In their strategy to promote infant circumcision and their latest propaganda attempt the Twitter Procircs are quoting from a Procirc Website which makes the dangerous claim that Circumcision will help create a generation free of HIV AIDS. This is a very dangerous public health statement because WE already have many African Nations where the circumcised populations have higher HIV rates than Non-Circumcised, and the USA which has the highest adult circumcision rates in the developed world, with also the highest HIV infections in the developed world. In fact reported in press there has been a rise in HIV infections following circumcision campaigns reports here: http://www.netnewspublisher.com/hiv-infections-rising-amongst-circumcised-men-in-botswana/
http://www.gabzfm.com/circumcised-men-still-run-risk-hiv-infection To say circumcision will create a HIV free generation is just irresponsible propaganda!!!!!!!
The First valid criticism of this pro-circumcision propaganda is that Routine Infant Circumcision violates the human rights of the infant. I argue and many support me, that Human Rights outweigh any possible health benefits. Consider female circumcision, there are 3 reported studies that show female circumcision lowers HIV infections in circumcised women. This has never been pursued because the human rights of females are considered more imortant than any possible health benefit. To remove a functional sex organ from a being that cannot consent is a human rights violation, for either sex male or female. The first point to make then is that even if there are health benefits (& this is hotly contested) that human rights take precedence over health benefits, and must not be violated in the pursuit of health benefits.
The Second refutation is the lack of medical consensus on the health benefits of circumcision in particular for infants or children. No Medical organisation in the world recommends infant circumcision, and since the wide publicity of the African Trials, medical organisations from Australia & The Netherlands have released explicit medical statements stating infant circumcision is niether required nor recommended. This is because there is zero evidence that infants require circumcision for health & well-being, even the AAP acknowldege this. The only potential benefit which has any relevance to an infant is UTI, which the medical literature shows is easily treatable with antibiotics and of low incidence in male infants (Female's have much higher UTI's and antibiotics is considered the best treatment & not surgery.) In fact the complications of infant circumcision (2 to 3 in 100) far outweigh any protective effect for a male infant UTI (1 in 100) making more children sick from circumcision than a UTI, not to mention losses of function, pain, and human rights violations. Outside of the USA, the foreskin is recognised as a normal functional sex organ of the male penis, and worth preserving for the male to enjoy when sexually active. Health outcome data shows that in developed countries, the nations with best health outcomes, including lowest HIV/STI's are all from Non-Circumcision cultures. There is a large body of evidence that shows intact men, live long healthy lives with foreskins intact. In Finland where these statistics are gathered the rate of circumcision for an adult requiring a medical circumcision are 1 in 16700. Most medical organisations believe that conservative medical practice, health education, safe sex behaviour, and genital hygeine, give far superior health benefits, in comparison to circumcision, without any losses of function or human rights violations. The point here is that the evidence of health benefits for circumcision is complex, somewhat contradictory, disputed, and it is strongly argued that other means can achieve superior health benefits without resort to circumcision surgery.
The Third Refutation is Relevance. In particular, that the data from the African RCT HIV Studies have zero relevance to infant children. The African research was conducted on paid adult male volunteers, who were part of Trials which went for between 18 to 24 months. And while these African studies have been widely criticised, if we put all our criticism of the African research aside, and take the results on face value, that male circumcision reduces the risk of HIV infections from females to males, over an 18 to 24 month period. The following can be said about relevance:
- The majority of issues where it is claimed circumcision has health benefits are for adolescent and adult males, and of these conditions most can be treated or prevented by other means such as barrier method use of condoms for STI/HIV, gential hygeine, HPV vaccine, and steroid creams or preputioplasty for tight foreskins. These do not apply to infants and using African Research on adults does not justify circumcision of infants.
- The research used to justify infant circumcision comes from Africa. Africa is a continent with Extreme poverty and disease, and has high prevalence of HIV & when sexually transmitted it is predominantly via hetero-sexual transmission, whereas in western nations, HIV is a low prevalence disease, and when sexually transmitted is predominantly via homosexual transmission, or a disease spread in the injecting drug user community from needle sharing. The small protective effect of circumcision if there is one, is only for heterosexual transmission protecting males from female infections. Condoms are more effective, and protect both partners not just one. Females are not protected from male circumcision, with one trial showing women were infected at higher rates by circumcised men. Circumcision is not protective for MSM, not protective for IV Drug users, nor for contaminated blood. The relevance of the studies only applies to consenting heterosexual adult male volunteers in high prevalence settings.
- Research outcome data and recommendations must logically follow from each other, therefore any recommendations can only apply to heterosexual adult male volunteers in high prevalence settings. These outcomes cannot be applied to infants, nor in low prevalence settings, and it is impossible to know whether an infant is heterosexual?
- The outcome data has no relevance to newborn infants or children.
- Infants do not have sex.
- Infants have not chosen their sexual orientaton or lifestyles.
- Infants may grow into men that want to be in faithful monogamous relationships.
- Most Infants born in low prevalence communities will never have exposure to a HIV infected sexual partner in their entire lives.
- Infants may grow into men that want to have an intact penis.
- Infants may grow into men that choose to practice safe sex, and use condoms consistently.
- Infants may grow into men, that choose to never travel to Africa, and to never have sex with HIV African infected women, or African sex workers.
- Infants may grow into men that choose celibacy for themselves.
- Infants may grow to be Gay Men.
- A man who is informed about sex, about safe sex, about condoms, and about circumcision, may make a choice for himself on any of these matters for himself, and it is not necessary that he be circumcised as a baby.
- Circumcision is not required in infancy and best left to the man to decide for himself when he understands the sorts of choices he wants to make for himself.
- Circumcision does not prevent HIV/STI's.
- Circumcision is not a barrier method, the circumcised penis is made of skin, and has vulnerable areas like the meatus & circumcision scar, and circumcised men get HIV/STI's and have to wear condoms.
- So if we give every benefit of the doubt to Pro-Circumcison advocacy, all they can ethically justify is that adult men, particularly those in high prevalence settings, be informed of circumcision's potential health benefits, along with the criticisms and harms of circumcision and doubts about its efficacy, and that if circumcised he must still use a condom, and it be left to adult men to make an informed consent decision for themselves.