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Wednesday, August 01, 2007

if in doubt, chop it off

I've become curious recently about the increasingly loud calls, from the global HIV-AIDS industry, for mass circumcision of men and boys in Africa. Supposedly this will significantly lower rates of HIV transmission. When I think about it, and dig around the topic, here's what comes up:

1) If male circumcision really is a solution to HIV transmission, why is it being pushed primarily on Africa? I haven't heard / seen reports of HIV doctors / researchers calling for mass male circumcision in Asia, Europe or North America.

2) Given the growing tide of activism and medical opinion AGAINST male circumcision in America, who is really pushing this agenda on Africa? And why? Is this a way of shifting the multimillion dollar circumcision industry(equipment sales, supply of foreskins for medical research, etc.) to a new - and relatively unregulated - market? Analogous to the tobacco industry honing in on Africa to offset shrinking markets in the global north? Who stands to make money out of it?

3) What's disturbingly absent in all the calls for mass male circumcision is the impact on African women. There's plenty of evidence that male circumcision actually increases the risk of male-to-female HIV transmission (Doctors Opposing Circumcision).

4) Male circumcision is not a politically neutral topic in African countries. It's inextricably bound up with issues of ethnicity and power, both pre- and post-colonialism. A glaring example in Kenyan public life is the way politicians of a dominant ethnic group routinely deride their opponents of other tribes as "uncircumcised" - implying that they are still children, and hence not fit to govern.

It seems highly likely that mass male circumcision programs, promoted on a platform of international-donor-funded HIV-prevention, could and would be coopted for political oppression and social control. What comes to mind is Indira Gandhi's infamous male sterilisation programme in India, a few decades ago, imposed primarily on men from lower-income and lower-caste communities.

5) If we recognize, universally and without qualification, that genital mutilation of girls is an act of brutal violence, which inflicts lifelong trauma on the survivors, why isn't the genital mutilation of boys recognized as equally brutal and traumatic? The whole concept of preemptive surgery e.g. foreskin removal to prevent future HIV infection, mastectomies on healthy breasts to prevent the risk of breast cancer, is deeply suspect - both scientifically and morally.

We now know that similar medical orthodoxies of yesteryear e.g. routine tonsillectomies, removal of gall bladders, etc. served no purpose except to enrich the doctors who performed them. And often had serious adverse impact on the health of the patients they were extracted from. So when a global campaign is mounted for over half of Africa's population to have a healthy, functional part of their bodies removed, extremely painfully, it should at the very least, raise eyebrows and provoke questions.

Some further reading:

1) Well-referenced and current (March 2007) statement by Doctors Opposing Circumcision, that casts doubts on many of the studies correlating male circumcision to reduced HIV risk. Equally importantly, it sheds light on the ways in which male circumcision may actually increase risks of male-to-female HIV transmission, by reducing likelihood of condom use and increasing likelihood of vaginal abrasion from violent intercourse.

2) The Sexually Mutilated Child is an unabashedly activist site that makes a very potent case, wrapped in grief and rage, against male circumcision. It carries graphic images of newborn babies screaming with pain and terror while they're circumcised, testimonies from both victims and parents, and is a fount of information on the foreskin (which I have to confess, I knew little or nothing about before). It also offers anecdotal food for thought on how the US-driven culture of male circumcision may feed into the Western medical system's abuse of women - and fascinating links to the commercial market in foreskins, and who makes money out of male circumcision.


Anonymous jestercat said...

A friend of mine who works as a doula told me that she opposes circumcision because it is an unelected and unnecessary surgery on the body of a young baby - not unlike genital-modification surgery done on intersex babies. Circumcision is like branding an infant; done for the vanity and to accentuate the religious identity of adults, not out of consideration of the health (physical or emotional) of the child.

8/01/2007 4:31 PM  
Blogger shailja said...

Yup - couldn't agree more. And since the US medical system is unequivocally profit-driven, there's no way circumcision of male babies would be a routine procedure, covered by insurance, unless there's money being made out of it at every level of the supply chain.

8/02/2007 3:17 AM  

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