The One Concept You Need to Know about Routine Infant Circumcision

Posted: October 22nd, 2015 | Author: | Filed under: "Voluntary", Parenting, STD | No Comments »

Here’s a frustrating analysis of circumcision, 5 Ways Circumcision Affects the Rest of Your Life. It’s throwaway click-bait at its core. I clicked, they won. There’s still something interesting within the list:

Most guys have no choice in whether they have a foreskin or not. Nearly 60 percent of male newborns in the U.S. get circumcised at birth, according to the Centers for Disease Control and Prevention. But your parents’ decision about that tiny bit of skin has far- and wide-ranging implications. …

The list deserves credit for not being entirely ridiculous in its approach. It provides the ethical map from its first words. The first item is circumcised men “last longer”. That isn’t presented as an unquestioned benefit. And the second item is the possibility of sexual difficulties for female partners from male circumcision. So, yay. But then the third item:

Before you get bitter[¹] about the female orgasm thing, thank Mom and Dad for this: Circumcised men are less likely to get penile and prostate cancer[²], research finds. …

It’s reasonable to get bitter about the “female orgasm thing.” It’s even more reasonable to get bitter about the “last longer” thing. The first five words of the author’s essay, “most guys have no choice,” demonstrate that mom and dad deserve no thanks or applause for taking that choice away. I accept that some men “thank mom and dad” for “last longer”. That post hoc rationalization can’t change the ethics. Bad things happen in every circumcision. Other bad things can also happen from circumcision. Until the child expresses his affirmative consent to non-therapeutic circumcision, mom and dad need to keep their preferences to their own body. His body isn’t their choice.

¹ Whether bitterness (i.e. anger) is productive as a driving motivation is a separate concern.

² Again with this.

I Guessed What Phase Two Involves

Posted: September 7th, 2015 | Author: | Filed under: "Voluntary", Control, Ethics, HIV | No Comments »

Oh, what could this transition be?

The National Voluntary Medical Male Circumcision taskforce has rolled out the second phase of circumcision on regions with a high burden of HIV this time targeting over 1 million men.

The chairman of the Inter County Taskforce on Male Circumcision Dr Ojwang Lusi said the program is transitioning to the second phase of implementation that will run to July 2019.

We all guessed what this means.

The second phase will lower the circumcision age of boys to between 10-14 years.

I assume there’s a Phase Three – or an undocumented aspect of Phase Two – involving infant “men”. Predictably, it’s obvious why.

Lusi further noted that some challenges emerged in the first phase that they will strive to address as the second phase.

He said most of the men above 25 years declined to go for the exercise with limited number of women getting involved in the exercise with their husbands.

Men won’t volunteer, so child men get “volunteered”. As always with those who are unethical, because outcome matters instead of consent.

Joint Government Effort to Eradicate Consent

Posted: June 19th, 2015 | Author: | Filed under: "Voluntary", Control, Ethics, HIV, Public Health | 2 Comments »

As always:

The Ministry Of Information and Communication Technology in partnership with the Ministry of Health and the centre for Disease Control in America are collaborating on a National Strategic framework known as the Voluntary Medical Male programme which is a joint government effort to eradicate the long struggle of HIV/AIDS infections.

HIV/AIDS has always been the countries top priority with the health ministry being pressured to reach their ambitious 2030 vision to bring HIV/AIDS infections to zero in the country.”The Centre for Disease Control and the Ministry of health have had three randomised controlled trial runs of the voluntary medical male circumcision programme prior to it’s launch in 2009. With the success of the programme around 20,000 sexual active males have been circumcised to date thus raising 80% awareness to men to encourage more males in considering medical circumcision,”said programme specialist Mr Dan Rutz of CDC.

Somehow success is measure in “males circumcised” without giving any statistics on HIV rates¹. So it’s easy to predict what “encouraging more males to consider ‘medical’² circumcision” means:

“Medical male circumcision has been found to be cost effective, as well as all procedures are free at clinics it has been known that healthy employers increases work productivity within any work environment which leads to a steady healthy work environment that enables the economy to grow,” added Rutz.All males that have not been circumcised are encouraged to do so as procedures can be performed at all local regional clinics in the country as government want to achieve it’s target to circumcise 330,000 men between 15 to 49 years by the end of 2016.The Ministry would also like to implement a national policy programme known as an Early Infant Circumcision strategy in the near future that will enable newly born babies to be circumcised.

