Circumcision campaign a disastrous policy

News  Vancouver Sun (Vancouver, B.C.). Tuesday, 22 August 2006.

Paul Tinari

Re: Circumcision could cut AIDS toll, Aug. 16

Trumpeting as a headline former U.S. president Bill Clinton's pro-circumcision statements made at the International Conference on AIDS is an insult to the intelligence of your readers.

Why is the opinion of a politician with no medical or scientific background given so much weight?

The fact is that nearly universal (non-consensual) circumcision has already been tried as a means of providing blanket protection to males from AIDS and other sexually transmitted diseases. The result was that the United States, with the highest rate of circumcision in the western world at 90 per cent, also experienced the highest rate of AIDS and other STD infections.

The lowest rates for all of these infections remains the Scandinavian nations – places where circumcision is virtually unknown (less than one per cent.) Today the Middle East is one of the areas of the globe where HIV infections are increasing rapidly. This is also an area where circumcision of both men (and many women) is essentially universal. It can be concluded that telling men that circumcision protects them against HIV infection is a disastrous epidemiological policy.

The fact is that the research so ignorantly quoted by the former politician is virtually useless because of the enormous number of confounding factors in the studies.

For example, the research did not address such important scientific questions such as: What is the rate of medical complications for circumcisions performed in the unhygienic conditions typical of Africa? Are the risks associated with circumcision greater than the risks associated with HIV infection? The cells of the labia are also susceptible to HIV infection, so what role does female circumcision play in reducing the rate of HIV infection? Is the well-known African propensity towards dry intercourse a factor in increasing the risk of HIV infection? What role do particular African cultural habits play in the rate of HIV infection?

What could be the explanation for the endless obsession of many in the West for concentrating on non-consensual male circumcision as a central pillar in their anti-AIDS strategy in Africa?

A similar campaign to improve the health of Africans was begun in the 1960s by multinationals intent with replacing natural breast feeding with profitable infant formula. The result was an unmitigated disaster.

Similarly, it is certain that this poorly considered circumcision campaign would be rife with unintended consequences that would create far more suffering than by simply following a policy of not doing anything at all.

Dr. Paul Tinari is a research epidemiologist who lives in Coquitlam.

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