circumcision at the Daily Dish
The Daily Dish’s guest bloggers continue to post on circumcision. Yet they continue to ignore what to me is the central issue regarding these studies, the vastly different rates of infection between sub-Saharan Africa, and the unique logistical and cultural factors that make sub-Saharan Africa an international outlier in both HIV infection and the types of people who contract HIV. Sub-Saharan Africa, when it comes to HIV and AIDS, is a unique place, with rates of infection and methods of transmission that simply aren’t seen in other parts of the world.
Which is why I think that circumcision is an enormously powerful tool for fighting HIV and AIDS in sub-Saharan Africa. It’s worth pointing out that none of the studies of circumcision as a tool for fighting HIV transmission took place in the developed world. These studies are demonstrating a clear advantage in fighting a terrible disease, but it is a clear advantage in one part of the world with a disease that is largely regional. And, again, it is a disease that, in the developed world, afflicts two kinds of people, men who have sex with men, and people who abuse intravenous drugs. And, again, the only method of infection that has shown any benefit in terms of reducing risk is female to male infection from vaginal sex. All of these studies have shown no reduced incidence of infection in homosexual sex. In the developed world– in America– HIV is not transmitted through heterosexual sex in any kind of statistically relevant way. Statistically, we know that it is almost always the case that HIV infections in America are the product of sex between men, the sharing of needles, passage from mother to child in utero, and the (happily, now much rarer) through blood transfusion. Deductively, we can understand that without the cultural practice of dry sex as practiced in sub-Saharan Africa, and without the incidence of untreated, open sores from other STIs, there isn’t the possibility of blood-to-blood contact that is the only reliable way that HIV is transmitted. And the risk of infection is only one half of the question when considering the public health risks of infection; the other half is the pool of infected, and again, outside of sub-Saharan Africa and particularly in America, the pool of non-intravenous drug using heterosexuals who have HIV is effectively zero.
If I was an anti-circumcision zealot, I would not recommend circumcision for men living in sub-Saharan Africa. And I would likely not want parents to circumcise their children on religious grounds. But I do think circumcision is a very important tool for preventing the spread of HIV and AIDS in sub-Saharan Africa; I think men should be encouraged in those cultures to be circumcised; and I think we should provide funding and education for them to do so in clean, sterile conditions. I additionally, of course, believe that ultimately parents are empowered to make the decision, whether for religious observation or whatever else. What I ask, however, is that a procedure with almost no proven medical benefit whatsoever for Americans not be recommended as a universal procedure for an entire sex based on a reduced risk of a disease when the people who are protected from that disease by the procedure don’t get the disease in the first place. And I want those arguing for routine circumcision to be more honest about who, exactly, is being zealous. Shouting “Lose the foreskin!,” as Rosin’s first post did, demonstrates that she is taking exactly the wrong kind of attitude towards the issue, and reveling in a lack of sensitivity or regard for the concerns of people who don’t think routine surgical procedures for negligible medical benefit make sense.
The only reason I can think of that Chris Bodenner and Hanna Rosin are not being honest about the number of people infected in the United States, and the essentially mythical nature of HIV infection from heterosexual sex in the United States, is out of some dedication to political correctness. In a very well-intentioned but ultimately harmful way, those pushing for AIDS awareness in the early and mid-90s ended up developing many myths about HIV and AIDS, particularly the size of the disease here in America (HIV is most certainly not a pandemic in the Western world) and of who catches the disease. Outside of our dedication to political correctness, the simple fact is that HIV and AIDS, outside of sub-Saharan Africa, afflict two groups of people, gay men and those who use intravenous drugs. That we have elided respect and love for the people who have the disease, and a dedication to fighting it, with the sympathetic lie that everyone has to fear HIV and AIDS, tells you something about our culture.
And Bodenner and Rosin’s reticence, I think, tells you something about the clarity of their thoughts on this issue. Whatever else you think of Andrew Sullivan, one thing he most certainly is not is someone who allows pleasant fictions to control his thinking on contentious issues. I put it to you that Andrew would be exactly the first person to admit to politically incorrect truths. It’s especially disheartening to read such muddled thinking about HIV and AIDS on the Daily Dish, where open and critical thinking on the virus and disorder is usually found. I hope one of the guest bloggers will consider the gaping statistical differences between sub-Saharan Africa and the United States, when it comes to HIV, in a post soon.