“Enable”. Newborn males won’t get to consider or volunteer. They will be considered and volunteered, their needs, preferences, and preventative options deemed irrelevant. They are only pieces by which public health officials measure their own professional success.

As always, when public health officials discuss voluntary or adult circumcision, they never mean voluntary or adult.

¹ A drop in HIV infections would be welcome. It cannot justify violating ethical obligations to protect the rights of non-consenting individuals.

² Circumcision in this context is medicalized, not medical. Merely performing non-therapeutic genital cutting in a sterile operating environment does not make it necessary. This is also not a defensible term to justify performing non-therapeutic genital cutting on a person who does not offer explicit consent.

“Voluntary” Never Means “Voluntary”, Part Who Can Keep Count?

Posted: January 30th, 2015 | Author: | Filed under: "Voluntary", Control, Ethics | No Comments »

Zimbabwe has a plan, because public health officials just know.

THE ministry of health has launched an ambitious US$100 million male circumcision programme that is expected to see at least 80 percent of the male population being voluntarily circumcised.

Some 400 235 males have been circumcised since 2009 with ministry managing to introduce the non-surgical method of circumcision at some sites and launch preliminary studies on infant male circumcision.

If the infants aren’t volunteered, they might not volunteer. So, as always, when public health officials propose voluntary, adult male circumcision, they never mean voluntary or adult. (e.g. EIMC) Bonus points to Zimbabwe’s health minister, I guess, because he didn’t pretend the plan was only aimed at adults. But, as I wrote in the PEPFAR-EIMC post, I suspect that means officials know they no longer need to pretend to care about ethics. That isn’t progress.

President’s Endless Plan for Avoiding Rights

Posted: January 28th, 2015 | Author: | Filed under: "Voluntary", Ethics, HIV, Politics, Public Health | 1 Comment »

PEPFAR held an event today, described as:

Join global health experts in PEPFAR’s sixth VMMC Webinar to consider the pros and cons of offering early infant male circumcision (EIMC) as part of routine Maternal, Newborn and Child Health (MNCH) care.

The title of the event was, “Scaling Up Routine Early Infant Male Circumcision within Maternal, Newborn and Child Health”. I wonder what the outcome of considering the pros and cons will be.

It’s also worth noting how circumcising infants has been separated as EIMC from “voluntary” male “medical” circumcision (VMMC). Is it progress if they’ve stopped pretending that infant circumcision is voluntary? Not really, I think, since no one involved cared anyway and dropping it means they’re comfortable with making it clear they don’t care.

Start a pilot project on the ethics of consent

Posted: December 1st, 2014 | Author: | Filed under: "Voluntary", Ethics | No Comments »

It’s banging a well-beaten drum, but as always, when public health officials discuss voluntary adult male circumcision, they never mean voluntary or adult. Again:

Kenya could expand circumcision of newborn babies if a pilot project in Nyanza is successful.

The organisation carrying out the pilot exercise reports that more parents are warming up to the idea of their babies being cut a few days after birth. The exercise follows earlier studies that proved circumcision of infants would be safe and acceptable.

Nyanza Reproductive Health Society says they have cut 600 male infants since January in the pilot programme.

If the 18-month project is successful, infant circumcisions will be rolled out countrywide. “The circumcision of an infant is safer, less technically challenging, faster, easier to care for postoperatively,” says Marisa Young, the PhD student at University of Illinois who is heading the project.

Was it acceptable to the 600 males circumcised in this program since January? Science without ethics is disgusting.

In 2012, Marisa published a study in the journal Pediatrics [ed. note: link], which revealed a high acceptance of circumcision for infants in Nyanza where circumcision is not a rite of passage.

“As adult MC becomes more prevalent, demand for Infant Male Circumcision (IMC) is likely to increase,” Marisa says in the study, which found mothers more willing to have their babies circumcised, compared to men.

From the beginning, WHO/UN/UNAIDS aimed for social acceptance, which would lead to high acceptance of circumcision for infants. We don’t want to admit we’ve made a mistake or been harmed in any way. To admit this, we must admit the obvious flaw in believing that “high acceptance of circumcision for infants” matters. The issue is always whether there would be high acceptance of circumcision by these infants. We do not know. Post hoc defenses are interesting, at best. They are irrelevant. But as we see again here in Ms. Young’s unethical study and program, the key is always to circumcise males before they can choose not to volunteer. It would be too obvious a violation to force circumcision on non-consenting adults, so children become the target.

