Georgina Guedes

Circumcision is not a particularly good way to combat Aids

2014-03-25 11:41

Georgina Guedes

Minister of Health Aaron Motsoaledi has taken to the airwaves to promote male circumcision. His radio ad features a young man enthusing about the benefits of his choice, and the pain-free experience he had at an official clinic.

I acknowledge that there are medical benefits to the circumcision of adult males, namely a reduction in the frequency of the transmission of HIV. This is particularly relevant in South Africa, a country with 0.7% of the world’s population but 17% of the world’s HIV infections.

This reduction is significant. A series of studies carried out in sub-Saharan Africa discovered that there is a 58% lower transmission rate of HIV among men who have been circumcised. This alone seems to make a very compelling case for giving the tip a snip.

However – and this is where I am very concerned about the Motsoaledi’s campaign – circumcision provides absolutely no reduction whatsoever in the transmission of HIV from infected men to their female partners. None.

Reduction, not prevention

Of course, I understand that if men are 58% less likely to contract HIV, then those who do not have the disease are not passing it on to their partners – I’m not an idiot – which is why I support the idea in general. I just have two serious concerns about the way it is being marketed.

The first is that, to an uneducated audience, the subtleties of a 58% reduction in transmission rates may not be appreciated. I can see a 58% reduction quickly being easily translated into: “You can have unprotected sex with me because I am circumcised so you won’t get Aids.”

I know that the South African government’s HIV prevention strategy has a number of elements beyond male circumcision, one of which is condom use, but I believe that these two elements should be promoted with equal weight. The glorification of the responsible choice to be medically circumcised overlooks the other, very relevant reasons for using a condom, no matter what the state of the penis.

No difference in pregnancy rates

In 2012-2013, 8% of South African pregnancies were of girls under 18. But this same portion of the childbearing population accounted for 36% of maternal deaths. Those teen mothers who do not die often do not finish their education or find meaningful employment and are frequently abandoned by the fathers of their children.

To be fair to Dr Motsoaledi is also extremely vocal about the issue of teen pregnancy, but I believe there’s a disconnect between this stance, and encouraging an action that makes it less likely for males to contract HIV, and therefore more likely to be cavalier about unprotected sex, doubtless resulting in an increase in teen pregnancies.

Use condoms

We know that young South African men are generally averse to condom usage (a study by the Human Sciences Research Council in 2013 showed that condom usage is on the decrease in South Africa), but this doesn’t mean we should give up on the most effective method of reducing HIV transmission. We should be flogging that message home.

I don’t believe that any one sex education and health campaign should supersede another, but I do believe that they shouldn’t be carried out in silos either. A responsible man doesn’t just go and get circumcised. A responsible man uses a condom every single time, unless he’s in a committed relationship and trying to have a baby. And that’s what those radio ads should be saying.

- Georgina Guedes is a freelance writer. You can follow @georginaguedes on Twitter.

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