Kicking Women off the HIV Circumcision Bandwagon

A few months ago when I asked whether mass circumcision was a good idea I didn’t think I was asking a rhetorical question. Reading an article today in the Lancet I gather that I’m behind the times. Apparently it’s already been decided that mass circumcision is a great idea. At least in Africa.

The study I was reading was another Ugandan circumcision study, this time looking at whether or not circumcising HIV positive men has any protective effect for their HIV negative female sex partners (the short answer is no). They had me irritated from the opening sentence:

“Three trials of male circumcision in HIV-negative men, including one undertaken in Rakai, Uganda, shows that circumcision reduced male acquisition of HIV by 50-60%; as a result, male circumcision is now a recommended strategy for HIV prevention in men.”

Powerful stuff, except it isn’t exactly true, is it. Circumcision is a recommended HIV strategy for men in Africa. But last time I checked it wasn’t being widely promoted for men living in Europe or North America (although I’d love to see the tag lines on those billboards).

I’m not trying to be cute or snarky. I understand that adult males in most African countries differ significantly from adult males in North America when we’re talking about HIV rates and risk. But given that we still don’t actually know why men who were circumcised had such a reduced risk of HIV aren’t we jumping the gun? After all, they don’t actually know that it was the circumcision procedure alone that accounted for the drop in HIV risk among those men. Circumcision isn’t the only thing that happened to those men during the study.

I’m not making any new arguments here, just wondering whether researchers and scientists (and funders) are debating any of this. The paper does raise a number of ethical issues related to circumcision as an intervention. For example they point out that if they only circumcise HIV negative men, being uncircumcised could become stigmatized as associated with HIV positive status. They’re answer to this is circumcise anyone who asks.

I find it really problematic when researchers write without precision. Saying that circumcision is recommended for men isn’t the same as saying it’s recommended for African men. When they erase the geographic/cultural/ethnic marker, they are erasing more than just the word. They are shutting down any discussion of geographic, cultural, ethnic bias, or how systemic biases might be influencing the results of these studies and the interventions being pushed.

Like I was in March, I’m trying to focus on the fact that these researchers intent is to do good for others, that there is no willful ignorance or harm being done. But reading stuff like this makes it harder for me to trust that.

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