Earlier this week, blogger and intactivist Andrew Sullivan posted a short piece titled Circumcision Spreads HIV? on his blog, the Daily Beast. Sullivan’s post is brief, but his message is critically important: the “African studies” being used as “evidence” to promote circumcision as HIV prevention are bogus, and the promotion of circumcision will actually increase HIV deaths. Sullivan cites an excellent new article by Oxford University’s Brian Earp, titled A fatal irony: Why the “circumcision solution” to the AIDS epidemic in Africa will increase transmission of HIV. Earp calls the pro-circumcision camp’s African trials “bad science at its most dangerous.”
“We are talking about poorly conducted experiments with dubious results presented in an outrageously misleading fashion. These data are then harnessed to support public health recommendations on a massive scale whose implementation would almost certainly have the opposite of the claimed effect, with fatal consequences.”
Earp goes on to explain why the trials are faulty, and how they show that mass circumcision will actually increase the spread of HIV.
I have felt for years that the entire campaign to circumcise Africa (because that’s what it is—it’s not true, unbiased research) stinks to high heaven. It’s medical imperialism at its worst (see my February 8 post, The Business of Circumcision, Indeed).
Since its founding in 2009, Intact America has been a small but important dissenting voice on this issue. We have looked at the ethics, the methodology, and the data produced by the crowd of mostly American, mostly circumcised scientists and social scientists who seem to feel that Africans cannot possibly be persuaded to use condoms, and that it’s ok to expose women to HIV if their male partners refuse to be tested and are circumcised nonetheless.
In 2009, we went to the Centers for Disease Control HIV Prevention meeting in Atlanta, and confronted the pro-circumcision CDC officials about their unethical promotion of circumcision for African men—the same officials who decry the genital cutting of women. We were instrumental in getting the CDC to refrain from releasing recommendations about circumcision as HIV prevention. And we have put the American Academy of Pediatrics on notice that any attempt to use the “African studies” to bolster the practice of infant circumcision in the United States will be met with serious exposure of that trade association’s ethical bankruptcy on the issue of circumcision.
Along with Intact America, people like Sullivan and Earp know the truth about the pro-circumcision camp conducting and promoting the “African studies.” They see the blatant disregard for informed consent; the misrepresentation of risk in absolute rather than relative terms; the deliberate non-disclosure of data that suggests the superior efficacy of benign, non-surgical methods of prevention; and the unbridled enthusiasm for mutilating the genitals of black Africans—all of which makes the Tuskegee syphilis experiment look like a warm-up exercise. The word is finally getting out: Circumcising Africa WILL KILL AFRICANS. Please read Andrew’s blog post as well as the Oxford article, and share them on Facebook, Twitter, and other social media networks. People need to know the truth behind these trials, and the truth that circumcision does not prevent HIV.
This is the second in a series of talking points for intactivists. As I mentioned in Part One, I know how difficult it can be to have conversations about circumcision with people who defend it – for whatever reason. People often ask me how I deal with certain questions or arguments. The purpose of these talking points is to share some helpful facts and approaches that have worked for me.
Obviously, we each need to find our own voice in talking about why we oppose circumcision. Over time, it’s important to discover what helps you connect with different audiences, and it’s always helpful to try to find some common ground. To avoid triggering immediate defensive resistance, it’s also advisable not to personalize the conversation, at least initially.
You can say, for example, “Most Americans don’t give circumcision a thought; they probably don’t realize that doctors in other countries don’t routinely cut off the ends of baby boys’ penises.” The person you’re talking with might not know this either; but now he’s learned something important, without being told he’s ignorant.
Or you can say, “Most American women have never even seen a normal penis! Isn’t that amazing?” The American woman you’re talking with won’t feel singled out; rather, she can agree with you that most American women have never seen a normal penis. And that’s a good way for her to start thinking about her own biases.
Here are my responses to some of the medical and hygiene arguments often raised to rationalize circumcision.
The circumcised penis is cleaner. If you can teach your child to brush his teeth, you can teach him to wash his genitals. Girls’ genitals have lots of folds, and – by the way – girls have smegma, too! We don’t worry about whether they can learn to keep themselves clean, let alone talk about what to cut off to make it easier for them to wash themselves.
