Below the belt: why routine circumcision will harm women and people of color

The Centers for Disease Control is considering promoting routine circumcision for baby boys in the US as a means of decreasing the spread of HIV, says the NYTimes.

Not only is this ignorant; it is dangerous. To women, and to people of color.

Public health policy makers have been talking up circumcision as a way to reduce HIV transmission ever since data first showed that it could reduce infection rates by up to 50-60% among African men. PEPFAR, UNAIDS and others jumped on the surgical bandwagon, ramping up efforts to promote circumcision in Africa. Family Health International even created a Male Circumcision Clearinghouse with the latest information on research and intervention.

And no wonder the joy. 50% reduction of transmission is fabulous. Unless of course, you knew that there was another way to reduce transmission by close to 100%, called... condoms. The fact is, promoting condom use in Africa has not been super-effective, and often because the public health officials have not found ways of addressing socio-cultural barriers to condom use: power differentials and gender dynamics; communication and negotiation; work migration patterns and their relationship to sex work. At a loss to address these underlying issues, interventionists jumped at the chance to make a medical intervention instead. Snip, snip, and a neo-colonialist intervention further disempowers men in a culture where disempowerment is one of the deepest running concerns.

And it is even more disempowering to women: early studies in Africa didn't bother looking at how circumcision might affect women. No data was collected on whether HIV transmission was reduced among female partners of circumcised men. More disturbingly, even, no studies looked at how de-prioritizing condom promotion could affect other sexual health issues for women: transmission of STIs; unwanted pregnances and abortion rates; sexual violence. How do you judge an intervention a success without looking at the whole picture?

Though this was glossed over in the NYTimes article, the Lancet released a study earlier this summer showing that "Circumcision of HIV-infected men did not reduce HIV transmission to female partners." So now we know, this much-touted (medically controlled) intervention does not protect women. Why promote it in the US, then, much less Africa or anywhere else in the world?

CDC says that they are promoting it amongst gay men, who are in one of the highest risk groups in the US. But circumcision performed at birth will clearly not be weeding out babies based on sexual identity--parents of all boys will be instructed to circumcise. This is not a huge change, the majority of boys in the US are circumcised, so why does it matter? It matters because if circumcision is touted as protecting against HIV, then other interventions--especially condom promotion--get short shrift, and both women and men lose in the end.

And those who are least likely to circumcise in the US are those from Latino and African American communities. Just as in Africa, rather than being willing to examine how culture and oppression might impact sexual decision making, we are instead stepping in with a paternalist intervention that implies that it is men and women (particularly men and women of color) who can't figure out how to make their own sexually heathy decisions, and it is the great white doctor who must step in and save them from themselves.