Ugandan men wait in line to be circumcised
(source: Science Guardian)
Routine male circumcision goes at least as far back as Abraham and simply refuses to die. In fact, a World Health Organization report from 2007 urging “that male circumcision now be recognized as an additional important intervention to reduce the risk of heterosexually acquired HIV infection in men” has led to a global renaissance of a practice that – justifiably or not – has been much maligned by activists in recent years. Other perceived benefits over the millennia have traditionally included protection from phimosis, general bacterial infection, penile cancer, cervical cancer in women, and of course masturbation (a biggie in the Victorian era). But no one could have anticipated the additional benefits it would bring to regions of Africa where the procedure was previously unknown.
Unlike female circumcision, the brutal excision of the female genitalia which is more accurately described as female genital mutilation, male circumcision is a fairly simple procedure that has been practiced throughout much of Africa for millennia for both ritual and hygienic reasons. In November 2008, the Kenyan government responded to the WHO recommendation by launching a massive nationwide male circumcision "rollout" aimed at circumcising 1.1 million men by 2013 (approximately 85 percent of Kenyan males have already undergone the procedure). It has concentrated its activities in Nyanza Province on the shores of Lake Victoria, where only about half of men between ages fifteen and forty-nine are circumcised and where the HIV/AIDS rate tops fifteen percent (President Obama’s father, a member of the Luo tribe, was born there). So far the government has trained over 700 health professionals to carry out the program and will soon be offering routine infant circumcision services as well. Around 75,000 Kenyan males have already taken advantage of the service.
What distinguishes the Kenyan crash program for adults from standard circumcision among Jews, Muslims, and Americans (aside from the critical issue of informed consent) is the way the government has linked the procedure to a medical check-up and basic health information. Candidates for the procedure are not only given a test for AIDS and other sexually transmitted diseases, they also get a brief lookover by a doctor along with advice on safe sex practices, basic health, and sometimes even diet and lifestyles. In many cases, circumcisers represent the first doctors many of these men will ever have encountered.Rwanda, Uganda, and Botswana are instituting similar programs and South Africa is likely to follow suit.
However, such programs are not without risks. There is a very real danger that African men will expect too much from the “invisible condom” of circumcision and proceed to engage in even more dangerous behavior than before. Moreover, despite a series of regulations, there is still a possibility that the surgery will be performed by unskilled practitioners with all the health risks that entails. Nor should we ignore the issues of loss of sensation, pain, general dysfunction, and other complications that have kept the debate over “the circumcision decision” alive for decades. It's still hard to say whether this blind faith in a usually unnecessary surgical procedure represents "medical progress" or a return to the magical thinking that is behind so many of Africa's problems today.
But despite these concerns, Africa’s current embrace of male circumcision may well represent a “short cut” to better health for all people on the world’s poorest continent.