IAC Panel on Male Circumcision Ignores Social Realities and Ramifications

I spent September through January this past year studying and living on the coast of Kenya. As I began to learn about the country's political and social history, I was surprised to learn just how tied in circumcision is to Kenyan life. Tensions between the major ethnic groups have often been symbolized by different initiation rites. For example, while the politically powerful and largest group, the Kikuyu, traditionally circumcise young men (as well as women) during initiation into adulthood, the second largest group, and often political rival, the Luo, do not. Discussions revealing ethnic and political tensions will often mention this difference as a symbol, and I heard multiple references to Luo as children or as dirty during my time there.

This is why, when the evidence for circumcision as a mode of preventing HIV infections in men is brought up, I am extremely concerned over how it would play out in a political and social context such as the one that exists in Kenya. I eagerly awaited discussion on this topic at the International AIDS Conference, and today was my first opportunity to attend a session. "Male Circumcision: Addressing Implementation Challenges and Demonstrating Impact" consisted of a series of presentations highlighting research on the implementation of male circumcision as a way to prevent HIV and AIDS. It was disappointing, although I take some of the blame for it not living up to my expectations. While I was looking for answers around social implications, this session focused mostly on the science and individual level results.

Even so, I was bothered by several parts of this presentation. First, I am concerned by the seeming promotion of circumcision instead of condoms. On further questioning, all the panelists stressed that male circumcision should be part of a comprehensive strategy that includes education, access to condoms, and counseling. However, in several off-hand remarks, and in the tone of the presentations, I sensed an attitude towards male circumcision as if it was the best thing to happen to the HIV/AIDS activist community since sliced bread. Don't get me wrong, the science is exciting. With studies suggesting that circumcised men are 50-60% less likely to get HIV, I would be shouting from the rooftops if I were a scientist. But male circumcision programs will not deal with abstract groups of potential HIV carriers, they will deal with human beings living in complex social realities.

This is why the panelists' lack of attention to the social realities that make male circumcision so complex annoyed me. In fact, I made a point of asking a question regarding the role of social realities in designing research and policy, and got basically no answers. The epidemiologists on the panel squirmed in their seats, and later one excused this omission by saying they did not focus on the social aspects - that was for someone else to do. This divide between the sociological and epidemiological aspects of HIV and AIDS only hinders efforts to find a comprehensive solution, and distorts the research evidence that is found. One presenter highlighted the success of programs in areas of Kenya to incorporate HIV/AIDS education and priorities into traditional initiation ceremonies (that included circumcision). However, because it was with a population that already circumcised its adolescent males, I was skeptical of its success.

A couple of the presenters replied that the results of their studies debunked myths that certain groups would be resistant to male circumcision. When I went up to the presenter who had shared his results from Kenya, however, he acknowledged the need for sensitivity towards political and social realities in the implementation of male circumcision programs and the importance of ensuring that circumcision is a choice for men, instead of a necessity. He also acknowledged the political realities. I was happy to hear that this was not being completely ignored, but disappointed that recognition of societal issues was an afterthought, rather than a focus of the panel.

Another omission by the panelists was that of the role of male circumcision and how this affects women. The panelists all noted possible biological benefits for women. When asked about women, a couple of the presenters mentioned that partners of the subjects of their study often approved of the circumcision for personal reasons. Frankly, I found these answers insulting. You are asked about the role of women and all you can come up with are that they really like how the circumcised penis feels in bed? What about the fact that male circumcision requires men to take on a burden, while male resistance to condom use already shows us that overcoming burdens is not always a realistic option? What about women as emotional and intellectual partners and loved ones of men, not just sexual partners?

Finally, one study, on male sexual pleasure and performance before and after circumcision, underscored this preoccupation with the sexual and physical over other aspects that influence the decision to be circumcised. I was confused as to why this study was important or relevant at all, since I am pretty certain that male circumcision has been around for centuries and Jews, Muslims, and other groups that are all traditionally circumcised seem to be able to function sexually just fine, as do groups that don't traditionally circumcise. When the findings showed little quantitative difference, this just confirmed the ridiculousness of the study to me.

Male circumcision can be an important tool in the fight against HIV and AIDS, but the panel I attended today only confirmed my fears over the way it will be used. There is another one on Thursday that I hope will address the complex social issues instead of the unenlightening and superficial ones.