One thing is not like the others:
Concurrent multiple sexual partners, low condom use, and low circumcision have fuelled HIV/AIDS transmission, a University of Zambia (UNZA) senior lecturer has said.
Giving Botswana, which reportedly has a high condom use and a high prevalence rate as an example, Dr Bowa explained that the problem was due to inconsistent condom use.
An individual’s irresponsible behavior will catch up with him, circumcised or intact, which is a nice way of introducing this study:
Background: Evidence for efficacy of male circumcision as an HIV prevention measure is increasing, but there is serious concern that men who are circumcised may subsequently adopt more risky sexual behaviors.
Before continuing, remember that the most recent trials investigating whether or not circumcision reduces HIV transmission ended prematurely because, having analyzed the initial results, the researchers deemed it unethical to continue the study without offering¹ circumcision to the intact participants. Okay, then. With that out of the way, the question is worthy. Will men engage in more risky sexual behaviors after circumcision?
Methods: Using a prospective cohort study, we compared sexual behaviors of 324 recently circumcised and 324 uncircumcised men at 1, 3, 6, 9, and 12 months after circumcision/study enrollment. The main outcome indicators were incidence of sexual behaviors known to place men at increased risk of acquiring HIV, namely, having sex with partners other than their wife/wives for married men or other than “regular” girlfriends for unmarried men.
And the glowing conclusion?
Results: During the first month following circumcision, men were 63% and 61% less likely to report having 0 to 0.5 and >0.5 risky sex acts/week, respectively, than men who remained uncircumcised. This difference disappeared during the remainder of follow-up, with no excess of reported risky sex acts among circumcised men. Similar results were observed for risky unprotected sex acts, number of risky sex partners, and condom use.
Supporters of circumcision – I’m only concerned about those who would force circumcision on infants – as an HIV prevention technique may draw the conclusion that circumcision does not encourage men to engage in riskier behavior. That conclusion is fine, and it gives a positive spin to this study, but it misses the point. The issue is not whether or not men refrain from risky behavior shortly after the procedure. Of course they’ll engage in less risky sex. The nature of an open, healing surgical wound immediately following circumcision almost guarantees that. I don’t need data to know that.
The issue is the long-term effect, especially considering how many now tout HIV prevention as an excuse to circumcise infants. Infants will not engage in sex for years, so the convergence of long-term behavior matters exclusively. If men continue to engage in unprotected sex with HIV-positive women after circumcision, those men will become infected. Regardless of the 50% reduction, the question becomes when, not if.
In our society, in the context of infants, circumcision alters nothing. It offers no change in the need for intelligent sex education. Personal responsibility and behavior will still matter most. However legitimate the protection is, and I have no reason to doubt it, the impact of circumcision on HIV prevention is miniscule, at least in the United States. We must require more than miniscule benefits to justify the risks and rights violation involved in infant circumcision. Every justification short of immediate medical necessity with no less invasive alternatives fails reason and should be discarded.
¹ Not offering the choice to adults is unethical, but taking the liberty to recommend forced circumcision for infants is not. Interesting lack of logic.