IAC Panel on Male Circumcision Ignores Social Realities and Ramifications


I
spent September through January this past year studying and living on
the coast of Kenya. As I began to learn about the country’s political
and social history, I was surprised to learn just how tied in circumcision
is to Kenyan life. Tensions between the major ethnic groups have often
been symbolized by different initiation rites. For example, while the
politically powerful and largest group, the Kikuyu, traditionally circumcise
young men (as well as women) during initiation into adulthood, the second
largest group, and often political rival, the Luo, do not. Discussions
revealing ethnic and political tensions will often mention this difference
as a symbol, and I heard multiple references to Luo as children or as
dirty during my time there.

This
is why, when the evidence for circumcision as a mode of preventing HIV
infections in men is brought up, I am extremely concerned over how it
would play out in a political and social context such as the one that
exists in Kenya. I eagerly awaited discussion on this topic at the International
AIDS Conference, and today was my first opportunity to attend a session.
"Male Circumcision: Addressing Implementation Challenges and Demonstrating
Impact" consisted of a series of presentations highlighting research
on the implementation of male circumcision as a way to prevent HIV and
AIDS. It was disappointing, although I take some of the blame for it
not living up to my expectations. While I was looking for answers around
social implications, this session focused mostly on the science and
individual level results.

Even
so, I was bothered by several parts of this presentation. First, I am
concerned by the seeming promotion of circumcision instead of condoms.
On further questioning, all the panelists stressed that male circumcision
should be part of a comprehensive strategy that includes education,
access to condoms, and counseling. However, in several off-hand remarks,
and in the tone of the presentations, I sensed an attitude towards male
circumcision as if it was the best thing to happen to the HIV/AIDS activist
community since sliced bread. Don’t get me wrong, the science is exciting.
With studies suggesting that circumcised men are 50-60% less likely
to get HIV, I would be shouting from the rooftops if I were a scientist.
But male circumcision programs will not deal with abstract groups of
potential HIV carriers, they will deal with human beings living in complex
social realities.

This
is why the panelists’ lack of attention to the social realities that
make male circumcision so complex annoyed me. In fact, I made a point
of asking a question regarding the role of social realities in designing
research and policy, and got basically no answers. The epidemiologists
on the panel squirmed in their seats, and later one excused this omission
by saying they did not focus on the social aspects – that was for
someone else to do. This divide between the sociological and epidemiological
aspects of HIV and AIDS only hinders efforts to find a comprehensive
solution, and distorts the research evidence that is found. One presenter
highlighted the success of programs in areas of Kenya to incorporate
HIV/AIDS education and priorities into traditional initiation ceremonies
(that included circumcision). However, because it was with a population
that already circumcised its adolescent males, I was skeptical of its
success.

A
couple of the presenters replied that the results of their studies debunked
myths that certain groups would be resistant to male circumcision.
When I went up to the presenter who had shared his results from Kenya,
however, he acknowledged the need for sensitivity towards political
and social realities in the implementation of male circumcision programs
and the importance of ensuring that circumcision is a choice for men,
instead of a necessity. He also acknowledged the political realities.
I was happy to hear that this was not being completely ignored, but
disappointed that recognition of societal issues was an afterthought,
rather than a focus of the panel.

Another
omission by the panelists was that of the role of male circumcision
and how this affects women. The panelists all noted possible biological
benefits for women. When asked about women, a couple of the presenters
mentioned that partners of the subjects of their study often approved
of the circumcision for personal reasons. Frankly, I found these answers
insulting. You are asked about the role of women and all you can come
up with are that they really like how the circumcised penis feels in
bed? What about the fact that male circumcision requires men to take
on a burden, while male resistance to condom use already shows us that
overcoming burdens is not always a realistic option? What about women
as emotional and intellectual partners and loved ones of men, not just
sexual partners?

Finally,
one study, on male sexual pleasure and performance before and after
circumcision, underscored this preoccupation with the sexual and physical
over other aspects that influence the decision to be circumcised. I
was confused as to why this study was important or relevant at all,
since I am pretty certain that male circumcision has been around for
centuries and Jews, Muslims, and other groups that are all traditionally
circumcised seem to be able to function sexually just fine, as do groups
that don’t traditionally circumcise. When the findings showed little
quantitative difference, this just confirmed the ridiculousness of the
study to me.

Male
circumcision can be an important tool in the fight against HIV and AIDS,
but the panel I attended today only confirmed my fears over the way
it will be used. There is another one on Thursday that I hope will address
the complex social issues instead of the unenlightening and superficial
ones.

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  • invalid-0

    The so called HIV researchers pusing circumcision are in fact just circumcision fans that are pushing circumcison. There is no doubt that one aspect of all of this is to try to increase RIC in the US. You see they are thinking about the social implications and on a worlwiide scale.

    Somehow in all of this, it is being missed that they are asking men to cut off a part of their bodies. This happens to be the part with thousands of nerve endings and it is the most sensitive tissue of the male genitals. So what kind of plan is this where the men don’t want to wear condoms so you chop off there most sensitive part and then say it will slwo HIV down just as long as most of them wear condoms?

