RWANDA: CIRCUMCISE ALL MEN—EVEN IF IT MEANS MORE “HIV” “INFECTION”
Posted by Henry Bauer on 2008/02/03
“Rwanda in mass circumcision drive” (BBC, 22 January 2008)
“Rwanda has launched a campaign to encourage all men to be circumcised, to reduce the risk of catching HIV/Aids. . . . soldiers, policemen and students would be asked to come forward first for circumcision. . . . ‘We will start this campaign with the new born and young men in universities, the army and police’. . . . While it will be nominally voluntary, correspondents say many in the armed forces will regard it as an order. . .
The UN World Health Organisation has said male circumcision reduces the risk of heterosexual HIV infection. . . . Innocent Nyaruhirira, secretary of state for Aids prevention, told the BBC’s Great Lakes Service, ‘It is a fact that men who are circumcised are 60% more likely to be protected against HIV during sexual intercourse’”.
“HIV study involving University of Manitoba among top medical breakthroughs. . . .
WINNIPEG—Work done by a researcher from the University of Manitoba is among the top 10 medical breakthroughs of the year, according to Time magazine. Dr. Stephen Moses . . . found male circumcision can reduce the risk of HIV infection in men who have heterosexual sex. . . . in Kenya and Uganda . . . circumcised men were roughly 50 per cent less likely than uncircumcised men to acquire HIV during sex with women. . . . Time picked the HIV study as the second-biggest medical breakthrough of 2007.”
On the other hand:
“Unhygienic Circumcision ‘Increases Risk of Hiv’” (SciDev.Net, London, 28 February 2007)
“Museveni scoffs at circumcision for HIV-Aids” (The Monitor [Kampala] 18 February 2007)
“PRESIDENT Yoweri Museveni has trashed claims that circumcised men are less prone to HIV/Aids infection. . . . “Why are Muslims and Bagisu dying? Who beats the Bagisu when it comes to circumcising men?” . . . Among the Bagisu, a tribe in eastern Uganda, every male, between adolescence and manhood, must be circumcised.”
“Circumcised male and female virgins were substantially more likely to be HIV infected than uncircumcised virgins [emphasis added] (Kenyan females: 3.2% vs. 1.4%, odds ratio [OR] Z 2.38; Kenyan males: 1.8% vs. 0%, OR undefined; Lesothoan males: 6.1% vs. 1.9%, OR 3.36; Tanzanian males: 2.9% vs. 1.0%, OR 2.99; weighted mean phi correlation Z0.07, 95% confidence interval, 0.03 to 0.11). Among adolescents, regardless of sexual experience, circumcision was just as strongly associated with prevalent HIV infection” (Brewer et al., Annals of Epidemiology 17  217-26).
“Circumcision does not affect HIV in US men—
WASHINGTON, Dec 3 (Reuters)— Circumcision may reduce a man’s risk of infection with the AIDS virus by up to 60 percent if he is an African, but it does not appear to help American men of color . . . . Black and Latino men were just as likely to become infected with the AIDS virus whether they were circumcised or not, Greg Millett of the U.S. Centers for Disease Control and Prevention found. ‘We also found no protective benefit for a subset of black MSM (men who have sex with men) who also had recent sex with female partners . . . . Overall, we found no association between circumcision status and HIV infection status among black or Latino’ MSM. . . . Experts knew circumcision would not protect a female sex partner, nor the male sex partner being penetrated. But Millett’s study found no benefit of circumcision to any of the men. ‘We also found no protective benefit of circumcision among those men reporting recent unprotected sex with a male partner in which they were exclusively the insertive male partner’ . . . .
HIV is much more common among black and Latino men than whites and this may offset any protection offered by circumcision . . . . Black and Latino men are more likely to have sex with other black and Latino men, and thus may be exposed to HIV more often than white men.”
Above all, since it is in Rwanda that mass circumcision is being urged or perhaps even enforced, consider the data in Rwanda’s own Demographic and Health Survey for 2005 (published July 2006; available at http://www.measuredhs.com/pubs/pub_details.cfm?ID=594&srchTp=). In Chapter 15, “HIV prevalence and associated factors”, Table 15.6 on p. 234 reports the rate of HIV-positive for circumcised men as 3.8% and for not circumcised men as 2.1%. IF circumcision has a causal relation to “infection by HIV” in Rwanda, then a program of mass circumcision seems destined to increase the “infection” rate in Rwanda by about 80%. Whether or not there is a causal relation, mass circumcision will have some deleterious side-effects owing to the risk of infection by real microbes that is associated with any surgery.
This sort of thing explains why such matters must be left to the experts; the rest of us could easily become confused by the published scientific evidence which shows that circumcision decreases the chance of acquiring “HIV”—or increases it—or makes no difference. Furthermore, that it makes no difference when you are “exposed” to it more–at least, if you are Black or Latino—in the United States, that is, because for Black men in Africa it does make a difference even though they are “exposed” to it one heck of a lot more than in the United States.
On the other hand, this sort of thing shows why public policies about such matters are too important to be left to the HIV/AIDS experts; just as war is too important to be left to the generals, and for the same sort of reason: they are preoccupied with their encounters with trees, and imagine that if you’ve seen one tree you’ve seen them all, and they understand nothing about the surrounding forest.
[Re-edited in the attempt to make clear that "HIV-positive" does not mean infection by a virus]