Tuesday, January 20, 2015


Churches in Swaziland have agreed to back male circumcision as a way to prevent the spread of HIV even though there in no concrete proof that the procedure works and attempts to get people to have the operation in the past have failed.

In 2010 the Accelerated Saturation Initiative (ASI) was introduced into the kingdom with the target to circumcise 80 percent of Swazi males between ages 15 and 49 within a year.

programme, a partnership between the Swazi Ministry of Health and Social Welfare and the US-based Futures Group, was then extended to March 2012 when initial efforts failed to achieve the targeted results and only about 20 percent - or 32,000 - people were circumcised through the programme.  
US$15.5 million was spent on the programme, or US$484 per circumcised male.
Now, the deadline to reach the target has been extended to 2018.
The male medical circumcision programme which has been introduced in a number of countries in Africa, but not in developed countries such as the United States or in Europe, is based on a claim that removing the foreskin helps to prevent the spread of HIV. However, evidence does not support this.
A report called Levels and spread of HIV seroprevalence and associated factors: evidence from national household surveys published by USAID, for example, which studied 22 developing countries, primarily in sub-Saharan Africa, found, ‘There appears no clear pattern of association between male circumcision and HIV prevalence - in 8 of 18 countries with data, HIV prevalence is lower among circumcised men, while in the remaining 10 countries it is higher.
In Swaziland, even before the ASI was started in 2010, the Government of Swaziland knew circumcision had no effect on the rate of HIV in the kingdom. The Swaziland Demographic and Health Survey (SDHS) of 2007 reported the infection rate for circumcised males was 22 percent while for those uncircumcised it was 20 percent, which suggested that circumcision did not prevent HIV spreading. 

The Church Forum, which is formed by the Swaziland Conference of Churches, League of Churches, Council of Swaziland Churches, Swaziland Conference of the Seventh Day Adventist and International Tabernacle Ministries, issued an official statement welcoming the procedure for medical purposes last week (15 January 2015). Churches had been reluctant to join the campaign because there were issues for them about whether God approved of circumcision. 

The Swaziland Government has signed up for circumcision in a big way since 2010, even announcing that newly born babies, who have no say in the matter, were expected to be cut. 

People in Swaziland are being misled into believing that circumcision can help, when the international medical community continues to debate whether there is any evidence that it can. An internationally-based organisation called Doctors Opposing Circumcision (DOC) published a lengthy report in which it urged that ‘Both the public and the medical community must guard against being overwhelmed by the hyperbolic promotion of male circumcision.’

DOC reported that there is no clear evidence as to the effects of circumcision.

‘One study found that male circumcision had no protective effect for women and another study found that male circumcision increased risk for women.

‘[A different study] found more HIV infection in circumcised men.

‘[Yet another study] found no evidence that lack of circumcision is a risk factor for HIV infection.

‘A study from India found little difference between circumcised and non-circumcised men.

‘A study carried out in South Africa found that male circumcision offered only a slight protective effect.

‘A study carried out among American naval personnel found no difference in the incidence of HIV infection between non-circumcised and circumcised men.'

This led DOC to conclude, ‘Instituting a program of male circumcision is of dubious value. It will divert resources from proven methods of epidemic control and it may generate a false sense of security in males who have been circumcised. The desensitization of the penis that frequently results from male circumcision is likely to make men less willing to use condoms. A program of male circumcision very likely may worsen the epidemic.’

The group had its own idea on why places like Swaziland might have higher rates of HIV infection than elsewhere, ‘The epidemic in Africa may have little to do with lack of circumcision and everything to do with the percentage of the female population engaged in female sex work. One study found a definite link between the number of female sex workers in the population and the level of HIV infection.’

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