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Public Health Fail: Circumcision Does Not Grant Immunity From AIDS

Francesca Bessey |
December 6, 2013 | 4:25 p.m. PST

Senior Opinion Editor

It is imperative we do not mislead the public about HIV/AIDS. (Aktionsbündnis gegen Aids, Creative Commons)
It is imperative we do not mislead the public about HIV/AIDS. (Aktionsbündnis gegen Aids, Creative Commons)
Well, the good news is that studies show circumcision may reduce a man’s risk of contracting HIV as much as 65 percent.

Since 2007, when word of these studies first began to get out, about 3.2 million African men have been tested for HIV/AIDS and voluntarily circumcised. Through public awareness campaigns, UNAIDS, the UN group leading the circumcision effort, hopes to see 20 million circumcised by 2015.

The bad news, however, is that ad campaigns aimed at promoting circumcision for AIDS prevention have conveniently forgotten to mention that circumcised people can still have AIDS.

According to a New York Times article published on the issue, “Many news reports have quoted women saying they believe that circumcised men are “cleaner” or “safer.” Health campaigns are supposedly encouraging this stereotype in the interest of creating a cultural imperative for young men to get circumcised.

The problem is that in doing so, they are also giving traction to a dangerous new AIDS myth in an area already rife with misconceptions about sexual health.

One Ugandan ad described in the article features a young, made-up woman gazing downward in shock with “You mean you’re not circumcised!” in prominent lettering below her face. The poster obviously intends to imply that women—particularly young, attractive women with nice nail polish on—are not about to have sex with a man who’s not circumcised and risk contracting HIV. 

Unfortunately, the corollary of such an over-simplified message is that circumcision is a green light for sexual activity, even though circumcised men can still have HIV and they most certainly can still pass it on.

In tiny print at the bottom of the poster, almost too small to see, is a warning from the Ministry of Health Advisory stating that having sex without condoms still puts men at risk, even with circumcision.

Excuse me a minute, but did we really just go there?

Are we really playing a fine print game with AIDS awareness? Experts agree that one of the leading causes of the spread of HIV is the massive number of people who are completely unaware that they have it; now, not only will we have those same people walking around not knowing they have the virus, but a great deal more walking around thinking that they can’t have it.

The fine print on the poster is one thing—but the fine print of this Times article is that there is something seriously wrong with how AIDS is being fought in southern and central Africa.

Circumcision may reduce a man’s risk of contracting AIDS, but great care must be taken to ensure that circumcision does not become a public symbol of being free of the disease. HIV is not spread through intercourse with an uncircumcised penis. It is spread through intercourse with a penis (and other genitalia) that has HIV.

And a circumcised penis can still have HIV.

Health campaigns, like those described in the Times, that encourage myths of circumcised men being “cleaner” or “safer” are therefore not only going to stigmatize uncircumcised men; they are actually going to increase incidences of unprotected sex with uncircumcised men on the false assumption that these men are immune to HIV.

Deluding millions of men into thinking their lack of foreskin makes them immune to AIDS? Probably going to contribute pretty heavily to the spread of AIDS.

The last paragraph of the Times article mentions that some men who test positive for HIV still opt to have the circumcision procedure. While I hope this choice isn't motivated by the desire to appear “clean” to potential partners and score unprotected sex, circumcision myths propagated by careless “public health” campaigns do clear the way for the success of this despicable strategy.

And the best part about all of this? Circumcision may reduce a man’s risk of getting the disease, but there’s no evidence to support a reduced risk of passing it on if he already has it.

So all of those people fooled into thinking they are protected actually face the same risk of contracting the disease from a circumcised partner with HIV/AIDS as an uncircumcised one.

While the news that there exists anything out there to reduce the risk of contracting HIV is fantastic, creating false expectations of immunity from the disease is almost sure to set back what progress has been made in getting people to acknowledge and manage their condition responsibly.

UNAIDS cannot ultimately control the posters used by Uganda’s health ministry. But this wouldn’t be the first time that states misled their citizens about an important health issue (with sexual health, it happens more often than not). And UNAIDS does have a responsibility to observe and influence how their goals are being implemented and to intervene if they are being promoted in a way that puts people at risk.

In this case, it wouldn’t take much. Just a little more thought on the full implications of the message being sent to the unsuspecting, often uneducated public.

The world tried to fight AIDS using shame and stigma for way too long; we can—and we must—do better.

Reach Senior Opinion Editor Francesca Bessey here; follow her here.


 

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