Mass circumcision — let’s put down blades for more research


I first heard about Aids in 1985 when my primary school teacher read a newspaper article during our social studies class.
Part of the article read: “…scientists and medical doctors are struggling to find a cure for an incurable viral disease which can wipe away the whole world in 28 years…”
We were scared as we didn’t want to die young.
It is 25 years since that day and the fears have dissipated with the passage of time, but UNAids reminds us that over 25 million people have died of Aids-related illness since 2007. There are another 2, 7 million new infections in 2008 alone, adding up to 33 million people living with the virus globally, with 70% of these being in sub-Saharan Africa.
Aids prevention has revolved over these 25 years from the frightening “Aids kills” campaigns of the late 80s to the more rational “ABC” campaign (Abstinence, Be faithful, use a Condom if A and B fail). The ABC proved to be successful before it was decimated by activists who thought abstinence denied people of their human right to sex.
The promotion of male circumcision by World Health Organisation (WHO) and UNAids as one of the methods to reduce HIV transmission scares me.
Even before any consultations are done, blades are already sharpened as several countries, including Zimbabwe, have launched mass circumcision programmes backed by millions of dollars from the West.
But the Malawi government has refused to be cowed and are demanding more clinical evidence before rolling it out. In other countries, men are expected to queue up in masses, as we did during cash queues, and go under the knife.
The flip-flopping by WHO and UNAids raises a number of questions considering that a few years ago circumcision, as a traditional and religious practice, was blamed for spreading HIV as it was believed the use of the same razor blade on many people could spread the virus.
It was also believed to increase vulnerability as the missing foreskin reduces lubrication, leading to bruising and bleeding.
Hundreds of botched circumcisions have resulted in deaths.
All of a sudden there is “compelling evidence” from studies in Uganda, suggesting that male circumcision reduces HIV infection by up to 60% as it “eliminates or changes bacterial communities of the male organ, which are blamed for inflammation and a number of infections affecting both men and women”.
The elimination of the foreskin through circumcision is thought to destroy bacterial ecosystem thereby reducing HIV risk in men.
They also argue that circumcision is hygienic without giving more evidence though we know that eyes without eyelids or gums without lips would not be cleaner; neither would a male organ without its foreskin.
This campaign does not offer enough information on who should be circumcised, at what age and what are the likely negative effects on young boys, leaving many parents in dilemma on whether they should get their sons circumcised.
What will happen if new evidence suggests otherwise. But would it not be more practical, less risky and more ethical, to encourage all men to use protection?
Historically, circumcision has been associated with curative myths on a number of diseases including sexually transmitted diseases (STDs).
Dr Paul M Fleiss, a clinical professor of paediatrics at the University of Southern California Medical Centre tells us that in the West, circumcision was used as punishment for young men for masturbating, which technically means that mass circumcision will make masturbation impossible as another safer sex method thereby pushing young men to look for partners.
The foreskin is an essential part of male body. Despite all the brouhaha about circumcision destroying the bacteria ecosystem, Fleiss argues that the foreskin, like that under-surface of the eyelids, the lips of our mouth or the inside of the cheek, the under-surface of the foreskin produces protective antibodies which fight against infection.
In addition to reducing the size by 25%, denuding and desensitising, circumcision leaves the urinary tract vulnerable to bacterial and viral pathogens.
Without the protection of the foreskin, the male organ easily dries up, making it susceptible to abrasion, irritation, cracking and bleeding resulting in a person being more vulnerable to HIV infection.
Studies in Malawi have shown that HIV prevalence is high in the southern region where circumcision is culturally more prominent.
Fleiss added that the US has the highest percentage of sexually active circumcised males in the Western world and the highest rates of sexually transmitted diseases, including Aids adding that the circumcised men are at a greater risk for bacterial and viral STDs, especially gonorrhoea and several others.
More local research is needed before introducing mass circumcision even as one of the HIV prevention method.
Recent figures show a decline in HIV prevalence from 16 % in 2007 to 13% as a result of behaviour change — not circumcision.
The Malawi case mentioned above is another clear example. Zambia and South Africa are showing signs of slowing down before mass circumcision.
All the same, did you know that foreskins are in great demand from a number of commercial enterprises and the marketing of baby foreskins is a multi-million-dollar-a-year industry? Pharmaceutical and cosmetic companies use human foreskins as research material and they use human foreskins as the raw materials.
But I am not going to be the sales person.

l Tapiwa Gomo is a development consultant based in Pretoria, South Africa