NOTEBOOK: Influencing the Discussion on Male Circumcision and HIV

In order to effectively slow down the roll-out of male circumcision, it will be necessary to determine a set of crucial points of discussion. The damage that male circumcision causes is gaining a wider audience [see posts from 4/30, 5/2, and 5/3]. Also, Its relation to female circumcision has been widely discussed and compared. These two points are the key offsets to the gain or perceived gain from its implementation in communities that do not accept or practice it.

Policies are being formulated for male circumcision to take its place among the prophylactic tools currently available. It is essential that the skeptical members of the HIV/AIDS activist community offer a well thought out policy alternative. One way of doing this is to look at the proposed policies and build from them to incorporate the concerns of individuals concerned about the ethics and wisdom of removing tissue as a prophylactic measure.

A couple of crucial first points:

1. The advocate HIV/AIDS organizations and individuals have been careful to state that male circumcision must not replace or displace current prevention tools. From a practical standpoint, the existing tools have not been fully implemented anywhere, except in the most developed countries. Therefore, it is inevitable that from a limited source of funding and human capital, resources will be taken away from testing, education, condoms, and even advocacy to get these highly effective existing tools in place.

2. The advocate HIV/AIDS organizations and individuals have been careful to repeat their stated belief that female circumcision bears no relation to male circumcision. They make the implicit assumption that male circumcision entails no physical cost to the individual either in sexual function or feedback of erogenous stimuli. This has been proven incorrect in two recent studies without question and in a third whose proper interpretation does not contradict and in fact supports from a different direction the conclusions of the first two. The repeated need to stress and point out the belief that female circumcision is qualitatively different rather than different only in degree demonstrates that a natural comparison inevitably flows from any discussion of surgery on human genitals.

The advocates of circumcision know that a skeptical constituency is out there. They are aware of the long-term opposition that male circumcision has enjoyed in the United States. Their likely (and stated) response will be to move quickly with the resources available to the HIV/AIDS community to put male circumcision in place before significant opposition can develop.

Once in place, male circumcision will take on a meaning independent of its original rationale. Overturning it then will be significantly more difficult than preventing it now. Whether the advocate organizations or individuals know this is unclear. That it is true is borne out by a century of gratuitous circumcision in the United States, half a century of it in South Korea, and the persistent myths of the benefits of the practice in countries where it is not in widespread practice.

The AIDS Vaccine Advocacy Coalition has put out a “special publication” entitled A New Way to Protect Against HIV? Understanding the Results of Male Circumcision Studies for HIV Prevention. It is an advocacy publication (propagandistic, rhymes with sadistic) aimed directly at convincing policy makers to begin pushing male circumcision. The next post on Male Circumcision and HIV will be a critique of this pamphlet with suggestions for inserting the ethical concerns that the proponents disregard.

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