“well, perhaps to you, but this is MY body!”

Posted: November 16th, 2014 | Author: | Filed under: "Voluntary", Logic, Regret | 1 Comment »

Musician and YouTuber Emma Blackery posted an excellent response to a question on Tumblr, Why are you getting rid of your tattoos? :(. Her reasoning is perfect and word-for-word applicable to circumcision, except for the obvious point that she chose her tattoos, whereas most circumcised males didn’t choose it.

Gonna answer this publicly – not for any malicious reason (as I’m not mad at anyone!) but simply because I’ve had SO many people phrase this question in a way to make me feel guilty.

I got many of my tattoos when I was quite young. The one on my leg is (in my opinion) very obnoxious, as well as being a mess as it was a coverup. The ones I can see in the mirror just don’t make me happy anymore. I’m a different person to the one that got all of these tattoos and they just don’t reflect me anymore.

My problem isn’t the people asking – it’s the way people are putting it, with unhappy emoticons and saying ‘why? they’re great!’ well, perhaps to you, but this is MY body! i’m the one that has to look at them every day, and i no longer want them. that’s honestly it.

“‘Why don’t you want circumcision? Circumcision is great!’ Well, perhaps to you, but this is MY body! I’m the one who has to live with it every day, and I don’t want it.”

If the press release says it’s “voluntary”…

Posted: August 1st, 2014 | Author: | Filed under: "Voluntary", Media Marketing, Politics, Public Health | No Comments »

There are few things more predictable in an article titled A Lesson in Health: Scaling Up Voluntary Medical [sic] Male Circumcision than the false use of voluntary. (all emphasis added)

[Seventh-grade teacher at Kopong Primary School in Botswana, Mothusi Joseph] Kgomo and five of his students who were circumcised that day (with their parents’ consent) are a few of the more than 1 million men and youth in sub-Saharan Africa who have chosen to protect themselves and reduce their lifetime risk of contracting HIV by participating in Jhpiego-supported VMMC programs. …

While the unprecedented scale-up of this lifesaving intervention in countries with high HIV-infection rates is impressive, what’s more remarkable are the people who helped make it happen: fathers who brought their sons to clinics, best friends who encouraged their peers, military lieutenants who set an example for their platoons, tribal chiefs and concerned wives, as well as nurses who took on added responsibilities and roles at health centers, and healthcare providers from neighboring countries who traveled long distances to help their fellow Africans during busy VMMC campaigns. …

This article – by Leslie Mancuso, President and CEO of Jhpiego – is adapted directly from a press release (pdf). That press release¹ declares that “More than 1 million men and youth in sub-Saharan Africa have chosen to protect themselves and reduce their risk of contracting HIV by participating in Jhpiego-supported voluntary medical male circumcision (VMMC) programs.” It’s always the same. When public health officials say “Voluntary Medical [sic] Male Circumcision,” they never mean voluntary. Never. I’d suspect the word will eventually be dropped altogether, just as adult disappeared, except it’s useful for the propaganda needed to circumcise healthy children.

¹ How soon before we get another “news” story about Selemani Nyika, Triza Liyasi’s husband, or Lt. Suwilanji Musamba?

The Majority of This Post’s Authors Oppose Unethical Practices

Posted: June 19th, 2014 | Author: | Filed under: "Voluntary", Control, Ethics, Media Marketing | No Comments »

It’s no longer surprising to see the hyperbole concocted to make circumcision appear legitimate. The latest example comes from the Southern Africa HIV and AIDS Regional Exchange, which summarized a survey with the following:

New study in Kenya reveals the majority of women prefer circumcised partners

To summarize the study – Women’s Beliefs about Male Circumcision, HIV Prevention, and Sexual Behaviors in Kisumu, Kenya, by Thomas H. Riess, Maryline M. Achieng, and Robert C. Bailey – the way SHARE does is presposterous. The study involved 30 women, with 23 of them saying they preferred circumcised men. The proper way to summarize it is the second line from the abstract:

Women’s beliefs about MC and sexual behaviour will likely influence the scale-up and uptake of medical MC.

