Global: Male Circumcision and HIV: A Broader analysis is required

02.03.2007

There have been a large number of studies dating back to the late eighties that have looked at the correlation between male circumcision – or lack thereof – and the risk of contracting HIV. The evidence from these studies shows a relatively high reduction in the risk of infection as a result of circumcision. As is the norm, these studies have to different degrees accounted for possible confounding variables, but do not pretend to delve into the broader socio-cultural issues that attend the problem. The studies have been predominantly medical in nature, and there is still a dearth of sociological research on the subject.

In an insightful article published in the Cape Times, Professor Jonny Myers alludes to the element of cultural hegemony underlying the almost casual way in which male circumcision is being mooted. He points to the ease with which groups who have traditionally circumcised males advocate for its cooptation into the AIDS fighting arsenal. Some of the medical evidence on the benefits of circumcision has been refuted, or at least reasonably challenged over in the last few years. Among these was reduced risk of penile cancer, urinary tract infections, sexually transmitted infections, and better hygiene. Today, medical reasons for routine male circumcision are not widely accepted.

To be clear, any intervention that helps the fight against the spread of AIDS merits utmost consideration. However, the more difficult to implement the intervention, the greater the efficacy standard required for it to pass muster.

One still gets the sense of a widely held misconception that those communities that do not practise male circumcision simply ‘neglect’ to do so. In fact, one could argue that not practising male circumcision is characterised by the same level of conviction as practising it. Some communities that do not circumcise males have other rites of passage that serve the same purpose. Introducing male circumcision in populations that do not practise it will require a “de-culturization” of the procedure.

A major obstacle that has characterised the fight against AIDS has been how to change deeply entrenched behaviour. How much more difficult will this be if the behaviour in deeply entrenched in cultural practises. In Western Kenya, for example, where certain communities practise ‘wife inheritance’ it has taken a serious re-orientation of cultural beliefs to make any headway. Furthermore, this has only been successful because sexual relations as a key factor in the spread of the disease are but a peripheral and dispensable aspect of the practise.

Another key consideration is how the underlying assumption that circumcision provides a measure of protection can lead to increased risky sexual behaviour. It is debatable whether the fight against the pandemic has achieved the levels of knowledge and attitudes requisite to reasonable counter this. The most successful communication campaigns have sought to minimize this risk by combining messages, for example, condom-use with abstinence and faithfulness.

Finally, this unfolding debate provides yet another unwelcome detraction from the fact that there still remains a dire need to expand basic health services to the majority who do not have it. This is arguably the biggest factor in the fight against HIV/AIDS. Yet it seems like we are about to ask for these over-stretched and ill-equipped services to add a surgical procedure to their list!

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Global: Male Circumcision and HIV: A Broader analysis is required