What gives you the right to talk about circumcision? You’re not a doctor. Gee, we talk about all sorts of medical topics all the time, don’t we? Thankfully, “consumer” empowerment is actively transforming the delivery of health care all around us, and for the better. Why shouldn’t circumcision be discussed openly by everyone, especially on behalf of those who don’t have a say in the matter? Even so, and for the sake of argument, if “routine” infant circumcision were a legitimate medical procedure, used to treat a serious or complex illness, then pointing out my lack of medical credentials might be relevant. But no physician organization in the world recommends circumcision. Also, by the way, I am a lawyer and I understand bioethics. I know that cutting off part of another person’s body – a person who has not consented – is legally, morally, and ethically wrong.
It’s just a useless little flap of skin. (Other versions of this are, “it’s just a snip,” or “it’s a skin tag,” as a radio talk-show host once said to me.) With all due respect, these statements reflect Americans’ ignorance about the normal male anatomy. Yes, an infant’s foreskin is small, about the size of a quarter (so are his fingers and toes and his heart, for that matter); but in an adult male, the foreskin comprises 15 square inches (that’s the size of a 3 x5 index card or 15 quarters) of specialized skin, loaded with nerves, blood vessels and muscle. The foreskin is an integral part of the penis. It protects the glans (head of the penis) and keeps it moist and sensitive. It also plays an important role in sexual pleasure for both its owner and his partner. By the way, women have a foreskin, too; it’s called the “preputial hood,” and some cultures that practice female genital cutting remove it. We have thoroughly outlawed this surgery on girls in the United States.
I hear circumcision prevents AIDS. This one is complex, but it’s important not to be intimidated by this subject. Obviously, the incidences of many diseases could be lessened by proactively removing healthy organs or body parts, but we pretty much don’t do that – and certainly not to people who aren’t old enough to understand and consent. The much-touted “African studies” that showed men to be at a relatively lower risk of contracting HIV from women if the former were circumcised found NO reduction in risk for male-to-male transmission, and circumcision actually increased the risk for male-to-female transmission.
- There is a lot of evidence that much of the HIV in sub-Saharan Africa is a result of unsafe medical practices – not sex.
- Most Americans don’t realize that European countries, where circumcision is extremely uncommon, have rates of HIV similar to or lower than the United States where circumcision is common. There is no epidemiological correlation between circumcision rates and HIV rates within the United States, or internationally.
- There is no evidence that United States saw any benefit from its very high rate of circumcision in mitigating HIV; American cemeteries are full of circumcised men who died from AIDS.
- The only way to prevent sexual transmission of HIV is to use condoms or practice abstinence.
Sometimes I ask rhetorically, “You’re circumcised, right? Well, would you have unprotected sex with an HIV-positive woman, figuring that you’re protected from getting HIV?” (This one violates my rule about not getting personal, but it’s worth it.)
Have you BEEN to AFRICA? This question – usually asked loudly with a look of great significance, implies that if I had seen first-hand the misery that HIV is causing in sub-Saharan Africa, I would say “try anything and everything” to prevent AIDS.” Instead, I usually say, “No, I haven’t been to Africa.” But … (I then go to the points on HIV immediately above).
Doesn’t circumcising men prevent cervical cancer in women? First, keep in mind that cutting off one person’s body part to protect a hypothetical future sex partner is unethical; that’s a straightforward bioethical principle that should not be dismissed. As for the prevention claim itself, this myth arose from observations that Jewish women had lower rates of cervical cancer than some non-Jewish women. No studies were done to determine the circumcision status of Jewish women’s sex partners; it was simply assumed that they were Jewish, and thus circumcised. However, there is no correlation between a woman’s risk of cervical cancer and her male sex partner’s circumcision status. Human papilloma virus (HPV) and smoking are the leading risk factors for cervical cancer.
What about penile cancer? Penile cancer is exceedingly rare. The rate of penile cancer in the United States, where most adult males have been circumcised, is similar to that in most European countries, where men are intact. Breast cancer is hundreds of times more common than penile cancer. What would you think about a proposal to remove the breast buds of young girls, to prevent them from developing breast cancer in the future?
