Monday, 7 December 2009

HIV/AIDS and Male Genital Cutting

I bet that title caught your eye! A few weeks ago when I should have been busy finishing my PhD, I went along to a Keele gender, sexuality and law seminar on 'HIV/AIDS: Male Genital Cutting and the New Discourses of Race and Masculinity'. Presenting were GSL stalwarts, Marie Fox and Michael Thomson.

The cutting the title speaks of is not a niche sexual practice but of course refers to circumcision. Since the 1860s the practice of circumcision has become secularised and medicalised, particularly in the USA. Here it was adopted by the white middle class, who believed it would protect the male body from dirt and disease. There was also the suggestion that it curbed sexual appetite and was therefore an invaluable technology in the war against masturbation. Unsurprisingly circumcision found favour among the "scientific" racists of the day as a way of managing the perceived "dangers" of black male sexuality. As Joane Nagel puts it, black men were seen as "a sexual predator, a threat to White southern womanhood and White male sexual hegemony" (in The Sociological Quarterly (2000) 41(1), p.12).

What has this got to do with HIV/AIDS? In recent years circumcision has found renewed favour in some medical circles because of the role it can allegedly play in HIV prevention. During randomised trials in sub-Saharan Africa over 2007-8, it was discovered that circumcision can reduce the risk of HIV transmission by 51-60 per cent (though these are subject to a degree of dispute). Nevertheless these are being used to justify the establishment of mass circumcision programmes in Africa to combat local epidemics, even though some studies show correlation and others do not.

There is a problem with how circumcision is being "marketed" too. Rather than being a magic bullet that will see off HIV it should be used as part of a package of measures, such as condom use, delayed sexual debut and reduced numbers of partners to better enable prevention. It's also necessary that circumcision's limitations are out there too. For example, in the West where circumcision takes place in clinical settings, there is still a two to ten per cent risk of complications. Replicated in a mass programme where clinical facilities are not so readily available you have the potential for creating another large-scale health problem. Furthermore, there's a possibility circumcision might encourage riskier sexual behaviour - especially if men have unprotected sex while the wound hasn't healed properly.

Returning to race, one question these observations raised is why are circumcision programmes being proposed for an African context? In the West HIV infection rates are declining, except in the USA, and yet no similar programme is proposed here. Plus viewed in the context of the racist history of circumcision in America, doesn't its promotion as a means of managing the sexuality of black African men - even for the laudable aim of tackling the spread of HIV - at least look a little politically suspect?

This isn't to say Marie and Michael are suggesting efforts at HIV prevention in Africa are a neo-colonial conspiracy. After all, the science behind circumcision might eventually prove robust. But it is worth reflecting that there exists something of a circumcision lobby in America and can therefore be seen as a "solution" looking for a problem. This and related questions came up in the subsequent discussion. Who are promoting circumcision? What agencies are working together? Why is it being pushed over other preventative programmes? How is it finding favour among key sponsors, who more often than not are not native to the countries affected?

Whatever the case, this paper demonstrates the difficult political questions that continue to bedevil the fight against HIV/AIDS.


Mark Lyndon said...

Circumcision is a dangerous distraction in the fight against AIDS. There are six African countries where men are more likely to be HIV+ if they've been circumcised: Cameroon, Ghana, Lesotho, Malawi, Rwanda, and Swaziland. Eg in Malawi, the HIV rate is 13.2% among circumcised men, but only 9.5% among intact men. In Rwanda, the HIV rate is 3.5% among circumcised men, but only 2.1% among intact men. If circumcision really worked against AIDS, this just wouldn't happen. We now have people calling circumcision a "vaccine" or "invisible condom", and viewing circumcision as an alternative to condoms.

The one randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised btw.

ABC (Abstinence, Being faithful, Condoms) is the way forward. Promoting genital surgery will cost African lives, not save them.

Phil BC said...

I completely agree. If circumcision was proven to work, then fair enough. But the science is just so over the place that it diverts resources away from programmes that have a proven track record.

Incidentally, the paper was more wide ranging than the thumbnail sketch I provide above but some of the policy and science stuff was new to me and I was unable to follow it enough to do it justice.

Intact America said...


On behalf of Intact America (, I'd like to thank you for being so outspoken about this sensitive subject. The work you're doing is very important to all of us who believe that circumcision is an unnecessary, harmful and risky procedure that should have no place in modern medicine.

Keep it up, Phil. And don't forget we're behind you.

-Intact America

Phil BC said...

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