US Cultural Imperialism in PNG and Male Circumcision

29 Jul

The somewhat bizarre claims of male circumcision enthusiasts include the belief that it reduces HIV transmission from females to males. These claims are often backed up by three rather unconvincing ‘field trials’, where HIV transmission was very high, among those who were circumcised and among those who were not, but was slightly higher among those who were in the control group (those who remained uncircumcised).

Most importantly, in the three field trials it was not shown that those infected with HIV were infected through heterosexual sex. They could have been infected through unsafe healthcare, such as the operation itself, through any skin-piercing cosmetic procedure, or through receptive anal sex, all modes of transmission that circumcision is not even claimed to protect against.

Across high HIV prevalence countries, HIV prevalence is sometimes higher among circumcised men and sometimes higher among uncircumcised men. Yet US funded mass male circumcision programs are being aggressively promoted in developing countries, regardless of whether HIV prevalence is higher or lower among circumcised men.

But what about countries where HIV prevalence is low nationally, such as Papua New Guinea? Even this article, which rants approvingly about mass male circumcision, cites national HIV prevalence as standing at about 0.8%. That’s lower than it is in many American cities. How many transmissions will be averted by circumcising all men (or all the men who ‘consent’ to having this operation)?

To put the question another way, how many men will have to be circumcised for each HIV infection averted? The figure must be hundreds, if there is any net benefit at all.

If each operation costs between $60 (an impossibly low figure claimed by enthusiasts) and around $500 (an estimate for how much each circumcision actually cost in Swaziland’s aborted mass male circumcision program), the cost of each infection averted will be very high; especially in a country that has many health and development problems, of which HIV transmission is nowhere near the most pressing.

HIV transmission is not, in any useful sense, a matter of genital hygiene. ‘Vaginal douching’ increases transmission. Even some forms of penile washing have been shown to increase HIV transmission. Appropriate penile hygiene can reduce transmission, but immediate washing after sex is not appropriate. However, with appropriate hygiene, circumcision status is irrelevant.

The belief that it is in some sense easier to wash a penis that is circumcised is an instance of cultural imperialism. The majority of men in the world are not circumcised, and many of them would probably agree that they have no problem keeping their penis clean. Those who have problems should seek help. But a personal hygiene problem (or preference about circumcision status) should not be used as an argument for mass male circumcision programs that claim to reduce HIV transmission.

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