The Sunday Mail
Dr Sebastian Ndlovu
It should be known that the idea that circumcision reduced transmission was based on an observation at the turn of the century of the prevalence of HIV in two different regions of the world.
The past few years have seen the rise of what I would like to call pro-circumcision zealots. One too many a foreskin have been summarily chopped off unsuspecting male organs of a beguiled male populace.
The theory or rather dogma of medical male circumcision has left the male population reeling from scalpel-wielding doctors with a predicated premise that the same will be a chimerical elixir for various afflictions. Forgive my skepticism but I believe we have taken the “religion” of circumcision too dogmatic and without any test for validity of the presumptions. That according to me is a recipe for a monumental disaster.
I personally agree completely with the notion that circumcision is a noble hygienic practice, it gets rid of an anatomical structure that could be a culture site of various biological flora thereby inadvertently producing a colossal effluvium if not properly cleaned. It is also probably true that circumcision will reduce the sensitivity of the skin of the male organ, thereby conferring some obvious benefits to the male during copulation. The issue that I am not yet ready to agree to without sufficient statistical evidence is the rather much acclaimed medical benefit of circumcision, and that with sufficient reason I should add.
We are made to believe that circumcision invariably reduces the risk of HIV transmission by about 50 to 60 percent. If that were true and it was about some other disease we would applaud this statistic and go ahead and arbitrarily circumcise all males.
But, however, it is not so, we all know that correct and consistent use of the condom reduces HIV transmission by 99 percent, the only other intervention that can parallel this is correct and consistent adherence to HIV treatment drugs (HA ART).
With that said, it seems redundant and Pharisaical to claim that there is a medical benefit of circumcising (which is debatable by the way), but then turn around immediately and say the benefit is negligible or totally useless when compared with other well-established methods. To cap this ludicrous argument, we go further and say: you still have to use the condom after the traumatic, borderline genital mutilation exercise!
Like seriously? This rationale appears very dubious to any sane mind, that on one hand we advertise circumcision as beneficial to reduce transmission, then on the other hand say, “sorry, you still have to use a superior method”! Sanity and reason will lead to the inevitable conclusion that with that particular respect, then the benefit of circumcision if any is deemed irrelevant and the act, therefore, adjudged to be a redundant and totally a futile exercise!
It should be known that the idea that circumcision reduced transmission was based on an observation at the turn of the century of the prevalence of HIV in two different regions of the world. The sub-Saharan region of Africa has always been known to have the highest prevalence of the scourge. However, the other part of the world, north of the Sahara and the Arab world had or has one of the lowest prevalence. Some observational minds then tried to reason on the trend and thereby realised a flagrant truth!
The Arab community circumcised their males routinely whereas the sub-Saharan Africans did not.
This gave the rise to the hypothesis, which at that time was still proper I should say, that circumcision probably could reduce the transmission of HIV. However, a credible biol-statistics expert would be open at this point to a host of confounding factors.
These include the very obvious fact that the strain that is common in the Arab world and the rest of the world is not as virulent as the one in sub-Saharan Africa. Also the societies have different cultural practices. It is possible that the practice of Sharia law in the Arab states deters the populace to a large extent from moral decadence and debauchery.
However, the predominantly Christian sub-Saharan religious terrain is neo-liberal when it comes to sexuality and arguably more lecherous. This definitely contributes immensely to HIV transmission and I would argue especially with the highly virulent HIV-1, Group M, Subtype C which is the most prevalent subtype in Southern and Eastern Africa.
The Council on Scientific Affairs of the AMA (1999) concluded that “behavioural factors are far more important risk factors for acquisition of HIV and other sexually transmissible diseases than circumcision status, and circumcision cannot be responsibly viewed as ‘protecting’ against such infections”. More recently, Talbott (2007) reports that it is the percentage of female sex workers in the female population, and the obvious background of prevalence, not the incidence of male circumcision, which determines the level of HIV infection. What a revelation!
It seems these confounding factors are not a worry to the HIV researchers in Africa. It is as if the studies they subsequently designed were a mere rubber stamp to the theory that definitely circumcision reduces transmission by 60 percent. The studies as we will later realise were fraught with overt inconsistencies and biases that would make any researcher cringe – the most evident one being this expectation bias.
I hope no big brother somewhere behind the scenes was sponsoring that notion – tantamount to an ongoing conspiracy of the highest order!
Sebastian Ndlovu is a qualified medical doctor. He writes in his personal capacity and opinions expressed here are his personal opinions not of any other corporate body or institution. He writes in an attempt to create public discourse on health matters, and thereby improve public health policies.
You can contact him on his email address [email protected].
