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.