Many Australian public hospitals maintain a ban on circumcision. The Royal Australian College of Phsyicians (RACP) recommends against circumcision, and it is now so unpopular that 80% of Australian boys are uncircumcised. However, a committee of public health experts has recommended reversing this ban and moving to encourage circumcision, on the basis of the many health benefits of circumcision. These health benefits have been known for a long time, but the medical fraternity have responded to strong public pressure in advising against non-medical circumcision, because it is seen as a form of child abuse. Indeed, in America recently there were efforts to ban the practice on the basis that it is a form of child abuse.
This would all be a largely irrelevant debate about men’s willies and the aesthetics thereof, except that circumcision has now been shown to be an extremely effective tool in the battle against HIV. The Bill and Melinda Gates Foundation and various international aid agencies are scrambling to fund circumcision programs in Africa, where they believe that this simple and harmless procedure can significantly reduce the transmission of one of the world’s nastiest diseases. Recently at a training course in the UK I met people involved in this process and saw examples of the kinds of non-surgical devices being used to circumcise adult men (it’s a kind of ring, and after just 1 or 2 days the whole process is over and you can go back to work).
Australia is undoubtedly contributing financially and organizationally to this effort as part of its increasing aid contributions to Africa. But isn’t there something wrong here? Circumcision is essentially banned in government run hospitals in Australia, is on the nose in the USA and is frowned upon in the UK, yet these same countries are recommending circumcising the entire African continent. It’s morally unacceptable child abuse in Australia but an acceptable public health intervention in Africa? How does this kind of attitude differ from previous eras when population control was conducted through sterilization, often not clearly explained to the recipients? Is it just another example of aid-as-imperialism? How is this different to a country where abortion is strictly illegal (say, Ireland) funding abortion-based population control programs in Africa? And how can the Australian aid community (or its public health activists) criticize Chinese aid programs while we’re doing something like this?
It’s also worth remembering that historically white colonialists have been extremely uncomfortable about black men’s sexual fecundity (and their mythically enormous willies). Yet here we are – advocating chopping the end off of those massive, fecund members in the interests of stopping a disease which (apparently) cannot be stopped in Africa through behavioral change alone. Even though in Australia we have it under control through – you guessed it – behavioral change. The public health double standard is disturbingly close to the sexual insecurity …
Don’t mistake me here – HIV is a desperate situation and circumcision a minor operation that I don’t think we should shy away from as a control technique. Furthermore, I think the western bans on circumcision are silly and of the same character as the AMA’s opposition to boxing. It’s not liberal. But this hypocrisy, in which doctors won’t tolerate it in Australia or the UK but will support funding for its widespread use in Africa, reeks to me of cultural imperialism. If you won’t tolerate it here, don’t do it there.
Compromise and Conceit 
March 6, 2012 at 1:13 pm
What you call “a committee of public health experts” was just a cabal of self-appointed circumcision fantics, some of them doctors who make their living from it, one a professor of molecular medicine (not surgery, paediatrics or urology) who has never seen a reason to circumcise he didn’t like, twists every statistic to make circumcision look good, and has co-authored an article with the editor of a circumfetish website.
Actually it is only in Queensland that as few as 80% of boys are left intact. Across Australia is is more like 88%, and in Tasmania, more like 95%. Since circumcision declined from nearly universal 50 years ago, there has been NO outbreak of any of the things it was supposed to be good against.
The scientific case that circumcision has any effect on HIV is very weak. Less than two years after circumcising a total of 5,400 men in three trials, 64 of them had HIV, compared to 137 in a similar group made to wait. That is the whole basis of the case. 703 men dropped out, their HIV status unknown. Contacts were not traced, so they have no idea which if any of the men actually got HIV from women. This study, http://tinyurl.com/7deqtap raises serious doubts that many actually got it from contaminated medical equipment. USAID found 10 out of 18 countries where more of the circumcised men had HIV than the non-circumcised. A Uganda study started to find that circumcising men INcreases the risk to women – already at greater risk – but it was cut short for no good reason before that could be confirmed. There is a serious risk that circumcised men will think they are immune and demand sex without condoms. Circumcision campaigns could prove disastrous in the fight against HIV/AIDS.
