My sport is swimming and recently in Copenhagen, Denmark I went for a workout one day at a local pool. In the shower afterward, I noticed two things: one, how uninhibited male Danes are. No showers stalls or curtains here. Everyone from old to young and in between totally bare-assed in front of one another – unlike the USA, where many guys shower in their swim suits then wrap themselves in towels and wiggle into their underwear under the towel. Stupid, but that’s another issue.
But nudity is not the issue of this blog post. The second thing I noticed was of a more ‘scientific’ note, the Danes are virtually all uncircumcised.
This observation came two days after a New York Times front page article about the ‘epidemic’ of circumcision that is reported to be happening in sub-Saharan Africa. Thousands of adult men there are being urged to flock to clinics to get clipped since the WHO sponsored and reported a wide-spread study, surely costing millions, that revealed a significantly lower HIV infection rate among circumcised sexually active men (presumed straight).
What’s wrong with this picture – with the conclusion African medical and government leaders are jumping to?
The Danish HIV infection rate is minuscule, percentage wise, compared with African infection rates, even though most men in both places are not circumcised.
It seems to me the African leaders may well be chasing a red herring and in so doing may be woefully misleading millions of Africans along the way. Given the fragmentary and sporadic health education most African men are offered–or are willing to accept–the great risk is that many of these men will misunderstand circumcision and believe they are thus protected from AIDS.
If these researchers had come to Denmark and checked the local male anatomy and studied the low HIV infection rate here, they might well have concluded HIV infection is NOT in itself correlated with circumcision.
So what is the issue that makes the difference?
A matter of size? A matter of libido? Sexual promiscuity? Social attitudes towards condoms? Why is the Danish HIV infection rate so low and the Africa rate so high?
I think HIV infection in male Africa has no precise correlation with circumcision. I think it’s a matter of hygiene and personal attitude: available cleansing places like bathrooms with running hot and cold water, body scrubs, detergent soaps, health care practices and condoms – as well as personal medical knowledge. (photo left: souvenir shirt for getting HIV tested; VCT = volunteer counseling and testing)
To its credit, study does acknowledge the factors of health counseling, use of condoms and reduced sexual partners in reducing infection rates. But of all the factors involved is disease transmission circumcision seems among the least significant. Bring hygiene, running water and a new attitude toward using condoms to Africa, not scalpels. (If a wife asks a husband to use a condom it’s as good as accusing him of infidelity, which can result in abuse or abandonment; it’s a catch 22 and the woman gets infected.)
The Danes have socialized medicine for everyone and are liberally minded; if there is a sexual problem it gets dealt with.
The Africans have few clinics and avoid sexuality talk. I have been to Africa (13 countries) and have seen how many people live, especially in rural villages and towns where few houses have running water and a doctor is likely to be fifty miles away.
So, my shower room observation is that the rush to circumcision is a misleading gesture that will not, in the long run, save anyone who is sexually active–gay or straight (or bi, as many African men are), but only mislead many into a false sense of security.
In possible fact, the surgery may well have a post-op reverse effect: many men will be eager to try our their new ‘freedom’ and have sex (condom-less as usual) before the wounds are healed, causing bleeding, and thus exposing them more to HIV than before the knife.
(click on photo to enlarge)
Further, the surveys did not begin to address the issue of MSM – men who have sex with men – of whom there are countless, but are not acknowledged by most African governments as a risk group. How does circumcision effect MSM, which is one of the highest risk groups?
To complicate the issue, the answer was reported by the Associated Press on August 25, 2009: ‘Study Finds Circumcision Does Not Protect Gay Men’
“The latest study, by researchers at the Center for Disease Control (CDC) in USA , looked at nearly 4,900 men who had anal sex with an HIV-infected partner and found the infection rate, about 3.5 percent, was approximately the same whether the men were circumcis
ed or not…” (Read the full report.)
Circumcision seems a severe, simplistic and inadequate response to a complex issue.
For further reading see:
– http://www.usaid.gov/our_work/global_health/aids/TechAreas/research/mcfactsheet.html
– http://www.irinnews.org/Report.aspx?ReportId=85405
– http://www.peripheries.org/2009/03/25/do-condoms-obstruct-the-fight-against-aids/
– http://www.nytimes.com/2009/08/30/weekinreview/30rabin.html
– http://www.nytimes.com/2009/08/24/health/policy/24circumcision.html?scp=4&sq=foreskin&st=cse
– http://community.nytimes.com/comments/www.nytimes.com/2009/08/24/health/policy/24circumcision.html?scp=2&sq=foreskin&st=cse
Richard Ammon
