I am very uncomfortable with the enthusiasm I hear regarding male circumcision as a strategy for reducing AIDS transmission in Africa.
Recent studies suggest that male circumcision offers some protection from the transmission of HIV, but does this mean that we should start amputating healthy tissue? Not necessarily. We don't, as a rule, amputate breasts because it would decrease the rate of breast cancer. So how, exactly, did we decide that this was a good idea?
I suspect that the main reason this strategy is so appealing to Americans (who have a great deal of influence in transnational aid organizations) is because we already like male circumcision. Or, perhaps more accurately, Americans tend to be kinda icked out by the uncircumcised penis. If most Americans were uncircumcised and we had the same sort of distaste for the circumcised penis that we now have for the uncircumcised one, there is no way that we would be promoting circumcision. We would promote condom use, which is significantly more effective for stopping the spread of HIV than circumcision and does not involve chopping off a part of the body we are born with. Sacrificing the foreskin is just something that Americans are comfortable with.
I worry, too, that the marketing of circumcision as an answer to HIV infection in Africa may make some individuals less cautious once circumcised. Public health campaigns often rely on oversimplification and hyperbole. Indeed, in an AP article published in multiple venues on Friday, a UNICEF AIDS advisor was quoted as saying that "circumcised men are relatively well protected against HIV." It sounds, here, like he is saying that circumcision is protection against HIV. Saying so is the kind of misinformation that will lead to more death in Africa, not less. Let's hope he was misquoted.
The comeback, of course, is: What's the harm? And the answer is: We don't know. Since being circumcised, in mainstream America, is not seen as a problem, no one asks the questions that could lead to us discovering that circumcision is harmful. We do know, however, that men lose sexual sensitivity with circumcision: nerve endings in the foreskin itself are lost and the skin on the head of the penis, no longer protected by the foreskin, thickens and becomes less sensitive. (Maybe it's just me, but I think that's unfortunate.) And, like any procedure, it's risky. In addition to the risk of excessive bleeding and infection, circumcisions are botched and sometimes babies lose more than their foreskin. The American Academy of Pediatrics does not recommend it.
Still, if the studies are right, then circumcising men will mean that some lives will be saved. That's great, of course. But the degree of attention and applause for male circumcision is disproportionate. Circumcision is not the answer to the AIDS epidemic. If circumcision could stop HIV, we never would have had an epidemic in the United States. Instead of vindicating our love of the naked penis, the media should focus on the real progress made in Africa. World AIDS Day will be commemorated on Saturday, December 1st with the news that AIDS transmission is down in Africa, but it's because of more monogamy, more abstinence, and more condom use, not losing those pesky foreskins.