Monday, December 20, 2010

Mass Male Circumcision; a Motiveless Crime?

Some of the staunchest advocates of mass male circumcision (MMC) as a means of protecting men from infection with HIV, and even herpes simplex virus (HSV-2), have found that the operation is unlikely to have very much effect. Many years of 'research' has been carried out on how to ram MMC down the throats of male members of the Luo tribe in Kenya's Nyanza province.

There has never been much convincing evidence that MMC would be effective in the first place, but circumcision advocates don't seem bothered by that. And the more certain it is that MMC will not do any good, that it may even do a lot of harm, the more enthusiastic advocates become. In fact, this data was collected before large numbers of Luo men were circumcised (or were claimed to have been circumcised, actual numbers are hard to come by).

This particular piece of research found extremely high HIV (and HSV-2) prevalence; 17% among males and 26% among females. Rates for both viruses were similar for circumcised and uncircumcised males. Rates like this contrast strongly with those found in the rest of Kenya, with national prevalence standing at 6 or 7%. The second highest male prevalence rates, found among the Maasai, are about half those found among the Luo.

Those promoting circumcision have not explained the huge differences between tribes in HIV prevalence rates. There are even anomalies such as the extremely high rates among female Luhyas (12%) when rates among male Luhyas are relatively low (1.9%).

In short, HIV rates are high among the Luo, many of whom are not circumcised. But circumcised Luos have equally high HIV rates. So why insist that lack of circumcision explains why members of this tribe have such high HIV rates? And why insist on MMC when this is obviously not going have much positive impact on transmission rates and may have a negative impact?

The research also shows that people have been hoodwinked by the hype that MMC has received. Men think they are less likely to be infected with HIV if they are circumcised and women think circumcised men are less likely to be HIV positive. What most people don't seem to realize is that the 60% protection that circumcision arguably imparts requires that condoms are also used.

But if condoms are used, uncircumcised men are also protected. The operation is not only possibly useless and potentially harmful but it is also completely unnecessary, even for those who think it may protect them. They could just use condoms.

The research notes that "Uncircumcised men who preferred circumcision were more likely to report inconsistent or no condom use, describe sexual partners as ‘casual’, and report current/recent genital ulcerations" and that these men may 'self-select' for an MMC program. The authors see this as a good thing but I would question their analysis of this finding.

Other research suggests that many men and women think male circumcision will protect them from HIV and that they don't need to use condoms. Even people who can give the 'correct' answers to questions about HIV and circumcision, as a result of having them drummed into their heads, seem a little too anxious to embrace an intervention which is not well understood (by them or anyone else).

Recommending, and even carrying out, an operation that is clearly unnecessary and possibly hazardous sounds distinctly unethical. Failing to establish why HIV transmission rates are so high among the Luo after so many years of research is bad enough, but it certainly does not support the contention that what Luos need is MMC. Having said all that, I am unable to supply a motive for the behavior of circumcision advocates and would love to hear from anyone who could do so.



Simon said...

Thanks to Hugh7 for the following comment:

The compulsion to circumcise is widespread and bizarre. One attempt at an explanation in terms of memetics (the study of memes, units of culture transmitted by imitation) is here ( But even that hardly explains the "adamant father syndrome" ( that seems to make men immune to rational argument.

The public misperception of circumcision is even worse than you've said. A recent study of women's attitudes ( found some think "circumcised = HIV-negative" - a recipe for disaster.

[For some reason the post didn't appear here!]

Simon said...

Thanks Hugh, yes, there's some academic research now that is aiming to reverse the pro-circumcision idiocy. I read and commented a few days ago on the paper you mention but it's far from academic. AVAC are an industry front. But it's a cruel irony calling a project 'whipt' when it's about violence and potential against women.