The United States of America (USA) is one of the few remaining superpowers in the world. They emerged so at the end of the 2nd World War and have since then had a command in most global trends, often intervening to cause changes in policy, governance and offer humanitarian aid. They, therefore, are a voice of both reasoning and reckoning in a matter that may touch on the rights and dignity of a (group of) person(s)
Outside of religion and cultural identity, circumcision is largely foreign to a significant population in Sub-Saharan Africa. It is primarily advocated for by governments, non-governmental organizations and other regional and international groups, with the latter three funding the bulk of such campaigns.
The conversation on circumcision must start from debunking the alleged benefits of the practice to males, and the net effect of the same over the years, as did that of Female Genital Mutilation. Circumcision remains a form of genital mutilation; removal (with loss of blood and scarring) of part or the entire foreskin from the glans. The practice is a form of barbarity we mete upon males, aside from the religious arguments provided for egotistical reasons (social and cultural identity). We spend eternity defending a practice whose beginnings are as sinister as the histories of the people from whom they originate.
We seem incapable of seeking truths outside of our current comfort zones, as they may upset our egos and challenge our fundamental understanding of our bodies and increase pressure on the creation of (proper/neutral) interventions for medical emergencies, as well as incorporating more considerations in the formulation of ethical medical practices. Racial and cultural diversities influence reception and view of the same topic to the degree that hardlines can be taken and conflicts arise. Ego
Voluntary Medical Male Circumcision is a campaign initiated in Africa, with the tag line “reducing HIV spread in males by 60%”. It was theorized and tested in the Republics of Kenya, Uganda and South Africa. Tests gave almost similar ranges in their results, averaging 59.63% for all tested groups. The targets groups were communities (tribes) that did not traditionally circumcise their males and were largely in HIV endemic zones. In classical Scientific Theory method, there was a control group (circumcised males) for investigation into an infection with such infamy. This is reminiscent of the Tuskegee Experiment. (https://www.cdc.gov/tuskegee/timeline.htm)
It is notable that the experiment and subsequent rollout of the program is predominantly in Africa and the African-American populations in the USA. The experiment has to itself many inconsistencies:
Lack of double-blinding: – According to the National Cancer Institute, a double-blind study is “A type of clinical trial in which neither the participants nor the researcher knows which treatment or intervention participants are receiving until the clinical trial is over. This makes the results of the study less likely to be biased. This means that the results are less likely to be affected by factors that are not related to the treatment or intervention being tested.”
The outcome was already predetermined and there were financial incentives, and as such the bias was in favour of ensuring that the control group (circumcised males) had a lower infection rate.
Risk compensation: – The Peltzman Effect (theory) explains changes in human behaviour in increased and deceased analysis of risks. Due to pre-known risks/benefits was sure to cause behavioural adjustments in the target groups, leading to an increase in reckless tendencies due to perceived reduced risks offered by circumcision. This has led to a steady increase in the total infections and subsequent deaths. While the numbers are going down, as a percentage of the booming populations in most African nations, the steady increase in infections among new and natively circumcised populations is an indicator of a flawed campaign.
Racial profiling: – While the virus is endemic to Africa, it is not the only affected continent. There is already a bad precedent with the inhumane trials carried out by the West, largely the USA, on African-Americans and other racial grouping in other regions i.e. Guatemala Syphilis testing 1946-1948. (https://www.history.com/news/the-infamous-40-year-tuskegee-study)
Skewed medical ethics in the research against the American Medical Association’s Principles of Medical Ethics: I, II, III, IV
7.1.2 Informed Consent in Research
(c) (iii) any known risks or foreseeable hazards, including pain or discomfort that the participant might experience; [Pain from the surgery and during healing, hypersensitivity in the initial days and gradual loss of the sensation and possible decline in pleasure during sexual intercourse].
