The English Guardian has put together figures for female genital mutilation (FGM) and the top ten are Somalia, Guinea, Djibouti, Egypt, Sierra Leone, Mali, Sudan, Eritrea, Gambia and Burkina Faso. But the top ten for HIV that I have been looking at recently are Swaziland, Botswana, Lesotho, South Africa, Zimbabwe, Zambia, Namibia, Mozambique, Malawi and Uganda. The table below shows just how dramatic the non-correlation is.
The English Guardian is calling for an end to FGM, of course, not for it to be used to reduce HIV transmission. But a far less dramatic non-correlation has been used to justify three randomized controlled trials of mass male circumcision in African countries. The results of these trials have been used to justify a continuation of mass male circumcision, supposedly to reduce HIV transmission, involving tens, even hundreds of millions of men, boys and infants, and several billions of dollars. While HIV prevalence is lower among uncircumcised men than circumcised men in some countries, it is lower among uncircumcised men in others, while in several more countries circumcision status makes no difference. The correlation coefficient is roughly zero.
Results of further research into mass male circumcision is being presented to 16,000 attendees at the Melbourne HIV conference this week, research carried out on people who are not aware that they are guinea pigs for the current obsession with the operation. Because, as the figures show, we have no idea why circumcision sometimes appears to ‘protect’ against HIV and why it sometimes appears not to. Nor do we have any idea what proportion of HIV is transmitted through sexual contact and what proportion is transmitted through non-sexual routes, such as unsafe healthcare, cosmetic and traditional practices.
Similarly, we have no idea why HIV prevalence is so high in some African countries but so low in others. The fact that HIV prevalence is very low in countries that practice FGM is not seen as justification for carrying out trials of the operation on millions of people and presenting the results at an international HIV conference (such trials would probably be carried in secret, anyhow). In fact, FGM status is quite rightly seen as irrelevant to HIV transmission, and that even if it is somehow relevant, carrying out trials into the operation as a HIV intervention would be entirely unethical.
International health and development institutions, the UN, the mainstream media, political and religious leaders all around the world, and many others, condemn FGM and would not consider it as a means of reducing HIV transmission. They would not even condone carrying out field trials into any kind of FGM, not even the less damaging kinds of FGM, the kind that does no permanent damage, because it is not ethically justifiable to carry out such an operation for no medical reason on infants, children, or even unconsenting adults.
But the research carried out by the people slapping each other on the back in Melbourne, presumably at some considerable cost, were financed by the likes of the Gates Foundation (which also funds the English Guardian’s Development section, where the FGM article appears), FHI 360, Engender-Health and University of Illinois at Chicago. Several (if not all) of these institutions have their origins in a ‘population control’ theory of development, the belief that the population of developing countries is too high, and lowering birth rates will increase development and reduce poverty; less polite people would call this ‘eugenics’.
I wonder if these parties have some information about, or beliefs about, mass male circumcision having some negative influence on fertility. Because, if they were to believe the same thing about FGM, would they also promote it with the same energy and persistence (and funding, and institutional backing)? What about other means of reducing fertility, such as Depo Provera, which has been associated with higher rates of HIV transmission? Gates and other ‘population control’ organizations certainly do promote that.
So promoting your favorite ‘public health’ intervention as a means of reducing HIV when the evidence is slim is bad enough. But this intervention involves something that is ethically unjustifiable unless it is carried out for medical reasons. So these various parties went a step further: they carried out, and continue to carry out, ‘trials’ of this operation on millions of people. The excuse is that it ‘reduces HIV transmission’. But using that kind of evidence, so does FGM.
Genital mutilation without consent is not ethically justifiable; the fact that HIV prevalence is lower in countries where genital mutilation is common does not justify mass male circumcision programs, where millions of people are unwitting guinea pigs to this neoeugenicist experiment. Those promoting mass male circumcision programs, funding them or working on them are involved in a crime of inestimable proportions, and must be stopped.
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There’s a lot that I can’t jive with here–not knowing how much hiv is acquired through sex via other routes–because data has spoken on it. I’m definitely troubled by the knee-jerk shift toward circumcision. I can’t complain about being circumcised–I obviously don’t know the difference. But it is a troubling act to put a child through, very troubling. Hopefully data will be more conclusive. Thanks for calling this what it is–no matter the science–a particular type of mutilation.
Thank you Tabias. You’re right to be cautious, not knowing how much HIV is a result of sexual transmission is a big problem because UNAIDS and WHO refuse to consider non-sexual transmission, which is likely to be a lot more common that is currently believed. Mass male circumcision programs depend on the view that HIV is almost always transmitted heterosexually in African countries (though not elsewhere). But the arguments for mass male circumcision are no stronger than arguments for mass female circumcision, is someone decided to make such a case. They may be slapped down, I hope they would be. But then, why are these Americans with a pathological regard for mass male circumcision not also slapped down? Instead, they are given hundreds of millions of dollars.