A new Tuskegee? Unethical human experimentation and Western neocolonialism in the mass circumcision of African men

Abstract

In 2007, the World Health Organization (WHO) and the Joint United Nations Programme on HIV and AIDS (UNAIDS) approved a campaign to circumcise millions of African boys and men. This policy followed the results of three randomized trials published between 2005 and 2007 reporting a relative risk reduction in female-to-male transmission of HIV of 50%-60% among circumcised men. 1 Given the urgency of the HIV crisis in sub-Saharan Africa (SSA), which represents over 70% of the global infection burden, 2 it is understandable that public health officials would seize on such an apparent "silver bullet." Between 2008-2018, 23 million men and boys underwent so-called "voluntary medical male circumcision" (VMMC) in

Voluntary Medical Male Circumcision: Responding to Brian Morris

“…Ghebreyesus as a "black Ethiopian" to suggest that VMMC policy is not racist (unaware that Ghebreyesus was appointed a decade after the WHO policy in question). As we discussed [2],…”

“…Others have noted Morris's reliance on his own polemical 'critiques' (such as the one to which we are responding) to populate biased summaries of the literature [7]. Further isolating himself, Morris proposes early infant circumcision for HIV prevention, omitting that such a program was already implemented, and subsequently suspended due to the high rate of adverse events [2].…”

Thoughtful comparisons: how do genital cutting traditions change in Sudan? A reply to ‘The prosecution of Dawoodi Bohra women’ by Richard Shweder

“…Followers of non-Muslim traditional African religions (for example, animists) of Sudan and the nowindependent South Sudan usually did not practise male circumcision, and for many, the natural unclothed and uncut penis has (at least until recently) been normative in rural settings (Beidelman, 1968) and circumcision would go against the norms. However, for the majority, male circumcision is further reinforced by medical acceptance, WHO (2018;2021) advocacy and the conventional thinking that is it neither particularly risky nor harmful to health or sexual well-being -though recent scholarship has questioned this (Fish et al, 2020).…”

“…The WHO differentiation of types of FGM/C results in a recommendation not for variable laws, but for a ban on all forms of 'FGM' (excluding Western-originating cosmetic genital surgeries), while promoting medicalised male circumcision (in the hopes it might reduce HIV infections). Despite various critiques of the WHO's positions (Hodzic, 2013;Fish et al, 2020;Shweder, 2022), these influential views underlie the strict laws that created tension between religion and law for the Dawoodi Bohra.…”

Non-therapeutic male circumcision in infancy or childhood and risk of human immunodeficiency virus and other sexually transmitted infections: national cohort study in Denmark

“…However, a considerable proportion of men in target countries remain reluctant to undergo such surgery. Questions surrounding VMMC's real-world effectiveness, combined with increasing knowledge about more effective and less invasive means of HIV prevention, reports of negative sexual consequences among some men undergoing the procedure at various ages [15][16][17][18][19], and bioethical concerns [20] may be among the relevant factors in explaining such reluctance.…”