    The original data of the Africa circumcison studies were flawed as to procedure, not double blind and done by circ proponents. They gave special condom advice to the cut and they lost more participants than got HIV. How about if the bulk of the lost that got HIV were cut (and pissed off that the mutuilation did not help). They now claim that the follow up data shows more than 60% risk change (more than 1.8% change in chance of getting HIV). However, there is no control group!

    The sexual satisfaction stuff is so out there. The study actually showed that the first time thay asked the men, they noted some problems. The second time everything was great with their penis (cut and natural). So the study participants learn to lie about their member? What useful information comes from asking a man if his penis is good at sex? I just don’t buy that function and satisfaction is improved. What about the ED that will show up as they reach 50? And my only disagreement with the bloger is “been around for centuries and Jews, Muslims, and other groups that are all traditionally circumcised seem to be able to function sexually just fine, as do groups that don’t traditionally circumcise.” That is not true. It is true that cut men can ejaculate, but if you don’t have those nerve endings, you are missing quite a bit.

    Finally, if Male circumcision can be an important tool in the fight against HIV why not female circumcison? Same cells removed same claims by those cut that the sex is enhanced or not so bad. Why the facination with cutting men. Yes female circ probably offers whatever protection male cutting does. It also does not affect condom use and females have a bit higher HIV rate.

  • http://TLCTugger.com invalid-0

    ^^ groups that are all traditionally circumcised seem to be able to function sexually just fine ^^
    – – – – -
    You’re tellng me it’s ok to cut off part of my body without asking me and I’m not to complain; I’m just fine? Somehow 94% of world’s population of women is protected from genital cutting by law (if not in practice), yet men are just supposed to not gripe that

    over half the sensual pleasure-receptive nerve endings are in the amputated foreskin.

    People with one eye poked out can still see where they’re going “just fine” too, but there is absolutely no moral justification for perpetuating non-consentual genital cutting, especially since you’re talking about an STD and infants don’t have sex.

    “Traditional” circumcision before adulthood is an evil that must be opposed. Whether people cut before they ever had a chance to know the differeence acknowledge it or not, foreskin feels REALLY good.

  • invalid-0

    “…circumcison [sp] studies were flawed as to procedure, not double blind….”

    How can you conduct a double blind circumcision experiment? I’m fairly certain that the circumcised men would be aware of their “treatment!”

    “How about if the bulk of the lost that got HIV were cut (and pissed off that the mutuilation [sp] did not help)[?]”

    Any RCT includes statistical modeling to account for dropouts. If this were a valid argument, NO data from ANY randomized controlled trial could be trusted. Clearly this isn’t he case. To argue that most of the dropouts were HIV+ indicates more effort to confirm one’s own biases than learn the truth.

    “However, there is no control group!”

    The uncircumcised men were the control group.

    “It is true that cut men can ejaculate, but if you don’t have those nerve endings, you are missing quite a bit.”

    Up until recently, the science regarding the sexual effects of circumcision was far from settled. However, the most comprehensive and well-designed experiment to date demonstrated that 98.5% of 4,500 men who were circumcised as adults, and who had already experienced sex, were satisfied with their sex life following the procedure.[1] This is statistically identical to the uncircumcised control group (98.4% were satisfied). Monofilament touch-test mapping suggests that the foreskin contains the most sensitive areas of the penis,[2] but removal of this tissue simply doesn’t seem to cause a less fulfilling sexual experience. Sensitivity and pleasure are NOT the same! There’s no reason to feel sorry for your circumcised friends, I’m sure they’re fine.

    “Yes female circ probably offers whatever protection male cutting does.”

    NO IT DOESN’T! The WHO fact sheet on FGM notes that it has “… no health benefits for girls and women.” Furthermore, the harm done by FGM so dramatically outweighs that of circumcision that this comparison is ludicrous.

    1. Kigozi, G., Watya, S., Polis, C.B., et al. 2008. The Effect of Male Circumcision on Sexual Satisfaction and Function, Results from a Randomized Trial of Male Circumcision for Human Immunodeficiency Virus Prevention, Rakai, Uganda. BJU International. 101(1):65-70.

    2. Sorrells, M.L., et al. 2007. Fine-touch pressure thresholds in the adult penis. BMJ. 99(4):864-869.

  • invalid-0

    Poking out an eye provides no medical benefit; circumcision clearly does.

  • invalid-0

    Sorry, the monofilament touch-test experiments were published in BJU International, not BMJ.

  • invalid-0

    Poking an eye out would certainly prevent eye infections. Circumcision seems a drastic and outrageous move to reduce infection rates. However if an adult male wishes to be circumcised, that’s his right and I would have no problem with it. My husband isn’t circumcised and I must say that I much prefer him just the way he is.

  • invalid-0

    How can you conduct a double blind circumcision experiment? I’m fairly certain that the circumcised men would be aware of their “treatment!”

    You could probably include a different type of surgical procedure as a control. It wouldn’t be blinded, but at least there’d be some sort of comparison group.

    That being said, I think the choice to be circumcized should be just that: a choice.

  • http://www.anthonybraden.com invalid-0

    Some of the commentators here seem to be taking a very aggressive and activist stance against male circumcision, and I don’t understand why.

    This is a religious (cultural, if you prefer) and/or medical decision, not a political one.