March 6, 2012 at 8:06 pm
Thanks for commenting Hugh. The original article is here and I guess you’re right, they’re a “cabal” of self-appointed somethings. But circumcision fanatics? I note that the article states there are no conflicts of interest: if you think someone in the cabal is making a living from circumcision, you should make a case to the journal so that they can withdraw or edit the article. Otherwise, perhaps you’re exaggerating?
The scientific case is pretty strong actually. 64 HIV cases compared to 137 is a huge benefit, and whether you pool the results or not there’s strong evidence that circumcision prevents a lot of health problems. In their words:
The drop outs you mention are largely because two of the three studies were stopped before proper follow up for ethical reasons (it would be unethical to keep the control group waiting given the strong evidence of the treatment’s efficacy). The article you link to is not a strong case: it’s sloppy with numbers, misrepresents the ethical concerns, and over-states the case for bloodborne transmission. I think the best response to the claims of the people in comments at that website is from the words of the authors of one of the studies it criticizes:
I should make it clear that, on the evidence available, I support circumcision as a preventive measure against HIV, and I think it should be considered as a routine recommendation for newborns in Australia (as recommended by the cabal). Of course I don’t support making it mandatory, though the cabal point out that it is easily comparable with vaccination in its effectiveness. I don’t support circumcision as a preventive measure against HIV in Africa, funded by western aid money, if we aren’t willing to support its use within Australia. That seems to me to be a very racist kind of aid policy.
September 21, 2022 at 3:32 am
I mean, I’m glad you posted the original article, because it was published in Scientific Research Publishing’s Open Journal of Preventive Medicine. Neither the publisher nor their journal can be found on the Directory of Open Access Journals, nor the National Library of Medicine catalog. Not looking good. Even worse, SCIRP’s Wikipedia page refers to it as a “predatory academic publisher” that are “considered to be of questionable quality”. It also has Brian J. Morris’s name attached to it, a man who is well known for his incredibly shoddy and suspect academic behavior like pushing out loads of bullshit “articles” in support of foreskin amputation.
If this is the quality of evidence that sways your opinion, then I’m sorry but you need to learn basic skills for analyzing research.
September 21, 2022 at 9:33 am
This is one of those weird drive-by comments that probably won’t elicit a reply, but in the interests of fighting misinformation I’ll do so anyway. I wonder why this 10 year old article is suddenly getting attention?
First, the article you refer to in the Journal of Preventive Medicine is not “evidence” or “research”. It’s a policy statement (the clue is in the title of the article!) The actual evidence I cited was in the first link in the post, which is to a report in The Lancet that two RCTs of male circumcision were stopped early due to the huge benefit of circumcision identified in them. Do you think that doesn’t count as evidence?
Second, the authors of that statement are not “shoddy and suspect”: Alex Wodak and Adrian Mindel are well-respected researchers in HIV prevention in Australia, and Stephen Leeder was dean of medicine and editor-in-chief of the Medical Journal of Australia (he was sacked from that position after criticizing the decision to sell the journal to Elsevier). Perhaps instead of criticizing the article on the basis of its authors, you should be asking why scientists with this level of authority have to go to a low-ranked, potentially predatory journal to get their message out? Could it be that the consensus I mention in my post is stifling good policy?
Third, regarding predatory journals: It is well known that Beall’s position on this issue (which is the citation given in the wikipedia page) is dodgy, since he is/was partially supported by Elsevier, and his statements on which journals are predatory are no longer relied on. It’s also a sad fact that these “predatory” journals are increasingly not predatory, because they serve an important role publishing articles from low-income countries and early-career researchers, on topics in health and science that are considered beneath the notice of the major journals. It’s no coincidence that these journals publish a lot of non-white, Indigenous or queer authors, often from lower-ranked universities or countries outside the Imperial core, who often write on topics related to minority or excluded populations. Consider this paper from the latest issue for example. It is by a non-native speaker of English, writing on a topic often associated with social exclusion, from a smaller university in Portugal, who usually publishes in Portuguese. This topic is of limited interest in big journals, doesn’t concern a large country or a multi-country study, and primarily affects policy in that country. These are the kinds of papers that “predatory” journals of this kind publish, but that doesn’t mean they’re invalid or unworthy of publication. You should find a better method for assessing research than just the journal it was published in, I’m afraid.