DOC applauds the recent publication of an article whose title effectively encapsulates some of the problems with the African circumcision campaigns. It is a melancholy reminder that we at DOC warned against such outcomes over 14 years ago, to no avail.

“A new Tuskegee? Unethical human experimentation and Western neocolonialism in the mass circumcision of African men.” Max Fish | Arianne Shahvisi | Tatenda Gwaambuka | Godfrey B. Tangwa | Daniel Ncayiyana | Brian D. Earp Developing World Bioeth. 2020;00:1–16.

In August, 2006, at the University of Washington, Seattle, Doctors Opposing Circumcision hosted the Ninth International Symposium on Circumcision, Genital Integrity, and Human Rights. The conference was attended by some 100 physicians, nurses, bioethicists, lawyers, professors, and other individuals concerned about the non-therapeutic (medically unnecessary) genital cutting of minors.

Among our Symposium efforts in 2006 was the creation of a formal submission to the nearby Gates Foundation. Along with PEPFAR, UNAIDS, WHO, and CDC, the Gates Foundation was in the beginning stages of funding male circumcision (MC)—later termed VMMC, voluntary male medical circumcision, and EIMC, early infant male circumcision—aimed at all of Sub-Saharan Africa, as an intended measure against HIV.

By the year 2020, some 25 million+ Africans have been circumcised through high-pressure social campaigns, often involving coercive and misleading methods of recruitment. And yet, there remains only limited and conflicting evidence that these millions of genital surgeries have had any substantial real-world effectiveness against HIV/AIDS.[1] At the same time, there is emerging evidence that in some regions, they have only aggravated the situation and created collateral injuries and infections.[2-4]

It is with no pleasure and much sorrow that DOC now notes that many of our urgent predictions and warnings of 14 years ago have come to pass, as the article in Developing World Bioethics describes.

We warned the Gates Foundation in 2006 about these likely risks:

  1. Medical colonialism, cultural imperialism, and roiling ethnic rivalries
  2. Experimentation on men not told they were already HIV-positive
  3. Risk to girls and women who might assume their Western medically-circumcised partners were now immune to HIV (and whose partners might encourage that delusion)—so-called risk compensation
  4. Septic circumcisions by lay operators with minimal medical training
  5. Septic rural settings where even clean water is unobtainable
  6. Botches in locales where surgical reconstruction would be completely unavailable
  7. Involuntary circumcisions of adults, and of minors who could not fully consent
  8. ‘Herding’ of African men and boys toward circumcision to please local elders and national health ministers well-paid by Western interests
  9. Increasing the incidence of FGC (female genital cutting), as all genital amputations might be normalized as Western HIV panaceas
  10. Initiating a genital cutting tradition (as in South Korea) which might linger generations after the scourge of HIV/AIDS was over or a simple cure found
  11. Iatrogenic transmission of other infections, including sexually transmitted infections

Over 14 years, reports from Africans themselves have noted instances of many of the risks and problems the Symposium members predicted in 2006, and there are unsettling reasons for this. The article in Developing World Bioethics quotes an earlier discussion of attitudes toward FGC vs. MC, which reveals the odd revulsion toward FGC by MC proponents in contrast to their enthusiasm for the Anglophone tradition of male circumcision, imposed on Africans where no tradition previously existed:

[…] they tend to think of the most extreme forms of female genital cutting, done in the least sterilized environments, with the most drastic consequences likeliest to follow [while simultaneously thinking of] the least severe forms of male genital cutting, done in the most sterilized environments, with the least drastic consequences likeliest to follow, largely because this is the form with which they are culturally familiar.[5]

There are many lessons to be learned here, not the least of which concerns the White, Western comfort with intrusive cultural imperialism, while simultaneously ignoring the need for reform in one’s own culture.

In 2006 or in the years thereafter, DOC received not the slightest professional or polite reply from the members of the World Health Leaders of the Gates Foundation to whom our petition was individually addressed. We have no indication that the medical and social risks and the racially insensitive intrusions we described in 2006 were ever even considered.

The original Symposium document is available to anyone who wishes to read it. It is amazingly prescient even in 2020—14 years on—and still has not received a civil response.

Sincerely,

John V. Geisheker, JD, LL.M
Executive Director,
General Counsel,
Doctors Opposing Circumcision

References

1. Garenne M, Matthews A. Voluntary medical male circumcision and HIV in Zambia: expectations and observations. J Biosoc Sci.2020;52(4):560-572.

2. Rosenberg MS, Gómez-Olivé FX, Rohr JK, Kahn K, Bärnighausen TW. Are circumcised men safer sex partners? Findings from the HAALSI cohort in rural South Africa. PLoS One.2018;13(8):e0201445.

3. Gilbertson A, Ongili B, Odongo FS, et al. Voluntary medical male circumcision for HIV prevention among adolescents in Kenya: unintended consequences of pursuing service-delivery targets. PLoS One. 2019;14(11):e0224548.

4. Luseno WK, Field SH, Iritani BJ, et al. Consent challenges and psychosocial distress in the scale-up of voluntary medical male circumcision among adolescents in western Kenya. AIDS Behav. 2019;23(12):3460-70.

5. Earp BD. Female genital mutilation and male circumcision: toward an autonomy-based ethical framework. Medicoleg Bioeth. 2015;5:89-104, p. 94.