GENITAL CUTTING: Geese get equal treatment in Africa at Dr. Piot’s urging

When the Kenyan and Ugandan studies were announced linking lower HIV infection risk with male circumcision, many sober voices immediately called for safe and consensual procedures by trained clinicians instead of those provided in the wild by folk doctors, if a given country decided to implement a mass circumcision campaign.

It was rather shocking then when Dr. Peter Piot, head of UNAIDS, called for infant circumcision to be implemented as a first step. After all, outside of the North American and Jewish experience, infant circumcision is widely seen as non-consensual and cruel with often unforeseen and unrecognized complications. But give Dr. Piot credit. For he must have known that there would be widespread resistance among people old enough to understand the pain and damage the procedure entails.

We reported right here on this blog what Dr. Piot must have been thinking. One Ms. Thoko Tsabedze, an HIV-positive mother from Macatjeni district south-east of the Swaziland capital, was quoted as saying, “It is difficult even when you try to talk to your son about circumcision. He says, ‘How am I going to take a bath publicly with my friends, I will be ridiculed’.”

So, is it true or not that what is good for the gander is good for the goose?

If so, Dr. Piot must be getting goose bumps to hear from a competing UN agency, the UN Population Fund, about clinics now being spotted “in Egypt, Kenya, Somalia, Djibouti and Yemen” offering female circumcisions to increasingly younger girls because of “increased awareness of the health risks associated with the practice” in non-clinical settings, i.e. by folk practitioners, and “to avoid refusals to participate,” i.e. give consent.

Imagine how these “clinics” will pick up steam when they learn of the Stallings study, echoing loudly the prophylactic effect of male circumcision, but in females who have undergone female circumcision!

Full fair use text of the Reuters article and the Stallings abstract after the hop.

Parents turn to clinics for genital mutilation: U.N.

UNITED NATIONS (Reuters) – More parents are turning to medical clinics to perform genital mutilation, wrongly assuming that it spares girls physical and psychological damage, a U.N. agency warned on Monday.

The trend has been spotted in Egypt, Kenya, Somalia, Djibouti and Yemen, according to demographic surveys and patient reports, the U.N. Population Fund said.

“This tendency arises from increased awareness of the health risks associated with the practice,” said Thoraya Ahmed Obaid, the fund’s executive director.

The practice, also known as female circumcision, usually involves cutting of the clitoris and other parts of the female genitalia. Many practitioners are untrained and use crude instruments.

The practice leaves lasting physical and psychological scars, in addition
to the risks it generates during childbirth, the U.N. Population Fund said.

Some 3 million girls face the risk of circumcision every year, Obaid said. An estimated 120 million to 140 million women and girls have been subjected to the cutting.

Immediate complications include severe pain, shock, hemorrhage, urine retention, ulceration of the genital region and injury to adjacent tissue. Hemorrhage and infection can cause death, the World health Organization said.

Obaid also warned that in some nations parents were subjecting “younger and younger” girls to the practice to avoid refusals to participate. Girls generally undergo the rite before the age of 10, often without anesthesia.

While predominant in 28 African countries, including Sudan, Chad, Sierra Leone and Djibouti, genital mutilation also takes place in some Middle East nations, such as Saudi Arabia, and among immigrant communities in Europe and North America.

Leopold, Evelyn. Parents turn to clinics for genital mutilation: U.N. Reuters. February 5, 2007.

http://today.reuters.com/news/articlenews.aspx?type=healthNews&storyID=2007-02-06T000616Z_01_N05474653_RTRUKOC_0_US-UN-MUTILATION.xml

Abstract

Female circumcision and HIV infection in Tanzania: for better or for worse?

Stallings R.Y.1, Karugendo E.2

1ORC Macro, Calverton Maryland, United States of America, 2National Bureau of Statistics, Dar es Salaam, United Republic of Tanzania

Introduction:

It has been postulated that female circumcision might increase the risk of HIV infection either directly, through the use of unsterile equipment, or indirectly, through an increase in genital lacerations or the substitution of anal intercourse. The authors sought to explain an
unanticipated significant crude association of lower HIV risk among circumcised women [RR=0.51; 95% CI 0.38,0.70] in a recent survey by examining other factors which might confound this crude association.

Methods:

Capillary blood was collected onto filter paper cards from a nationally representative sample of women age 15 to 49 during the 2004 Tanzania Health Information Survey. Eighty-four percent of eligible women gave consent for their blood to be anonymously tested for HIV antibody.

Interview data was linked via barcodes to final test results for 5753 women. The chi-square test of association was used to examine the bivariate relationships between potential HIV risk factors with both circumcision and HIV status. Restricting further analyses to the 5297 women who had ever had sexual intercourse, logistic regression models were then used to adjust circumcision status for other factors found to
be significant.

Results:

By self-report, 17.7 percent of women were circumcised. Circumcision status varied significantly by region, household wealth, age, education, years resident, religion, years sexually active, union status, polygamy, number of recent and lifetime sex partners, recent injection or abnormal discharge, use of alcohol and ability to say no to sex. In the final logistic model, circumcision remained highly significant [OR=0.60; 95% CI 0.41,0.88] while adjusted for region, household wealth, age, lifetime partners, union status, and recent ulcer.

Conclusions:

A lowered risk of HIV infection among circumcised women was not attributable to confounding with another risk factor in these data. Anthropological insights on female circumcision as practiced in Tanzania may shed light on this conundrum.

Presented at the 3rd IAS Conference on HIV Pathogenesis and Treatment, Rio de Janeiro. July 24-27, 2005.

http://www.ias-2005.org/planner/Abstracts.aspx?AID=3138

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