What about urinary tract infections? UTIs occur in both intact and circumcised boys (and in girls, too). These can be easily treated with antibiotics, a much safer and more humane option than the permanent surgical removal of a body part.
I look forward to getting your feedback on what works for you, when promoting intactivism!
By Georganne Chapin
Donald G. McNeil, Jr.’s recent New York Times article, AIDS Prevention Inspires Ways to Make Circumcisions Easier, applauded medical equipment manufacturers for producing single-use circumcision instruments efficient and “safe” enough to circumcise 20 million men in sub-Saharan Africa. The article accepted at face value claims that mass circumcision will reduce the spread of HIV, and ignored the ethical problems of a U.S.-funded sexual surgery campaign carried out upon the bodies of black African men.
On February 7, the New York Times printed two responses, one of them mine. Under the heading, Business of Circumcision, my letter reads:
To the Editor:
Re “AIDS Prevention Inspires Ways to Make Circumcisions Easier” (Jan. 31): With 20 million men targeted to undergo “assembly-line” circumcisions, it’s no surprise that medical equipment manufacturers are rushing to cash in. It appears, though, there’s no money to be made from informed consent; that issue didn’t figure anywhere in this enthusiastic report on the plans of researchers and organizations dominated by white, circumcised Westerners to surgically reduce the penises of poor, non-English-speaking Africans.
The male foreskin comprises 15 square inches of erogenous tissue. Its removal results in an open wound and permanent reduction of sexual sensation.
The second letter extols the virtues of the Shang ring, one of the two circumcision devices mentioned. The authors of this letter are physicians affiliated with the questionable research and HIV “prevention” agenda for Africa.
The plan to circumcise 20 million African men is a sinister combination of cultural/medical imperialism and the big business of international health. The researchers who have made their careers by promoting mass (and even universal) circumcision are almost all Americans. Several were known for their pro-circumcision agenda before they ever became involved in the African “trials”—which were, from the onset, really circumcision campaigns. Participants were randomized into two groups, “circumcise now” and “circumcise later,” rather than “circumcised” and “not circumcised,” which would have been the proper way to study objectively whether circumcision status truly affects HIV transmission. (See, e.g., Gray RH, Kigozi G, Serwadda D, et al., Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial, Lancet 2007; 369: 657–66.)
Promoters of circumcision as HIV prevention, and the press reporting on these efforts, both fail to acknowledge the methodological problems with the African studies. These same researchers’ own subsequent work has shown that male circumcision actually increases women’s risk of contracting HIV from their circumcised partners. The research subjects have become victims of the intentionally promoted fallacy that circumcision is a “vaccine” against HIV. A recent investigation in Zambia showed that many men circumcised as part of a mass circumcision effort there resumed unprotected sex before their incisions healed, jeopardizing their wives or girlfriends—women who will find it very difficult to negotiate “safe sex” with men who believe they’ve just received a surgical “vaccine.”
Inextricably intertwined with the bad science is the utter disregard for ethical and public health issues begging to be acknowledged in any report on the African circumcision campaign.
How do you ensure informed consent in a population of poor, non-English-speaking men, who are being lined up, hundreds in a day, to have part of their genitals removed?
How do you ensure partner education, when men who do not know or wish to know their HIV status are being circumcised anyway, without being tested—leading them to believe that they are now “safe” from AIDS?
How, despite the promotion of single-use surgical devices, do you ensure that there is no re-use of contaminated medical instruments—syringes, scalpels, scissors, etc.—and how do you ensure safe disposal of medical waste in countries with inadequate sanitation and an underdeveloped health care infrastructure?
How do you ensure that men who develop serious complications—not to mention circumcised men and their female partners who still contract HIV—are appropriately treated and even compensated for what they have lost, due to our peculiar fixation on altering the male anatomy?
Mostly, how do we get the mainstream American press to ask these obvious questions? Why is getting the truth out dependent on me managing to get a 100-word letter printed in the New York Times?