Male Circumcision and HIV

DEFUNDING CIRCUMCISION: Where Medicaid doesn't pay, parents ask why do it, leading to better informed consent (and a decline in the procedure)

Why has the circumcision rate fallen to <33%? Amber Craig explains that parents often feel coerced by hospitals and doctors eager to collect Medicaid funds for the procedure. I would add they are bribed by Medicaid funding. Who can refuse a free service purporting to "help" one's child? Morevoer, where Medicaid doesn't pay, parents ask why more often. When a genuine conversation on the procedure ensues, parents more often than not opt to keep their baby boys intact.

A CALL TO ACTION: Lobby the CDC to release the numbers on neonatal circumcision

As the United States starts to fall in line with the rest of the world viz neonatal circumcision, many would like to see the trend reversed. The stats delivered at the AIDS 2010 conference in Vienna, purportedly from the CDC, would seem to be a sharp reversal for the likes of Halperin, Kilmarx, Bailey, Epstein, Bailis, Gray, Fenton and the others who harbor a fixation on genital cutting.

How should the challenge to our momentum be confronted? First, we need to lobby the CDC to release the numbers. With Halperin's self-described "cabal, mafia of nerds" in charge at the CDC, we shouldn't expect them to release these numbers voluntarily unless it serves their purpose of promoting infant male genital cutting. El Bcheraoui's slide may have been an oversight with an unintended consequence of rallying the intactivist troops. So let's capitalize on that, and get CDC to open their books and release the numbers.

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Poor reporting, cooked books or the truth? Slide appears, seemingly to verify sharp drop in American neonatal circumcision

This slide (below) has been making the facebook rounds. Looks legit, and it apparently was presented during Charbel El Bcheraoui's AIDS 2010 - Vienna presentation on circumcision complications. It does not provide a source for these numbers, which is a little concerning.

Photo Source: Intact America?

If true, this is a stunning success for the intactivism movement. I wonder if it is a prelude to a backlash led by the insurgency at the CDC and AAP, or represents a backlash to the insurgency itself. It's more than a little confusing for those who have labored for years against the practice.

J. Steven Svoboda: Circumcision Lawsuits

As a lawyer, I had to post this discussion by J. Steven Svoboda of the Attorneys for the Rights of the Child. I've always dreamed of a law practice where the focus is on helping victims of coerced or substandard circumcisions. Steven explains how difficult circumcision cases can be even when you win. 

I want to acknowledge James Loewen (Bonobo3D on YouTube) who conducted this interview. He is producing first rate original content that is at this stage only an aspiration for this blog. Thank you, James, for the noble work you do in producing a record of the efforts of humanitarians like Steven.

Circumcision lobby launches attack on Latinos, resorts to ethnic stereotypes

Is this how the circumcision lobby wishes to "open a dialogue?" By resorting to ethnic stereotypes? When a population, including their health care providers, expresses concerns about "cost, cultural differences, [degree of] health benefits, pain and injury to the penis, perceived HIV risk, religion, sexual performance, and sexual pleasure," this is the best the lobby can do? Chalk it up to machismo, ignorance, and ethno-centrism?

Right: image / flickr / katutaide / Try to fuck me now

Apparently, the authors of a new study entitled, "Making the Case for Circumcision as a Public Health Strategy: Opening the Dialogue" believe so.

In this case, the target is American Hispanic men and Hispanic parents. On the issue of culture, the authors write:

Machismo values were associated with a negative attitude toward circumcision among Hispanic men. For neonatal circumcision, most practitioners estimated low rates of male circumcision among their patients, while some males felt that male circumcision was simply no longer a "trend" for patients. Female practitioners more often posed practical strategies to increasing male circumcision acceptability among their patients, but noted that their female patients reported machismo as a barrier to condom use or sexual risk reduction, and as such, male circumcision would be difficult to implement among men though several practitioners noted that attitudes about sexual behavior and machismo are changing.

