Intactivism News

Dutch News
May 7, 2008

Father 'not guilty' in circumcision case

A father who had his sons aged three and six circumcised against the wishes of his ex-wife has been found not guilty of causing them serious physical harm, the Parool reports on Wednesday.

But the man was given a six week suspended jail term for taking the boys away from their mother, who has custody, against her will.

[How can it be a more serious crime to take them from their mother against her will than to cut part of their genitals off against her will (and theirs)?]

Renal and Urology News
May 6, 2008

Urologist Sued by Patient Mum about His Diabetes

The surgeon should have ordered a urinalysis prior to performing a circumcision on a 53-year-old man

BY ANN W. LATNER, JD

Dr. U, 41, was a sole urologist in a small community in the Midwest. He'd been in private practice for only two years, but he felt quite positive about his professional prospects and his future—until he was sued.

It all started routinely when a new patient, Mr. K, a 53-year-old man, came in. He was asked to fill out a medical information form as well as provide his in-surance information before entering the examination room. After skimming the medical information form, Dr. U spoke to Mr. K, and examined him. He discovered a urological lesion that the patient claimed he'd “had for several months and that it just wouldn't heal.” Dr. U recommended circumcision, and subsequently scheduled Mr. K for the procedure the following week.

The surgery was performed in Dr. U's office under local anesthesia. The procedure was routine, and both Dr. U and the patient expected a positive outcome. However, serious problems soon developed. Over the next three months, Mr. K kept returning to Dr. U's office with a host of issues, including pain, an unusual protrusion, urination problems, and lack of sensation. Then Mr. K abruptly stopped coming to Dr. U's office, or calling, and sought the help of another physician.

The new physician ordered a urinalysis that indicated Mr. K had diabetes. When the new physician asked whether Mr. K was aware that he had diabetes, the patient answered that he was aware. “Do you take medication?” queried the physician. “No, I just try to eat healthy and exercise sometimes,” replied Mr. K. “Did you tell your previous doctor?” asked the new physician. “He didn't ask,” replied the patient. “Did Dr. U do a urinalysis before your circumcision?” asked the physician. “No,” replied Mr. K, “Should he have?”

Diabetes hinders recovery
Armed with information from his new physician that his uncontrolled diabetes was probably responsible for his poor recovery from surgery, Mr. K hired a plaintiff's attorney. The attorney immediately hired an expert board-certified urologist. The expert stated that Dr. U should have performed a urinalysis prior to surgery [... probably instead of surgery]. Had he done so, said the expert, he would have been aware of the diabetes and could have worked with the patient to get the condition under control to avoid complications. The attorney began an action on behalf of his client, suing Dr. U for negligence for failing to order a urinalysis prior to surgery, and alleging that the urologist also was negligent in failing to properly treat the postoperative complications.

...

The defense attorney pounced on Mr. K during cross examination. After making Mr. K state that he knew that he had diabetes, he launched into a line of questions about the medical form that had been filled out in Dr. U's office.

After six hours of deliberation, the jury found Dr. U 54% at fault for Mr. K's injuries, and Mr. K 46% at fault. The jury awarded $200,000 for past and present pain and suffering and $1,750,000 for future pain and suffering.

... [Mr K's] total award, therefore, is reduced by 46%. Dr. U was 56% at fault due to his failure to inquire about diabetes or perform a urinalysis prior to surgery. He is responsible for paying 56% of the $200,000 and $1,750,000 in damages.

...

A comprehensive medical form, a thorough conversation about medical history, and basic screening tests (urinalysis and/or blood) are clearly good insurance before performing any surgical procedure, no matter how routine it may seem.

From the April 2008 Issue of Renal And Urology News

Comment by Sarah
What's sad here is that the problem the patient presented with - a sore which would not heal - was a red flag to diabetes. Sadly he went to a circumcision oriented doctor who was predisposed to believing that the problem was inherent in the patient's normal male anatomy - blind to the underlying health condition which was causing him to have a problem. Had the non-healing sore been located on his big toe - I doubt that diabetes would have been overlooked.

