Newborn circumcision for HIV prevention in Zimbabwe
It is fair to say that the connection between male circumcision and HIV prevention is known by now, i.e. the idea (supported by a number of research studies) that being circumcised reduces your chance of gaining the virus from an HIV-positive woman during sex. There are those who doubt the results of the studies, which is predictable when you are talking about a controversial surgical intervention to control a highly stigmatizing infectious disease in circumstances of poverty. And, perhaps less known, are the initiatives taking place throughout sub-Saharan Africa, backed by powerful donors like the Bill and Melinda Gates Foundation, to circumcise males for this purpose. If estimates are to be believed, hundreds of thousands of circumcisions prevent thousands of new HIV infections. HIV will not be circumcised out of existence, but in the face of a deadly epidemic you take what you can get.
Previous efforts have been focused on circumcisions among adolescent and adult males. These are men who are (just about to be) sexually active and likely to acquire HIV. These were also the populations for the studies showing that circumcision lowers HIV risk. This is why the new plan in Zimbabwe to promote circumcision among newborns is interesting and potentially explosive, for different reasons. Circumcising infants would only have an effect on HIV prevalence in the next generation. By the time that the infants become sexually active, the landscape of HIV/AIDS may have changed: perhaps there will be more effective means of prevention, perhaps there will be a cure, perhaps there will be a vaccine. Importantly, infants are in no position to give informed consent: there are strong arguments in favor of allowing persons to choose for themselves in such a case. It is also not clear how the public health approach in Zimbabwe relates to traditional male circumcision practices, nor how the intervention is going to be 'sold' to parents in communities who do not traditionally circumcise. Worries about circumcised men feeling more protected than they really are abound. And as for the newborn circumcision policy: recommended circumcision? Incentivized circumcision? Mandatory circumcision? So this is very much a work in progress, and we will see where it goes.
Previous efforts have been focused on circumcisions among adolescent and adult males. These are men who are (just about to be) sexually active and likely to acquire HIV. These were also the populations for the studies showing that circumcision lowers HIV risk. This is why the new plan in Zimbabwe to promote circumcision among newborns is interesting and potentially explosive, for different reasons. Circumcising infants would only have an effect on HIV prevalence in the next generation. By the time that the infants become sexually active, the landscape of HIV/AIDS may have changed: perhaps there will be more effective means of prevention, perhaps there will be a cure, perhaps there will be a vaccine. Importantly, infants are in no position to give informed consent: there are strong arguments in favor of allowing persons to choose for themselves in such a case. It is also not clear how the public health approach in Zimbabwe relates to traditional male circumcision practices, nor how the intervention is going to be 'sold' to parents in communities who do not traditionally circumcise. Worries about circumcised men feeling more protected than they really are abound. And as for the newborn circumcision policy: recommended circumcision? Incentivized circumcision? Mandatory circumcision? So this is very much a work in progress, and we will see where it goes.
Labels: bioethics, HIV, male circumcision, Zimbabwe
posted by Stuart Rennie at 6:26 PM
3 Comments:
Another reason to doubt the studies is that for millennia circumcision has been an interverntion in search of an excuse, and for over a century, but until recently only in the developed world, a "cure" looking for a disease. It is striking the the resarchers who made this claim and the entrepreneurs now promoting mass-circumcision - many of them the same people now wearing different hats - are almost all from the USA and almost all circumcised men. You may call that "argument ad hominem", but it could be called conflict of interest.
What is striking about the neonatal circumcision campaign in Zimbabwe is
1) Surveys have twice shown more of the circumcised men to have HIV than the non-circumcised, one before the circumcision campaign began, the other nearly two years after. Similar figures have been found in 10 out of 18 countries for which USAID has figures. There are also many methodological problems with the three trials on which the HIV is based.
2) While proponents are claiming with spurious certainty that "200,000 infant circumcisions will prevent 1500 HIV deaths", with an infant mortality rate of 3%,6000 of those babies will die in their first year, long before they are at any risk of HIV.
You are right to raise the issue of informed consent when the ethics of neonatal question are under question in Germany, Scandinavia and the United States.
Every human being has rights. Cutting off part of an infant's sex organ, ostensibly for his own good, is a violation of his human rights.
Circumcision does not prevent HIV, in spite of propaganda to promote this specious nonsense.
Wherever circumcision is forced upon children there are horrific accidents, botched circumcisions that don't factor into the statistics that promote forced genital cutting (mutilation) as a "health measure."
In the real world (outside of the questionable African studies) circumcision does NOT prevent HIV.
Denmark: 2 in 1000 adults have HIV / Male Circumcision Rate: Less than 2%
USA: 6 in 1000 adults have HIV / Male Circumcision Rate: 80%+
Circumcision does NOT protect against HIV! The only way to protect against an HIV is by having safe sex. Use a condom!
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