Confusion About Circumcision Common Where Program is Most Active

Given the amount of money that has been thrown at male circumcision programs purporting to reduce HIV transmission from females to males, a small study reveals that more women than men have incorrect and dangerous views about the operation. However, it is unlikely to dampen the enthusiasm of the HIV industry, which likes to boast that several hundred thousand men have already been circumcised, out of a target of over 20 million.

But the survey also makes the rather dubious claim that female partners of recently circumcised men found sex more enjoyable. I'm sure I have heard that claim before and I wonder if participants knew that circumcised men are more likely to transmit HIV to women. Many people seem to forget that they will still need to use condoms after circumcision, although promoters of the operation are often so intent on pushing the program they pay a lot less attention to condom use and 'safer' sex practices than they used to.

The survey finds that half of the men and three quarters of the women see HIV as less of a threat and that condoms are less necessary after circumcision. A fifth of women said they would be more likely to have more than one sex partner and nearly a third said they would be more likely to have sex without a condom. The authors of the study say there is a need to involved female partners, but that is hardly the only need. Many of the people being circumcised, according to the (not particularly impartial) reports the media like to brandish, are young, single and not yet sexually active. What the study demonstrates is that some people are seriously misinformed by the HIV industry hype around circumcision. If the proponents had done a bit of research earlier, or listened to some of the critics, they would long ago have seen the need for this kind of survey.

According to someone involved in the massive circumcision program in Nyanza province in Western Kenya, many women already do accompany their partners when they go for pre-circumcision counselling. But then the counselling is clearly not very successful. People seem to think circumcision will 'protect' them, which is what they are told. But why should all those who don't bother using condoms now, or the ones who don't always use them, suddenly start using them just because they are circumcised? Why would they even go for the operation if they will still have to use condoms? Wouldn't it be better just to use condoms? Condoms give the highest level of protection known. And while those who currently use condoms may opt for the operation, they shouldn't be at high risk of being infected with HIV.

If people in Nyanza, who are closest and most exposed to the mass male circumcision program are so misinformed about circumcision, what about the 85% of Kenyan men who are already circumcised? Will they think there is any need for them to use condoms? How about their partners, will they know that circumcision only gives partial 'protection' (at best) and that the optimistic figures bandied about are from carefully controlled trials? The conditions found in such trials will not be found in the real world (which seems to be OK for some researchers and for the HIV industry). Those going for the operation really don't know what the outcome will be for them or for their partners and their partners seem to know even less.

Mass male circumcision programs are something of a black box intervention because it is not yet known if they work, and if they do, how they might work. A lot of less well publicized research suggests that the programs will not work, and some show that they could increase HIV transmission. The figures purporting to show that the operation is cost-effective are based on assumed data, as are the projections of how many infections would be averted if all uncircumcised men received the operation.

Incidentally, the modellers who give us such confident projections about the benefits of circumcision have also come up with the claim that, even if a lot of recently circumcised men face an elevated risk of HIV transmission through resuming sexual intercourse too soon after the operation (from female to male if the man is negative, but also from male to female if the man is positive), the net effect of mass male circumcision programs is beneficial. But the net benefits are highly questionable and to accept them, you would need to buy into the whole HIV industry orthodoxy about HIV almost always being sexually transmitted in African countries. Either way, even the potential gains claimed in this paper may not be realized.

[For more about circumcision related risks for males and females, see the Don't Get Stuck With HIV site and blog.]