To cut or not to cut: Why has male circumcision become a dilemma?

Just as you begin to think that the dispute about including male circumcision as part of HIV/Aids prevention has ended, a sceptic “rocks the boat” and the debate appears to start all over again and; some people begin to wonder whether “to cut or not to cut”

When the proponents of safe male circumcision for HIV/Aids prevention present their arguments, you actually begin to think that male circumcision is the way to go. Their arguments are based on scientific evidence from research studies known as randomised clinical trials. They say that such trials are the “gold standard” when it comes to issues of research evidence and, they go on to cite studies that show that inclusion of safe male circumcision in the array of HIV/Aids prevention strategies will result in a reduction of HIV/Aids infection.

According to the male circumcision advocates, male circumcision is the most compelling evidence-based HIV/Aids prevention strategy to emerge since the results from mother-to-child HIV/Aids transmission clinical trials. They point out that although male circumcision does not provide absolute protection (reduces the risk of HIV infection by about 60 per cent), implemented as part of a prevention package that includes HIV counselling and testing, treatment of sexually transmitted infections and promotion of safe sex practices; there would be a reduction in HIV/Aids infection.

Medical guidelines circumcision can reduce the risk of urinary tract infections and cut the risk of penile cancer and sexually transmitted diseases. Photograph: David Levene

But, not everybody seems to be convinced. The sceptics contend that the randomised clinical trial that the proponents of safe male circumcision talk about are not only flawed and does not reflect the reality outside the study environment, but mixes up the issues of surgery and behaviour. They insist that safe male circumcision provides a false sense of protection that can lead to an increase in HIV/Aids infection.

They go on to cite examples of countries where male circumcision is widely practiced yet there is no evidence that HIV/Aids infection rates has dropped significantly. According to the sceptics, a risk reduction of 60 per cent means that a total of about 60 men have to be circumcised to avert just one HIV infection in places where HIV/Aids infection rates are high.

Sometimes, the debate just degenerates into “name-calling” with the pro-circumcision camp accusing the sceptics of being self appointed “quack scientists” who do not know what they are talking about. The sceptics also retort that the pro-circumcision advocates are just agents of “circumcised scientist and profiteers” using their financial power to force their beliefs and lucrative agenda on Africans.

Without consensus or “a cease-fire agreement” between the two camps, the pro-circumcision coalition has rolled-out safe male circumcision with the sceptics watching in awe. While the advocates for safe male circumcisions are encouraging men to go for the “snip”, the sceptics are also cautioning the men about the folly of removing their genital foreskin.

Amidst this confusing situation, male citizens of this country whose foreskin and behaviour has been at the centre of the dispute, are expected to decide on whether “to cut or not to cut” despite the fact that they seem to have been left out of the debate. Neither the pro-male circumcision camp nor the sceptics are brandishing minutes of meetings or even research finding about post-male circumcision sexual behaviour (that cover the socio-economic diversity in this country) to support their arguments.

The dispute about surgical removal of the male prepuce and HIV/Aids is most likely to continue for a while. Whether there will ever be consensus about including male circumcision in HIV/Aids prevention, only time will tell. As to how much damage the sceptics have done to the male circumcision drive, no one can ascertain at the moment. One thing that you can be sure of is that some years to come, attributing any increase or decrease in HIV/Aids infection rates to safe male circumcision will be controversial.

Mr. Onen is a Non-profit Management Consultant with Ascend-Consult. 
[email protected]

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