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.