Adoption of male circumcision to fight HIV dangerous and unethical

A South African human rights group urges government to halt male circumcision adoption, calling the plan dangerous and unethical.

"The promotion of male circumcision is sending the wrong message, creating a sense of false protection, and placing women at greater risk for HIV. Males are already lining up to be circumcised so that they no longer need to wear condoms (v). Women may be the most harmed by the promotion of male circumcision (vi)," says Dean Ferris, director of the National Organisation Information resource Centres - South Africa (NOCIRC-SA).

New studies released since the three randomized control trials (RCTs) on HIV and circumcision show that RCT results cannot be applied to the general population of Sub-Saharan Africa or anywhere else (i).

Two studies published in 2008 concluded that male circumcision is not associated with reduced HIV infection rates in the general sub-Saharan population. The study specifically analysing circumcision rates and HIV in South Africa found that, "Circumcision had no protective effect on HIV transmission (ii).

"Infection rates between both groups leveled off at the end of all the RCTs and circumcision may only delay HIV infection, but does not affect overall rates.

In South Africa, the Zulus do not practice circumcision, while the Xhosas do practice circumcision. The HIV rates of each group are statistically the same.

"Especially troubling is the extraordinarily high rate of complications from male circumcision in Africa. A 2008 WHO bulletin reported an alarming 35% complication rate for traditional circumcisions and an 18% complication rate for clinical circumcisions (iii).

African's overburdened health care system cannot handle the tens of thousands of circumcision complications that would result from mass circumcision campaigns," Ferris contends, "A 2008 study found that increased use of condom promotion would be 95 times more cost effective than male circumcision in preventing new HIV infections (iv).

"Ferris goes on to say, " Studies have shown that the removal of the foreskin results in a less sensitive penis (ix). A less sensitive penis coupled with the reduced sensitivity afforded by condoms, may encourage males not to use them (x). It is unethical for circumcisions to be carried out on adult males unless fully informed consent has been obtained. The number of reports of African males agreeing to circumcision so that they no longer need to use condoms reveals that they are consenting to the surgery and are not being fully informed of its consequences.

Women may be the most harmed by the promotion of male circumcision. In addition to the false sense of security reducing safe sex practices, male circumcision INCREASES the risk of HIV transmission to women before the wound is fully healed [vii]. A 2008 WHO report found that 1 out of 4 circumcised African males still had not fully healed at 60 days post operative [viii].

Of particular ethical concern is the recent increase in advocacy for neonatal circumcision to prevent HIV. Neonatal circumcision places newborns at immediate risk of infection, hemorrhaging, penile damage and in rare cases even death (xi, xii). It is unethical to place newborns in the immediate risk of these complications to potentially reduce their risk, if at all, of acquiring HIV 15-20 years later when other prevention methods may exist.

"Ferris concludes, "the promotion of male circumcision for HIV prevention is fraught with logistical, monetary, ethical and human rights concerns. Proponents of circumcision have yet to suggest a long term monitoring system in order to evaluate failure or success of the exaggerated claims based on the three RCTs which are in contrast with real world population samples. While the world is desperate for a silver bullet to end the HIV epidemic, the use of male circumcision is not the answer that we have been waiting for.

"Wilfred Ascott - NOCIRC-SA: Communications Advisor - Ferris - NOCIRC-SA: National Coordinator -

NOCIRC-SA - National Organisation of Circumcision Information Resource Centres – South Africa


[i] Garenne M, Long-term population effects of male circumcision in generalized HIV epidemics in sub-Saharan Africa. African Journal of AIDS Research 7(1), 1–8 (2008).

[ii] Connolly C, et al., Male circumcision and its relationship to HIV infection in South Africa: Results of a national survey in 2002 S Afr Med J 98, 789–794 (2008).

[iii] Bailey RC, Egesah O, Rosenberg S. Male circumcision for HIV prevention: a prospective study of complications in clinical and traditional settings in Bungoma, Kenya. Bull, WHO 86(9), 657–736 (2008).

[iv] McAllister RG, Travis JW, Bollinger D, Rutiser C, Sundar V. The Cost to Circumcise Africa. Int. J, Men's Health 7(2), 307–316 (2008).

[v] Nyakairu, F. Uganda turns to mass circumcision in AIDS fight. Reuters Africa 13 August (2008). bodyandhealth/sexualhealth/ story.html?id=2788448d-1b51-44e2-9fef-ab591d723ad7 (March 2, 2009).

[vi] Irin, Swaziland: Circumcision gives men an excuse not to use condoms. UN Office for the Coordination of Humanitarian Affairs 31 July (2008). (March 2, 2009).[vii] Wawer M, Kigozi G, Serwadda D, et al. Trial of male circumcision in HIV+ men, Rakai, Uganda: effects in HIV+ men and in women partners. 15th Conference on Retroviruses and Opportunistic Infections 3–6 February, Boston. Abstract 33LB (2008).

[viii] Bailey RC, Egesah O, Rosenberg S. Male circumcision for HIV prevention: a prospective study of complications in clinical and traditional settings in Bungoma, Kenya. Bull, WHO 86(9), 657–736 (2008).

[ix] Cold CJ, Taylor JR. The prepuce. BJU Int. 83 Suppl.1, 34–44 (1999).

[x] Gusongoirye D. Rwanda: Nothing can fight HIV/AIDS better than discipline. The New Times (Kigali) 12 February (2008).

[xi] Williams N, Kapila L. Complications of circumcision. Brit. J. Surg. 80,1231–1236 (1993).

[xii] Paediatric Death Review Committee: Office of the Chief Coroner of Ontario. Circumcision: a minor procedure? Paediatr. Child Health 12(4), 311–312 (2007).

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