcision statement on HIV
    Doctor's Opposing Circumcision is a Seattle based physicians group that provides education, information and advice on medical circumcision and its effects.
  • Statement on AIDS and Circumcision from the International Coalition for Genital Integrity
    Another thorough treatment of male circumcision's likely impact on the spread of HIV from an "alliance of organizations dedicated to protecting the normal anatomy of males, females and the intersexed ... [that] was formed to coalesce the many activist organizations, each with a specific focus, into one, common voice."
  • Does circumcision prevent HIV infection? - NORM-UK
    John Dalton puts together a critique of the African studies and their weaknesses. He examines the evidence, appropriateness, and possible outcomes from promoting circumcision and calling it a "prevention."

Sources

  • HIV/AIDS Medscape [free registration required]
    This site is owned by WebMD.com. It is a great source for breaking news. I wouldn't necessarily trust it completely on the issue of circumcision as it is US-based. But the HIV/AIDS coverage is pretty good.
  • UCSF HIV InSite Gateway to HIV Information
    The University of California - San Francisco is a leading medical teaching and research university in the HIV/AIDS field. Generally very reliable, it occasionally oversells or misstates the prevention message, most obviously and unfortunately regarding circumcision.
  • IRIN PlusNews
    I don't like this source because it tends to be a bit sensationalist, in my opinion. But it is pretty good for divining which way the wind is blowing.
  • Aidsmap: Circumcision News
    An otherwise great source, they have recently begun to climb on the bandwagon. The tone of the reports seem reticent as evidenced by their providing some great quotes. Coincidence? Inadvertent? Maybe, but hope not.

Medscape HIV/AIDS Headlines