Future Medicine - Future HIV Therapy
May 2008, Vol. 2, No. 3, Pages 193-199

Male circumcision is not the HIV ‘vaccine’ we have been waiting for!

Lawrence W Green, Ryan G McAllister, Kent W Peterson & John W Travis

...

Conclusion

Regardless of whether circumcision might offer some heterosexual males a partial degree of protection from HIV, numerous other issues need to be thoroughly considered before instituting mass circumcision campaigns.

In short, given the large number of unknowns, confounding factors and lack of long-term follow-up in the three R[andomised ]C[controlled ]T[est]s, it is premature to recommend circumcision as an HIV-prevention strategy. Much more evidence must be gathered on real-world efficacy of male circumcision as a prevention tool before mass surgeries are implemented.

An objective scientific assessment must be conducted to determine if the three RCTs are applicable in real-world settings. And, to determine the true cost of a circumcision campaign, there must be a comprehensive resource analysis of the plan. These mass circumcision costs also must be compared with the opportunity costs of funding ABC campaigns.

As part of these assessments, the very real risks of circumcision surgery, including directly increasing HIV transmission to men as well as indirectly increasing transmission to women, surgical risks such as hemorrhage, other infections, meatal stenosis, need for repeat surgery and even death, must be considered.

Finally, the value and function of the foreskin as an integral part of the male sexual organ [31] and the ethical issues surrounding such surgery, including informed consent, the possibility of coercion and the dangerous implications of conveying erroneous messages of HIV immunity, must also be carefully considered in any analysis.

ABC programs offer nearly full protection from HIV infection, yet even if circumcision’s effectiveness matches the 50–60% effectiveness the RCTs reported, it only partially protects men, does not protect women at all, and leaves women more vulnerable to unsafe sex practices being forced upon them.

Those promoting circumcision argue that circumcision is an additional tool that will ultimately reduce infections more than just relying on condoms, monogamy and abstinence. However, African males are already lining up to be circumcised, thinking they will no longer need to use condoms. Rather than complementing ABC programs, promoting circumcision will undermine the ABC approach by diverting funds and encouraging risk compensation behavior, ultimately leading to an increase in HIV infections.

The world community must cautiously review and carefully consider the long-term consequences of mass circumcision campaigns, from the risk of increasing deaths and infections to human rights violations. In the rush to save lives, many may instead be lost and human rights trampled in the stampede. Circumcision is not the panacea the world has been waiting for in the battle to stem the HIV crisis.

Orlando Sentinal
May 5, 2008

Florida Gators star Tim Tebow's legend grows when 'Dr. Tebow' assists with surgeries on a missionary trip

Dave Curtis | Sentinel Staff Writer

Fans by now know the legend of Tim Tebow by rote: he plays quarterback as well as anyone in America, sings on stage with the stars of country music, makes girls swoon every time he smiles.

During spring break, Tebow added a new facet to his fame. In an impoverished village outside General Santos City in the Philippines, Tebow helped circumcise impoverished children.

On the Friday of a weeklong trip to the orphanage his father's ministry runs in Southeast Asia, Tebow assisted with the care of locals who had walked miles to the temporary clinic that the ministry helped organize. More than 250 people underwent medical and dental procedures, some of them from "Dr. Tebow," who has no formal surgical training.

"The first time, it was nerve-racking," he said. "Hands were shaking a little bit. I mean, I'm cutting somebody. You can't do those kinds of things in the United States. [- unless you call it "religion"] But those people really needed the surgeries. We needed to help them."

...

Tebow started as a helper and gofer, holding tools and running errands for the medics. By afternoon, he was asking questions and looking for more active ways to help. And by the end of an exhausting day, he was wearing gloves and a mask, wielding surgical scissors, finishing off stitches with a snip.

...

The locals started by hearing a brief Christian sermon from one of the Tebows and then moved to a brief medical exam from a Filipino doctor.

...

Others saw Moleno, who after a crash course from the Filipino professionals, circumcised 10 boys and removed six cysts, some the size of tennis balls. Tebow helped with the last few circumcisions, growing more comfortable with each one.

