ABC, not circumcision, gives best defence against HIV

By David J. Llewellyn

Dr. Myers Lugemwa is to be congratulated on his insightful article on the attempt to circumcise Uganda by US doctors. It is so obvious that Abstinence, Being Faithful and Condoms (ABC) are the only rational defense against the HIV virus, that it is hard to believe that many in the international health community have bought into the ridiculous "circumcise to prevent HIV" theory.

The best way to prevent sexually-transmitted HIV and all other venereal diseases is by ABC. It is that simple.

It appears that there may be more to the push for circumcision than merely the improvement of public health. Some of those pushing this strategy have their academic reputations and careers on the line. Others have familial traditions that emphasise circumcision. For example, Daniel Halperin, one of the foremost proponents of the "circumcise to prevent HIV" movement, admitted in a newspaper article years ago that his grandfather had been a part-time Jewish ritual circumciser. He has also been quoted as saying that women like circumcised men and that sex is better if you are circumcised — two very subjective statements with which most uncircumcised men and their wives would disagree. Others may feel the need to validate their own circumcised status or academic theories by encouraging others to be circumcised.

Two of the primary authors of the recent randomised controlled trials recently have collaborated with long-time proponents of circumcision on the formulation of a pamphlet encouraging women worldwide to push their husbands to be circumcised and to circumcise their sons. One of those proponents, a circumcised middle-aged Australian, the primary author of the pamphlet, has written that circumcision is "an imperative" for the 21st Century!

As the Trojans learned, one should always "beware of Greeks bearing gifts," even if those "Greeks" are Americans. Ugandans should know that one of the early proponents of medicalised circumcision in the US, Peter Remondino, M.D., in the late 19th Century advocated circumcising all black Americans to prevent what he called "the Negro rape crisis."

Modern day Ugandans may wish to consider whether or not the US push to circumcise them has any similar patronising, racist overtones or overtones of colonialism.

We know that the foreskin is an integral part of the penis. A recent study has shown that it is the most sensitive part of the penis. Earlier unrefuted studies proved that it contains most of the fine touch nerve receptors in the penis. It may well mediate the ejaculatory reflex.

It makes intercourse easier and more enjoyable for both the man and the woman. No rational man would give up his foreskin if he realised the sexual consequences. It is immoral and unethical to remove normal, sexually-valuable tissue from an infant or child, male or female, without present medical necessity. Ugandans should think twice about what they would be losing before agreeing to circumcision for themselves or their sons.

That Americans may still circumcise the majority of their sons is not an example to emulate.

As Dr. Lugemwa points out, circumcision began in the US in a vain attempt to prevent masturbation. Of course, it did not work. But Americans became invested with their circumcised penises and it has proven challenging to change their minds. Nevertheless, Ugandans should know that the rate of circumcision in the US has been dropping slowly for the last 30 years as the public has learned of the value of the foreskin. In California and some other western states, the circumcision rate for newborn boys is below 35%.

Ugandans should also know that circumcision did not prevent HIV from wrecking havoc in the US. The US has a much higher rate of HIV infection and a much higher rate of circumcision than does Europe. This puts the lie to the hypothesis that circumcision "prevents" HIV. It is not a "vaccine," although its proponents would like Ugandans to believe that it is. One might reasonably wonder what the real motive is behind those who would try to sell a mutilating surgery to others with such hyperbole.

Ugandans wanting more information about the controversy surrounding male circumcision might wish to consult www.cirp.org or www.doctorsopposingcircumcision.org.

The writer is an attorney at Law Atlanta, Georgia, US