Making the Cut: Circumcision in Africa
There's been a lot of buzz about male circumcision in sub-Saharan Africa lately. Because of the data supporting MC as an anti-HIV measure among heterosexuals, it has gained the support of major players like the World Health Organization and the United Nations' AIDS programme. More and more African clinics are offering the procedure, and the West is pouring in some serious money to help out. A few months ago, an African schoolteacher friend asked me to help arrange circumcisions for 20 people—and I hadn't even brought it up! "We need your help in finding consent forms, though," he added.
"Consent forms?" I asked.
"It's for my students," he explained. "The boys are all about 15, they all want the procedure, but we have to get their parents' permission first."
What happens to boys whose parents don't consent? None in that group had that problem, so it's an academic question for me—but I do wonder.
As a sex-positive activist, I can't help but be aware of the very serious male circumcision critiques out there. It's clear that there's a history of MC being historically promoted as a health measure by questionable science ... not to mention questionable anxieties about male sexuality.
At the same time, though, as an HIV worker, it is actually my job to pay attention to recommendations of the World Health Organization. And in populations where HIV is spread primarily through penis-in-vagina sex—such as sub-Saharan Africa, where I work—the WHO very clearly recommends male circumcision. (The evidence is less clear about whether circumcision is helpful for anal sex.)
In fact, an acquaintance who works for the Centers for Disease Control recently mentioned that the WHO specifically strengthened the wording of its pro-circumcision recommendation, because the people who drafted it were aware that health workers might face considerable anti-circumcision pressure. In other words, they found the science so convincing, and were so sure that anti-circumcision activists wouldn't accept it, that they chose more powerful wording than usual in an attempt to counter skepticism.
Many Western men feel justified violation about circumcisions that occurred at birth, without their consent. I sympathize, but I'm frustrated by how health workers are sometimes portrayed during the debate. Our actions do not stem from some quasi-fetishistic, deranged desire to chop men's junk. We're swayed by science, and we want to do what works. Plus, it's pretty clear that encouraging people to abstain, be faithful and use condoms isn't working, at least not in Africa.
There are whole African countries where 40% of pregnant women and 25% of the general population test positive for HIV. Terrified men around these parts are lining up to be circumcised. Under these circumstances, it can be difficult to stay patient with the anti-circumcision rantings of privileged Westerners who have no idea how good they've got it. Some of my fellow health workers have simply turned off their ears.
Others have evolved soundbites in response. One told me, "When American guys freak out about circumcising African men, I say that even if it does reduce sensation—and there's evidence that it doesn't—it's kind of like riding a motorcycle with a helmet. Riding without a helmet is more fun, and if you live in an area without too many accidents, it's a reasonable risk. But if you live in an area where people all around you are dying of motorcycle accidents, the risk becomes much less acceptable."
A good soundbite, I think. Except for the fact that motorcycle helmets are removable, and circumcision isn't.
On the other hand, failing to wear a motorcycle helmet doesn't put others at risk ... but increasing one's own HIV risk by failing to be circumcised puts future partners at risk as well.