Mutilation or Education?

Anyone who knows me well knows that one topic that really incenses me is genital mutilation. Lately I’ve been hearing (and reading) a lot about the circumcision/HIV trials in Africa and it has irked me enough to blog about it.

A little background: over the past decade, several studies have taken place in African nations with high HIV rates to assess if male circumcision provides protection from HIV. Basically, the researchers recruit thousands of HIV-negative male participants, circumcising half of them and leaving the other half intact. After several months the men are tested for HIV. The studies reported that, depending on the specific trial, the circumcised men had 50%-60% fewer cases of HIV than their intact counterparts, and, although they were replete with shortcomings (i.e.: they were not double blinded, and the circumcised men were told to abstain from sex for six weeks following the procedure, giving them a shorter amount of time in which to become infected), many health and HIV organizations are now promoting circumcision as a means of preventing HIV, and it seems like every newspaper and magazine in the United States has reported the findings as “promising.”

What has been left out of the medical and media reports is the curious fact that, worldwide, some of the countries that have the lowest rates of circumcision are also those that boast the lowest rates of HIV infection. It is in fact the nations where circumcision is incredibly rare—namely nations of northwestern Europe—that have the world’s lowest rates of HIV infection (the exception to this is the Muslim world, where circumcision is almost universal and HIV rates are very low. However, in Islamic nations the consequences for sexual activity outside of marriage are often harsh corporal punishment or even death.)

If you look at a world map of HIV prevalence, a worldwide map of circumcision rates, and a worldwide map of Gross Domestic Product, you will notice that the HIV rate is much more closely correlated, negatively, with GDP than with circumcision (keep in mind that the circumcision map has only three categories while the others have 4 and 6, making it less nuanced. Canada, for example, has a lower circumcision prevalence [30%] than the U.S. [80%] but the two appear to be equal on the map). My theory for why this is pretty straightforward: richer nations, because they have the resources, generally provide mandatory, comprehensive sexuality education to all students, which includes information about HIV, STDs, and contraception. The one glaring exception to this is the United States, where sexuality education is not mandatory and, when it is offered, often does not include information about condoms or STDs. And, not surprisingly, the U.S., although it has a high GDP and a circumcision rate of close to 80%, has an HIV rate of 0.6%. Compare that to Denmark, Finland, Germany, Iceland, the Netherlands, Norway, and Sweden, the United Kingdom, where the vast majority of men are uncircumcised and the HIV rates are between 0.1% and 0.2%. Japan, too, has a high GDP, mandatory HIV education in public schools, a very low prevalence of circumcision, and an HIV rate of less than 0.1%. Obviously, possession of a foreskin is not a risk factor, so I find it incredibly disturbing that American researchers are being given multi-million-dollar grants to go to African countries and mutilate the genitals of thousands of African men under the guise of “trying to help them.” Why not offer HIV education instead? Or condoms? These researchers are basically using a poor, high-risk population of people of color as guinea pigs. I’m not sure if anyone has yet critiqued the HIV/circumcision studies through a critical race lens, but it really smacks of colonialism.