Notebook: Is male circumcision an acknowledgment of failure?

Opponents of circumcision claim its use to combat HIV infection is a pessimistic approach. Proponents say it is a hopeful one. Ironically, the proponents’ hope stands in stark juxtaposition with its assumption of past and future failure.

For 25 years, the world has battled HIV/AIDS with the hope, and even assumption, that a vaccine was right around the corner. The astounding success in battling world diseases from polio to cancer in the last century has conditioned humanity to expect no disease, save old age, to be beyond our ability to contain and roll back. AIDS was a rude awakening that the world is only now coming to grips with.

Yet, HIV/AIDS is a disease with more resources thrown at it than almost any other disease in the modern world. It victimizes fewer people on a yearly basis than heart disease, cancer, drug abuse, and auto accidents. More people die every year of malaria and even starvation than HIV/AIDS. Yet, this disease is relentless in its march across the world. It is slow. But it moves with a fierce power.

It isn’t hard to understand why the world fears it. What is astounding and almost beyond understanding is why the world is so reluctant to roll out proven prevention methods. Culture and inertia have conspired to stop the prevention agenda from moving forward ahead of the pandemic. The West, particularly NGOs of the West, never tires of lamenting this state of affairs in places like Africa and India.

So, why is male circumcision considered hopeful by its proponents?

Clearly, circumcision, like all efforts, competes in a marketplace of acceptance. Talking about prevention methods, such as correct condom usage, empowerment of women, and curtailing wide sexual networks, presents greater ongoing obstacles than even submitting one’s genitalia to a disfiguring and experientially altering surgery, if said surgery works every time, which we know is unfortunately not the case. And this is doubly true when we are talking about doing it to those unable to consent.

It is therefore hopeful because it avoids these emotional and destabilizing subjects. It also does an end run around the ethical considerations because when parents submit their boys to genital surgeries, it is considered a personal choice for the parents, as the boy does not exist apart from his parents. It is a way of achieving what can’t be achieved in the adult population. It assumes we have failed with strategies aimed at adults and entire societies where methodologies can’t be rammed down people’s throats. It assumes past and future failure in overcoming culture, indifference, and politics. And hence, many have noticed the recent encouragement of the adoption of infant or childhood circumcision as a starting point.

Opponents of circumcision in contrast find the procedure pessimistic because it seems to be a kind of surrender to the perceived futility in the realm of human affairs. They haven’t yet given up on rational decision-making despite all the apparent evidence to the contrary. Africa and India, they say, lack resources of all kinds, i.e. education, political power, adequate emphasis on wealth generating infrastructure and cultural values, in short, development, and opponents say this is the real reason HIV/AIDS is on the march. Opponents point out that development goes far beyond containing disease. It raises living standards, more equitably redistributes power, and gives hope through health. In other words, the holistic approach should be preferred to piecemeal, “arsenal” type prevention strategies.

Opponents are optimistic despite all the evidence to the contrary. Proponents have given up and perhaps see profit in doing so, whether professionally or in prestige. Opponents see pessimism in circumcision because they are optimistic in the proven methodologies and in a holistic approach. Proponents see optimism in the procedure because they are pessimistic as to the alternatives.

More sober voices have expressed doubt as to the effectiveness of male circumcision, noting that within countries, over time, the HIV rates are about even between the circumcised and intact. It seems not just pessimistic but wholly wishful that male circumcision will somehow change the rate of infection.

The proven methods of female empowerment, correct condom usage, and over all development remain our only effective means of stemming the disease so far. Who wins the circumcision argument may not matter in the long run viz. HIV rates. It will matter viz. quality of life for the men and in maintaining pressure on the world to push what works.

-Editors

This entry was posted in Medicine and tagged , , , , , , . Bookmark the permalink.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s