Male circumcision: To cut or not to cut?

One of the most popular sessions at the International Aids Conference was probably the session on male circumcision (MC). The session room was so full that many of us had to go into the overflow room and watch the panel discussion on large TV screens. I was very suprised on several accounts. For one, male circumcision is very common in Ghana where boys are circumcised at a very young age, usually in hospital whilst still babies and secondly I had no idea male circumcision was being touted as potential prevention to HIV. My curiousity on Male Circumcision and HIV/AIDS had initially been aroused during the satellite session held by the International AIDS Womens Caucus when some women expressed dissatisfaction with the promotion of Male Circumcision so I thought I would go along to the session to find out some more. As usual, I will outline what the key messages by the different speakers were.

Alvaro Bermego from the UK gave an overview of the main issues including what is known, what is unknown and some challenges where male circumcision is concerned.

What we know:

* Prevalence of HIV in African is lower in countries where a prevalence of MC is greater than 80%.

* Risk of acquiring HIV is higher immediately post MC.

* Promotion of MC has started in Southern African communities with length waiting lists of people wanting MC.

* No direct protection for women from MC

What we don't know:

* Impact of large scale roll out of MC on HIV prevalence

* Whether increased risky behaviour may negate benefits of MC

* As surgery is non-reversible could it affect novel techniques in future that may be developed?

Challenges:

* Safety - adult MC can cause psychological and medical problems

* Will circumcised men be more likely to blame women if they become HIV positive?

* Many people believe it will cause a reduction in sexual sensation - although Alvaro has not seen any conclusive results to support this

* Interests/Resources behind MC is being pushed as a scientific medical bullet because the desired results haven't been attained from microbicides.

The second speaker Mogomotsi Supreme Mafalapitsai from South African spoke about the need for gender analysis and clear communication plans to disseminate information on MC as well as the need for MC to be integrated into existing preventation systems. Mafalapitsai also pointed out some of the cultural/religious aspects of MC including the belief in some Southern African cultures that circumcised men are weak. Some implication for MC affecting women oulined by Mafalapitsai include:

* Women being blamed and seen as carriers of HIV
* Resumption of sex prior to healing puts women at increased risk of HIV
* Women have the burden of caring for circumcised men
* HIV positive men are discriminated against as unable to understake MC due to compromised immune systems

A feminist perspective on MC was provided by Marge Berer who emphasised that partners of men have a right to protection and that MC is the only preventative method that does not protect men and women. Some of the arguments made by Berer included:

* MC as a preventative method would only work if there is a 75% prevalence rate which can take years to achieve. (In the Q&A session, a representative from UNAIDS Kate {didn't catch her surname)said that the prevalence rate could be as low as 30%)

* MC is useless for HIV positive men and untested men whether circumcised or not

* Are men going to be circumcised indiscriminately?

* MC is only 50-60% effective, less suitable options cuch as MC are being identified as there have been so few solutions. Imagine a condom that is 40% ineffective?

* Who was consulted before MC programmes began? Were HIV positive people and women consulted?

Berer went on to ouline the following proposals about involving women in MC:

* Women need to be involved as partners including information for couples counselling

* Women need to be consulted on policy levels with more funding targeted towards grassroots organisations and women.

Berer ended her session by saying

' The snip alone won't do it, there must be a link between the penis and the brains' whilst calling for the Pleasure Project to open an office in every country.

I have just googled the Pleasure Project. Let me know your thoughts on male circumcision, the pleasure project and female condoms (my latest acquisition from AIDS 2008)

Nana Sekyiamah
Programme Officer
Fundraising & Communications