Counter to SHARE’s summary, the authors note (emphasis added):

There are limitations to this study. Since we relied on self-reports it is possible that some respondents could have fabricated answers or not fully disclosed information based on what is socially acceptable, particularly on sensitive topics such as sex and HIV. We did attempt to select respondents who were representative of sexually active women ages 18-35 but given the small sample size and geographic location of our research, our data might not be generalizable to other populations, particularly those where MC is not being promoted as HIV prevention. Our intention has been to gain insights into female perceptions and sexual behaviors related to MC in western Kenya in order to inform and improve programs scaling up MMC for HIV prevention in the region.

It’s misleading to report the study as revealing what the majority of women prefer.

Of course, it’s irrelevant what the majority of women prefer. The ethics center on what the male prefers for himself. In what ways could we rewrite this paragraph to allegedly demonstrate something about what women should do – or have done to them – to conform to the preferences of men?

Respondent: Actually, me personally, I hate uncircumcised men.
Interviewer: Why?
R: I just feel they are dirty and, … this last time, some other guy seduced me, … I didn’t know he was uncircumcised. So when we went out a bit for around four months, so it’s this day was he was telling me like we go to bed, after finding out that the guy is uncircumcised I just told him it can’t work. He should go get circumcised first and come back.
I: So how did he react?
R: Well actually he felt bad, but later he came to understand. That is when he went and got circumcised and we are together now. (25 year-old Luo woman)

Body shaming is body shaming, whoever its target may be. Repeatedly the excerpts emphasize a belief that circumcised men are “clean” and intact men are “dirty”. While the authors note this, and are perhaps genuine, in saying:

… While some women support MC based on their personal experience and beliefs, there may also be the potential for discrimination against uncircumcised men as circumcision programs scale up in sub-Saharan Africa. …

I find no reason to believe public health officials cared or will care. Discrimination is a strategy of these campaigns, as in this awful propaganda ad from Uganda. And the tactic is already paying the expected dividends. The interview excerpts in this study are evidence of that:

I: Do you desire circumcised men?
R: Of course a circumcised one (laughs).
I: Why not the uncircumcised one?
R: I don’t want diseases. (22 year-old Luo woman)


I: And say you get some man who is not circumcised, what will you do?
R: You tell him that circumcision is good, a circumcised person has less chances of getting infected with these diseases, these minor diseases.
I: And if he still refuses?
R: If he refuses you just leave him. (27 year-old Luo woman)

The excerpts also reveal the well-tested “heads, circumcision wins / tails, foreskin loses” approach to sexual satisfaction.

… no matter how the lubrication is, that foreskin will, I don’t know, it moves … and then let me say they don’t stay long. … Yeah they didn’t stay long when you guys are the uncircumcised. Out of curiosity I did ask how come you don’t take long. They say like if that skin is moving it makes them crazy and they release so fast, and I said, okay. And then unlike the circumcised people maybe it’s to our advantage, the ladies, maybe it could be not to them but I think to our advantage they’ll take long. Like they might make you reach a peak faster than the uncircumcised. (23 year-old Luo woman)

The authors state that circumcision campaigns “should ensure that MMC promotion campaigns and counselling are clear that studies have shown that MC does not affect male time to ejaculation.” But campaigns like this count on individuals to sell the message, however well they grasp or fail to grasp that message. Intentionally engaging people to market on behalf of public officials involves spreading anecdotal evidence. There is no comfort or absolution in “the studies show” once they’ve started the game of telephone.

There also remains the possibility that the sources for the claim that circumcision does not affect male time to ejaculation are inaccurate. Note, too, that whether or not the male considers this change good is nowhere to be found. The ethical issue remains absent in this push for networked propaganda.

Another Reminder

Posted: April 15th, 2014 | Author: | Filed under: "Voluntary", Public Health | No Comments »

When public health officials advocate for voluntary adult male circumcision, they never mean voluntary or adult. From Zimbabwe:

The ministry was working together with the Population Services International (PSI) on the programme.

PSI director for voluntary medical male circumcision Ngonidzashe Madidi said for the purposes of sustainability, they were studying the early infant male circumcision (EIMC) to ensure protective effect of male circumcision is sustained.

Madidi said they wanted EIMC to run parallel with the adult Voluntary Medical Male Circumcision (VMMC) programme.

“Currently, EIMC is in a study phase and we are happy to say we managed to circumcise at least 560 babies successfully,” Madidi said.

Are the infants happy? Do they think it was successful?