(iv) the likelihood of therapeutic or other direct benefit for the participant; [Loss of a prepuce leading to an exposed glans, vascular changes]
(v) that there are alternative courses of action open to the participant, including choosing standard or no treatment instead of participating in the study; [ABC: Abstinence, Being Faithful to one’s partner and proper use of condoms, PrEp/ PEP, post-coital care of the penis]
(vi) the nature of the research plan and implications for the participant; [The adoption of a new way of life/norm is bound to shake up an individual’s sense of identity and processing the same. There is recorded regret for deviation from the norms of patient’s community]
(vii) the differences between the physician’s responsibilities as a researcher and as the patient’s treating physician [in using local centres for research, patients are unable to differentiate between the researcher, whose goals are largely data collection and the local physicians. In many cases, the treating physician doubles up as the data collection officer, having been recruited for the duration of the experiments/research]
As seen above, the VMMC project, despite its alleged benefits, was seemingly built on warped logic and seems to live off an increasing number of infections for its justification: Death. Skeletons piling high up to heaven. The spike in infections among youth (14-25) is at an all-time high and cause for concern, as they are now a majority circumcised (Kenya). Doing the same things and expecting change; a fool’s game.
Of interest is that the biggest players in the campaign are domiciled in or affiliated to the USA:
PEPFAR – The U.S. President’s Emergency Plan for AIDS Relief
US-CDC – The U.S. Centres for Disease Control
DOD – Department of Defence
JHPIEGO – John Hopkin’s Program for International Education in Gynaecology and Obstetrics
USAID – The United States Agency for International Development
UNAIDS – The Joint United Nations Program on HIV/AIDS
WHO – World Health Organisation
Bill and Melinda Gates Foundation
The United States government therefore has the latitude to review complaints about the research and subsequent rollout and intervene to stop the program. Taking into effect the effects on the culture, confidence and identity of the recipients, it is paramount that such basic tenets of an individual’s life remain unsullied. There can be, as with the Tuskegee case, a commission of inquiry into the entire process, vested interests, malpractices, results, complaints and net effect of the campaign with regard to the spread of HIV in affected countries.
There already exists proof that the advent of circumcision served largely to mark transitions, offer tribal and religious identities. Having established the biological losses incurred, psychological discomforts and the barbarity/malpractices witnessed in many communities.
A multisectoral review and critical dissection of the role and relevance of the practice outside of the communities/regions from which certain faiths originate (primarily the Abrahamic Faiths) is important. Assimilation of beliefs without the discomfort of culture is important, and as such, fundamentalisms witnessed among Christians, Jews and Muslims may need to be challenged. Diversity is the bane of human existence, regardless of homogeneity of thought and purpose.
A fight against traditional methods circumcisions, which are responsible for a considerable percentage of adverse urogenital complications is a campaign the USA can champion. As witnessed in a few Scandinavian countries, neonatal circumcisions should be discouraged and the decision left to the person as an adult or a teen or reasonable age. The latter is the norm in South Korea, a case study of the influence of the conservative values from the USA on foreign nations they have a strong grasp of.
A discouragement, possible legislation and later prosecution of persons who carry out the equivalent of, or an experiment in the spirit and guide of the Tuskegee and Guatemala experiments in the study of Syphilis. There should be an emphasis on the sensibilities of carrying out and funding of research that is physically, mentally or culturally altering among the perceived poorer/disadvantaged populations, especially by more powerful nations.
Collaborative results and complaint reviews need to be held by the host nation and its responsible agencies/bodies alongside the donors, research institutions and foreign nations from whence the study emanates. This helps them review and adjust the goals and processes to make them best tailored to the local communities with minimal risk or social upset. The USA can censure any persons, bodies found in contradiction of the laid-out procedures.
Funding of anti-circumcision by interested parties and normalization of the same is paramount. With this, local campaigns may be mounted, and information disseminated effectively. Sensitization fora, banners and other forms of print media as well as formulating and delivering memoranda to our politicians other policy influencers will cost a dime. As such, local campaigns will need any and all financial and material aid they can pull. Grants and other forms of aid will be a boost in the arm.
The USA, Big Brother, knows all and sees all. They therefore make a necessary ally in the fight against circumcision on a continent where the practice in preached with the reverence and manna from heaven narrative to the Israelites in the desert.