In summary, the following barriers to circumcision were described: lack of information about the health benefits of circumcision, machismo, the cost of the procedure, and worry about the pain involved in the procedure.

Students of the circumcision lobby will of course note that a certain exaggerated masculinity, another term for machismo, has long been associated with high rates of circumcision in many populations, including among Americans. When it comes to intact men, machismo is bad, but if it eases the acceptance of genital cutting (especially of others too little to voice a preference), it's good?

The authors pluck a choice quote from the interviews conducted to collect the data for this paper. The intent is clearly to point to the obstinate machismo affecting the Hispanic doctor's advice to his patients.

Provider: . . . from the point of view of someone who is selfish and is worried about their own pleasure, I have no problems saying that I’m not circumcised.

Facilitator: And you wouldn’t have it done now?

Provider: No! For nothing in the world.

Did an interviewee even say this in the context of discussing how he advises his patients? It's a legitimate question addressed to researchers with clear views in favor of mass circumcision. With each passing "study," it is becoming clearer that the circumcision lobby has no respect for people who reject their vision of a circumcised world. They care little for the value others place on health care choice based on personal preference, autonomy, and respect for the individual.

There is much more in the paper that begs to be deconstructed in the search for the psychic impulse to cut others too small to voice an opinion, much less resist -- or to convince parents to do it to their little boys. I'll leave you with one last example of researcher bias.

Regarding neonatal circumcision, the researchers fall into a classic trap of confusing patients and parents, stating, "Most practitioners working with neonates felt that patients had little knowledge of male circumcision or of its association with HIV, and generally discussed it with parents after their babies had developed a urinary tract infection."

True, it isn't clear who makes this mistake, the authors in paraphrasing or the doctors in the original interviews. The authors never clarify. Nevertheless, it remains true that when it comes to neonatal care, the child is always the patient.

In the case of incompetent patients, i.e. those too young or mentally unable to make health care decisions, the guardian, or in the case of children, the parents, are mere proxies ethically and legally capable of consenting only to those procedures immediately necessary for the health and well-being of the child, a set of criteria that neonatal circumcision cannot meet.

Citation: José G. Castro, Deborah Lynne Jones, Maria Lopez, Isabel Barradas, Stephen M. Weiss. AIDS Patient Care and STDs. June 2010, 24(6): 367-372. doi:10.1089/apc.2009.0353.

Download pdf: Making the Case for Circumcision as a Public Health Strategy: Opening the Dialogue

Sexism and Circumcision: A YouTube response powerfully presents the case for considering female and male circumcision together

YouTuber freedomof5peech has created a fantastic video response to fellow YouTuber AngryAussie. Freedomof5peech succeeds in perfectly encapsulating the most compelling arguments for considering male and female circumcision together, and goes further to demonstrate that female circumcision cannot be viewed separately from the male counterpart. Powerfully presented.

UPDATE: YouTube channel freedomof5peech was suspended due to false terms of use complaints. The video in this post is now available from the new channel now known as freedom0speech, and has been embedded below.

Royal Dutch Medical Association issues statement on male circumcision of infants and children, AAP now has model statement to draw on

The Royal Dutch Medical Association* has come out with its first ever male circumcision policy statement regarding infants and children (very thoughtfully provided in English as well as in Dutch). According to the preamble, the reasons for this are the following.

The reason for our adoption of an official viewpoint regarding this matter is the increasing emphasis on children’s rights. It is particularly relevant for doctors that children must not be subjected to medical proceedings that have no therapeutic or preventative value. In addition to this, there is growing concern regarding complications, both minor and serious, which can occur as a result of circumcising a child. A third reason for this viewpoint is the growing sentiment that there is a discrepancy between the KNMG’s firm stance with regard to female genital mutilation and the lack of a stance with regard to the non-therapeutic circumcision of male minors, as the two have a number of similarities.

