Laura Engelman is an intern for the Male Circumcision Consortium at FHI 360, where she collaborates with a team to conduct research and apply findings on male circumcision as a biomedical tool in the fight against the spread of HIV in sub-Saharan Africa. In this two-part piece, she discusses the benefits of and controversies surrounding medical male circumcision.
Voluntary medical male circumcision (VMMC) has been proven to reduce men’s risk of HIV acquisition and is recommended as part of a comprehensive HIV prevention strategy for communities heavily affected by HIV and with low rates of male circumcision. Three randomized controlled trials (RCTs) conducted in Kenya, South Africa, and Uganda (published between 2005 and 2007) showed overwhelming evidence in favor of male circumcision as a risk reduction strategy against female to male HIV transmission. These studies found that removing the foreskin of the penis, where HIV receptor cells thrive, reduces a man’s chances of contracting HIV through vaginal sex by approximately 60 percent.
VMMC is especially important for males in their late teens and early 20s as many men in this age group have recently or will soon become sexually active. Also, because many men in this age group are not yet married, they may have multiple sexual partners. Furthermore, adolescents might not yet have learned ways to reduce their risk of acquiring HIV or other sexually transmitted infections. The counseling component of a comprehensive package of MC services is thus especially relevant for adolescents.
Medical male circumcision (MMC) does sometimes raise some controversial questions and concerns, particularly in regards to adolescents. For example, many non-circumcising communities view MMC as an affront on their cultural traditions. Other communities hold circumcision sacred as a rite of passage or religious tradition and do not want this ancient ritual taken over by medical professionals.
Whereas infant Jewish males are typically circumcised on their eighth day, Muslim boys can undergo the procedure anytime between birth and puberty. In many sub-Saharan African communities, circumcision is not performed for religious reasons but rather as a cultural rite of passage for adolescents. Combined with other rituals meant to test maturity, strength, and wisdom, circumcision represents a passage from boyhood into adulthood. This traditional circumcision, however, oftentimes involves only a small cut to or partial removal of the foreskin and may not effectively reduce the risk the HIV acquisition. Furthermore, these traditional circumcision ceremonies can be associated with unsafe practices and negative health outcomes.
On Monday, September 12, we will post part two of this piece, which illustrates how community concerns over VMMC can be allayed and how community members become valuable advocates of the procedure.