International

Can male circumcision reduce HIV and AIDS?

HIV testing Sierra Leone
Renaldah Mjomba
By Renaldah Mjomba: June 20th, 2012

What is VSO’s position on male circumcision? Does the organisation advocate for males to be circumcised as an approach towards reducing HIV and AIDS? When and how should the procedure be carried out?

You can get answers to the above and many other questions from our newly published paper ‘VSO’s position on Male Circumcision.’ And that is not all, through concerted efforts of our health and HIV and AIDS programme managers and committees, we have now published two other papers ‘VSO’s position on Criminalization of HIV and AIDS’ and ‘ VSO’s position on Community and Home Based Care.’  In addition to ‘VSO’s position on Gender in HIV and AIDS Programming,’ that was released earlier on in the year, we have now published four papers on HIV this year.

Should a person living with HIV who doesn’t disclose his/her status and goes ahead to have unprotected sex with a person who is not infected be ‘brought to justice’? Our position on criminalisation of HIV transmission provides answers to this and many other questions.

The four papers consolidate some of our key learnings on some of the difficult and controversial issues in HIV and AIDS, a theme the organisation has been intervening on for the past decade. Since the biannual International AIDS Conference on 22–27 July is around the corner, our staff and partners will widely distribute these papers. They’ll also be attending the conference to learn, advocate and share their experience of our HIV and AIDS programmes.

I hope that our offices and volunteers will find them a useful tool both for advising partners as well as influencing policies at different levels. I also hope that you will find the papers interesting and help VSO to reduce infection rates and improve the lives of those living with HIV and AIDS.

Comments

7 comment on Can male circumcision reduce HIV and AIDS?

  1. Sam Roberts says:

    I think it is wrong that VSO could advocate for the genital mutilation of baby boys, even with provisos, while at the same time condemning its female equivalent. Christopher Hitchens’ arguments on this matter in ‘God is not Great’ are very powerful. A short extract is available on this website: http://fearofignorance.wordpress.com/2007/11/02/hitchens-on-circumcision/

  2. Sam Roberts says:

    Further, this practice clearly doesn’t have the level of effectiveness to warrant such a recommendation. There is a clear risk, as outlined in the paper, that people will assume they do not need to use other methods with proven effectiveness.

  3. Steve Lewis Steve Lewis says:

    I can’t agree with you Sam, because the major scientific world authorities such as UNAIDS and WHO – World Health Organisation -have all come out in favour of voluntary medical male circumcision. “There is now strong evidence from three randomized controlled trials undertaken in Kenya, Uganda and South Africa that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%”. Statistically this is of huge importance in high prevalence countries of Africa. You are right of course that it would not be effective in isolation, but the position paper does emphasise that point.

    • Saurabh says:

      I think that even if circumcision did sinalficngtiy reduce the HIV transmission rate in consenting adult men in Africa practicing unsafe sex under unsanitary conditions and dangerous cultural beliefs (and even that is a BIG if ), I don’t think that research is remotely applicable to performing circumcision on non-consenting American infants, growing up with easy access to sanitation of all forms and condoms, in a culture where no one believes sex with a virgin cures AIDS. Of course, circumcision offers no protection for women or gay men, either, or any protection for needle drug users, which means that the most common methods of transmission and the groups with the highest infection rate in the US wouldn’t benefit, anyway. All of this is irrelevant to me, anyway, as I think it’s a basic violation of human rights and human decency to perform elective, cosmetic surgery (often unanesthetized) on an infant. Cutting parts off babies without dire, immediate need is wrong. Why does the argument need to past that?

  4. Sam Roberts says:

    Thanks Steve. Your response doesn’t answer the point about the advocating of infants being involuntarily circumcised provided parental consent is in place.

    While there is a reduction in HIV/AIDS among circumcised men, surely this is only among those who are not using other more highly effective means such as condoms.

    Further, are you aware of any behavioural studies into the types of risks taken by circumcised men versus those who aren’t? For example, does the advocacy and promotion of this practice result in more risky behaviour, perhaps in the belief that they have sufficient protection through their circumcision?

  5. Renaldah Mjomba RenaldahMjomba says:

    Thank you very much for taking time to read the blog and expressing your opinion!

    The nature of HIV and AIDS is to some extent quite complicated because it brings together Culture, Biology, Human rights, Economics, Politics etc into one melting pot! As a result, there are a number of issues that may be deemed controversial such as ‘Harm Reduction’ (for injecting drug users); Right to access to treatment and Health services for LGBTIs (Lesbians, Gays, Bisexuals, Transgender, Intersexuals) and Prisoners; Right to Social Protection (for the infected and affected); Male Circumcision etc.

    Regarding male circumcision, there are several schools of thought against it, including but not limited to religious and cultural beliefs and practices among others. Likewise, those who advocate for it, do so for a myriad of reasons too (e.g. aesthetics, as a rite of passage, religious beliefs etc). VSO respects all these different opinions – Whether for or against the practice.

    The position we have taken on Male Circumcision is solely regarding the transmission of HIV (and not any other reason!). VSO acknowledges the biological rationale that points out the benefits of male circumcision as regards HIV transmission. As indicated in the paper and references, the position is backed by research and scientific findings. Having said so, we are also sensitive to the fact that Male circumcision alone is not a remedy, all males, circumcised or not must employ the same range of prevention measures so as not to be infected.

  6. Sam Roberts says:

    If VSO respects all these opinions with respect to male genital mutilation, does it also respect those related to female genital mutilation? If not then by what logic is the distinction made?

    In Germany it seems that a more enlightened rights based approach is being adopted with the child’s right to decide overriding other considerations, parental consent not being sufficient: http://www.bbc.co.uk/news/magazine-18793842

    With respect to circumcision entered into voluntarily by adults there must be questions asked about their motivation for doing so if it is widely believed that it offers some protection against HIV/AIDS.

    Are you aware of studies which monitor the relative sexual risks taken by those who have and haven’t been circumcised? My hunch would be that those who have been circumcised will engage in more risky behaviours in the belief that they are protected by this means and, if this is the case, then VSO’s position is flawed from the outset.

    With papers like this you have to be very careful about the key message that people take from it. As things like this filter through networks the secondary provisos are usually lost while the headline survives. In this case your headline is advocating for circumcision of infants and adults in order to provide protection against HIV/AIDS as opposed to rejecting this solution in favour of the only truly effective means which is widespread condom use. While it is fine to point me in the direction of the ‘small print’, it is difficult to do this for others once this type of communication takes on a life of its own and becomes blurred and reinterpreted on its way to the people it serves to help.

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