Male circumcision should not be seen as a ”silver bullet” in fighting HIV infection, University of Cape Town researchers said in a paper published in the latest issue of the South African Medical Journal.
The evidence for the preventive benefit of male circumcision is ”rather modest”, and does not warrant ”heroic policies or practices”, humanities student Alex Myers and co-author, public health professor Jonny Myers, said.
”The current zeal and naive enthusiasm for promoting circumcision as an Aids-prevention tool show lack of regard for the limited degree of benefit likely,” they said.
Potential harm includes the possibility that newly circumcised men will feel less inhibited about having risky sex.
There is also the threat of surgical complications ”and worse” from the operation itself, and increased costs and strain on thinly stretched health services.
Recent research has shown that HIV infection is about three times more likely as a result of the circumcision procedure itself in three African settings — Kenya, Lesotho and Tanzania.
One should also not lose sight of the ethical issues of circumcising non-consenting infants.
The authors said that in the Eastern Cape, where most men are circumcised, the HIV prevalence rate is not meaningfully lower than in KwaZulu-Natal, where most are not.
They also said it is useful in weighing up circumcision to ask how consistent attitudes are on preventive surgery.
A Tanzanian study has found that female circumcision reduces HIV transmission. Biologically, the explanation for this is probably the same as for male circumcision.
If female circumcision is medicalised in a similar way to male circumcision, it can be made safer and less damaging.
”The downplaying of these facts in the media is a powerful reflection of Western cultural attitudes,” they said.
”We have already decided that female circumcision is an appalling human rights violation and so do not even flirt with the idea of using it as an HIV prevention tool.
”Similar arguments apply to mastectomy in teenage girls, even though this would be effective to prevent breast cancer in later life.
”The difference with male circumcision is that it is still tolerated in Western and other parts of the world, rendering it politically acceptable.”
This tends to lower ethical barriers to recommending male circumcision as an HIV/Aids prevention measure. — Sapa