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To cut or not to cut? Introduction to the debate

Beginning from 2007, WHO, UNAIDS, some donors, and some African governments have been promoting mass male circumcision to reduce HIV transmission. In 2009, USAID laid out plans to circumcise 35 million men in 14 African countries during 2011-2015





To cut or not to cut? Introduction to the debate

A lot of evidence and arguments dispute the claim that mass circumcision is an appropriate response to Africa’s HIV/AIDS epidemics (follow links for more details and resources):
1. First, the programs are a shot in the dark. They are based on the common but dubious assertion that sex accounts for most HIV infections in Africa. If that’s not so, then circumcising millions of men is unlikely to have a big impact on Africa’s epidemics. There is already a lot of evidence that skin-piercing procedures may be a bigger risk than sex for many if not most adults (see other pages in this website, including: sex vs. unsterile instruments in AfricaCases & Investigations; and data linking HIV to injections).
2. Second, even if circumcision reduces a man’s risk to acquire HIV through sex, if he doesn’t know his partner is HIV-negative, he would still have to use condoms to be safe, not just safer. So circumcision is unnecessary (if a man uses condoms), and may increase risk (if a man or his partner considers circumcision an excuse not to use condoms).
3. Third, claims that mass circumcision will significantly lower HIV risk in Africa are based on evidence from selected studies only. A full view of available evidence shows: more HIV in circ’d vs. intact men in some African countrieslimited epidemics in many countries where most men are intactinconsistently lower risk for new infection in circ’d vs. intact men; and sometimes higher risk for women. Furthermore, key studies selectively reported collected data on sex and blood risks — raising questions about what really happened, as well as the intentions of researchers who did not report relevant collected data.
4. Fourth, circumcisions are promoted with insufficient care to ensure that the procedures are safe — putting men at risk to get HIV, hepatitis B, hepatitis C, and other infections. Some evidence says that African men and boys likely got HIV during circumcisions.
The evidence and arguments considered in this site focus on interactions between circumcision and HIV infection. This is a narrow approach to a complex issue. Aside from HIV, many other factors are involved in a man’s or family’s decision to circumcise or not. These include other real or supposed health risks and benefits, sexual satisfaction and performance, community practices, and religious beliefs.

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