The statement starts with a very useful summary of the longer discussion that follows. This summary is provided in bullet points and is reproduced below.

• There is no convincing evidence that circumcision is useful or necessary in terms of prevention or hygiene. Partly in the light of the complications which can arise during or after circumcision, circumcision is not justifiable except on medical/therapeutic grounds. Insofar as there are medical benefits, such as a possibly reduced risk of HIV infection, it is reasonable to put off circumcision until the age at which such a risk is relevant and the boy himself can decide about the intervention, or can opt for any available alternatives.
• Contrary to what is often thought, circumcision entails the risk of medical and psychological complications. The most common complications are bleeding, infections, meatus stenosis (narrowing of the urethra) and panic attacks. Partial or complete penis amputations as a result of complications following circumcisions have also been reported, as have psychological problems as a result of the circumcision.
• Non-therapeutic circumcision of male minors is contrary to the rule that minors may only be exposed to medical treatments if illness or abnormalities are present, or if it can be convincingly demonstrated that the medical intervention is in the interest of the child, as in the case of vaccinations.
• Non-therapeutic circumcision of male minors conflicts with the child’s right to autonomy and physical integrity.
• The KNMG calls on (referring) doctors to explicitly inform parents/carers who are considering non-therapeutic circumcision for male minors of the risk of complications and the lack of convincing medical benefits. The fact that this is a medically non-essential intervention with a real risk of complications makes the quality of this advice particularly important. The doctor must then record the informed consent in the medical file.
• The KNMG respects the deep religious, symbolic and cultural feelings that surround the practice of nontherapeutic circumcision. The KNMG calls for a dialogue between doctors’ organisations, experts and the religious groups concerned in order to put the issue of non-therapeutic circumcision of male minors on the agenda and ultimately restrict it as much as possible.
• There are good reasons for a legal prohibition of non-therapeutic circumcision of male minors, as exists for female genital mutilation. However, the KNMG fears that a legal prohibition would result in the intervention being performed by non-medically qualified individuals in circumstances in which the quality of the intervention could not be sufficiently guaranteed. This could lead to more serious complications than is currently the case.

The AAP now has a model statement it can refer to and draw from for its upcoming revision of its own male circumcision policy position. I hope they turn away from the forces that are lobbying for issuance of an approving statement or one like we just had on female circumcision that urges relaxed standards, and moves towards this kind of statement on the male counterpart to FGM.

Download KNMG Viewpoint - Circumcision - Netherlands

*Also known by the Dutch acronym KNMG which stands for De Koninklijke Nederlandsche Maatschappij tot bevordering der Geneeskunst.

Foregen spearheads new effort to conduct clinical trials in cellular regeneration to benefit circumcised adult men

Foregen is a new non-profit formed in Italy by Vincenzo Aiello and Carlo Alberto Cirioni with the help and assistance of James Chegwidden (UK) as its official spokesman and Erik van Ingen (NL) as coordinator of projects, to raise funds for clinical trials that will explore recent advances in cellular regeneration to benefit circumcised adult men. Foregen explains the effort:

The majority of foregen's work is for males who have suffered physical and psychological damage from the ill-effects of circumcision, an operation usually forcibly imposed upon them unnecessarily as babies without their consent, and for no medical reason. Research has now demonstrated well the functional and sensory losses to the penis when circumcised, as well as the potential for serious psychological damage for those on whom such surgery was imposed by force. Fortunately, regenerative medical techniques now offer a greater possibility than ever to regrow human tissue, and especially dermal tissue, lost in prior trauma. However, those techniques have not, so far, been applied to those who are suffering from an unnecessary circumcision. foregen exists to promote and arrange a clinical trial which will use those techniques to regrow the tissue removed at circumcision, thereby helping to restore normal penile function and sensitivity for those males who desire it, with the help of regenerative medicine.

