This section of dontgetstuck presents evidence to support critical debate about the impact of circumcision on men’s risks to get or transmit HIV. This introductory page links to other pages: % of circ’ed vs intact men with HIV in Africa; % of adults with HIV vs % of men circ’ed around the world; risk to get HIV in circ’ed vs intact men; critique of three key trials of circ to protect men; evidence men got HIV from unsafe circumcisions; impact of male circumcision on women’s HIV risk; and an annotated list of articles and websites on circumcision.
If you have decided to get circ’ed, and are not interested in evidence or debate, click here for advice about how to ensure you do not get HIV from the circumcison procedure.
To cut or not to cut? Introduction to the debate
Beginning from 2007, WHO, UNAIDS, some donors, and some African governments have been promoting mass male circumcision to reduce HIV transmission. In 2009, USAID laid out plans to circumcise 35 million men in 14 African countries during 2011-2015. This rusk to cut ignored a lot of evidence and arguments (follow links for more details and resources).
1. First, the programs are based on the common but dubious assertion that sex accounts for most HIV infections in Africa. If that’s not so, then circumcising millions of men is unlikely to have a big impact on Africa’s epidemics. Is it a massive medical experiment? There is already a lot of evidence that skin-piercing procedures may be a bigger risk than sex for many if not most adults (see other pages in this website, including: sex vs. unsterile instruments in Africa; Cases & Investigations; and data linking HIV to injections).
2. Second, even if circumcision reduces a man’s risk to acquire HIV through sex, there are other ways to do so that are safer and easier. Notably, some evidence shows that intact men who wait after sex to wipe their penis — letting sexual fluids deal with HIV — have less risk for HIV than circumcised men (here’s another link on this point). In any case, because circumcision (or waiting to wipe after sex) provides only partial protection, men still need to use condoms to be safe, not just safery. So circumcision is unnecessary, and may increase risk (if a man or his partner considers circumcision an excuse not to use condoms).
3. Third, claims that mass circumcision will significantly lower HIV risk in Africa are based on evidence from selected studies only. Three key tudies selectively reported collected data on sex and blood risks — raising questions about what really happened (one of these studies found but ignored low risk for HIV in men who waited to wife after sex; see links in pt 2, above). A full view of available evidence shows: more HIV in circ’d vs. intact men in some African countries; limited epidemics in many countries where most men are intact; inconsistently lower risk for new infection in circ’d vs. intact men; and sometimes higher risk for women.
4. Fourth, circumcisions are promoted with insufficient care to ensure that the procedures are safe — putting men at risk to get HIV, hepatitis B, hepatitis C, and other infections. Some evidence says that African men and boys likely got HIV during circumcisions.
The evidence and arguments considered in this site focus on interactions between circumcision and HIV infection. This is a narrow approach to a complex issue. Aside from HIV, many other factors are involved in a man’s or family’s decision to circumcise or not. These include other real or supposed health risks and benefits, sexual satisfaction and performance, community practices, and religious beliefs. Other websites address these other issues.