It isn't hard to imagine that something as miraculous as this sort of advance in foreskin restoration could give one pause. The masses who have suffered in silence and isolation from unnecessary non-consensual circumcision have asked whether this is for real. Offer a man a plausible path to the seemingly impossible and he will drop his guard and often open his wallet.

Fortunately, the intactivist community is well-schooled in the ways of the charlatan thanks in part to the likes of Schoen, Fink, Halperin, Kilmarx, Gray, Auvert, Morris, Bailey, and numerous others peddling sexual surgery as the solution to one malady after another. So, Vincenzo has encountered some questions.

His response has been to seek a transparent solution to alleviate concerns and garner support for the fundraising that will be necessary for this clinical trial. Please watch the following.

Ron Low is the inventor, founder and evangelist behind the foreskin restoration device, TLC Tugger. He is well-respected and well-known in the intactivist community, and utterly devoted to the cause of ending genital surgeries on children. I know him personally and am fully sold on this effort now that he is on board.

If you can, please help raise the $100,000.00 needed for this first step in making possibly the most effective remedial measure for childhood circumcision a reality for millions. Donate here.

AAP okays some forms of FGM, prepares to usher in gender neutral circumcision policy?

The American Academy of Pediatrics is moving backwards fast. It has now decided that female genital mutilation also known correctly and rightly as female circumcision (so as not to differentiate and distance it from male circumcision) is okay as long as it is medicalized and can be characterized as a "ritual nick." This is all said to be in deference to communities who practice this atrocity and in an effort to confer beneficent cultural sensitivity to their way of life no matter how it impinges on the rights of their often US citizen daughters, who enjoy or should enjoy the protections of US law and the Constitution said laws are founded upon.

Really, AAP? Dedicated to the unhealthy agenda of all its members, maybe?

The first big issue is the fact that one person's ritual nick is another person's mutilation. So what definitions are to be used? The U.N.'s? Those written into various state, federal or foreign jurisdiction laws? Perhaps those of the ethnic community from which the girl comes? Genital cutting always takes on a life of its own and often devolves into the most invasive where perceived to be minor or cosmetic. Any examination of cosmetic surgeries generally and male circumcision particularly will reveal this truism. Medical opinion as to what a "nick" is will be ever changing just as medical opinion changes as to what a complication in male circumcision is. The conflicts of interests between the doctor, the victim, the parents, and any prosecuting authority to characterize and define will create chaos and pain and suffering only the surgery itself can rival. 

Second, the whole concept of equality under the law is that exceptions to prohibitions against violating the rights of others are prohibited even where a whole community's cultural identity is at issue. Supposedly, we're living in the 21st Century and not the 8th. Hence, we adhere to the decidedly modern notion of equal protection. A little girl's right to genital integrity is not abridged solely due to her age and ethnic derivation. If a grown Somali woman wants to submit to blood-letting, let her. However, she should be thrown in jail if she does it to her daughter and so should any doctor complicit in it.

Advocates such as the AAP should be civilly held accountable for encouraging such barbarism.

So why is the AAP making these terrible policy statements? It may not be about the girls. Rather it could be about the upcoming revision to the male circumcision policy statement. The equal protection argument works just as well against infant circumcision of boys. You can't say girls deserve protection, but boys don't and hide behind a thin argument of health benefit that will never reach consensus in the medical community. Eventually, something has to break. Either boys and girls can be cut or they can't. Collectively. Either the laws of the land protect children from genital cutting. Or they don't. Taken as a whole.

I wouldn't be surprised if the AAP is looking far and wide to adjust all its positions to be able to counter any argument that supports male children over doctors and parents who wish to cut them. If the AAP decides to cave in to pressure to recommend male circumcision against all reasonable assessments of the evidence, this will be exactly how it appears. 

Link: American Academy of Pediatrics (AAP) Is Advocating for U.S. Pediatricians to Perform Certain Types of Female Genital Mutilation (FGM)

PRICELESS: The meme moves into intactivism