"I got a kick watching him," Bob Tebow said. "He did a great job, and he didn't look really nervous. I wouldn't let him cut on me, but he did well and helped where there was a need."

The men worked until dark, Bob Tebow said, and still had to turn away at least 50 people. The Americans performed in tight quarters by their standards and helped introduce basic tenets of medical care to their Filipino friends; Young said he got some strange looks from his professional colleagues when he wanted to sterilize tools between each procedure. [And they're circumcising "to prevent the spread of HIV/AIDS"] ...

All three remembered the reactions of the children they helped heal.

"It's really vivid for me," Tim Tebow said. "I don't remember anybody crying while we treated them. Those kids were so tough."

Dave Curtis can be reached at dcurtis@orlandosentinel.com.

[This story was repeated many time with every "humorous" string pulled. One photo shows him and friends with Stanley knives]

joe-ks.com
May 5, 2008

Billboard in Swaziland

This billboard, from Swaziland, was reproduced in a humour website.

• The only "benefit" mentioned is "pride".
• Nothing about having to go on using the condoms ...
• ... even though the International Planned Parenthood Federation is a sponsor.

New Vision (Uganda)
April 30, 2008

News in brief...

Circumcision campaign on

KAMPALA-The Uganda Muslim Suuni Association has launched a circumcision campaign. Chairman Yusuf Shubdin said the free service would also be offered to non-Muslims. Presenting the association’s annual report at the Uganda Muslim Supreme Council on Monday, Shubdin said the campaign was in response to the Government’s call on people to get circumcised. He said the exercise would be carried out every Thursday at Aldina Mosque in Old Kampala. Shubdin also said the mosque would take care of the circumcised people until they heal.

Mail & Guradian Online (Cape Town)
April 28, 2008

Mpofu snips circumcision doccie

Matthew Krouse

Buntu Majalaza died after a botched circumcision last year.

The SABC pulled a documentary on circumcision hours before it was due to be aired in response to a complaint from a member of the Congress of Traditional Leaders of South Africa who had not seen the programme.

The decision to stop the showing of the documentary was made unilaterally by SABC head Dali Mpofu, because the documentary had not been approved by an advisory body set up to guide the public broadcaster on cultural and traditional issues.

The advisory panel was set up a year ago after the broadcaster bowed to pressure from the National Heritage Council and Contralesa to halt a coming-of-age mini series titled Umthunzi Wentaba that traditionalists believed "dishonoured" circumcision.

This week award-winning reporter Hazel Friedman's full-length Eastern Cape investigation titled Rights of Passage was pulled hours before it was to be broadcast on Tuesday's Special Assignment. Friedman's report had looked into the death of 25-year-old University of Cape Town student Buntu Majalaza. He died of septicaemia as a result of a botched circumcision last year.

Special Assignment staff members tell of a frantic last-minute rush to make Mpofu a copy of the programme so that he could suspend the broadcast.

Friedman, who won the Vodacom Journalist of the Year Award last year, said this week that she was "outraged" by Mpofu's decision. In making the programme she had consulted provincial ministers for culture and health in both the Eastern Cape and the Western Cape and had received permission to film in hospitals.

"The programme was approved by our Special Assignment executive producer Johann Abrahams and head of current affairs Themba Mthembu.

"I know that we are not allowed to talk to the media but I am certainly allowed to speak in defence of a story that was absolutely respectful of tradition. It did not violate any secrets or undermine the role of any legal representative or any legal cultural custodians," Friedman said.

A staff member who spoke off the record said Mthembu and head of television news Amrit Manga had viewed the final edit of the programme and were also alarmed when Mpofu had single-handedly pulled the completed work off air. As the editor in chief and SABC Group chief executive officer Mpofu is allowed to take unilateral decisions.

Kaizer Kganyago, SABC spokesperson, said on Wednesday that the programme had been suspended because "we had not consulted everybody. Umthunzi Wentaba caused a lot of hoo-ha and we committed to consult widely before we flight any programme of this nature. By [Tuesday] we had not finalised all the steps that we wanted to go through and a decision was made to put the programme on hold."

Contralesa president, Chief Phathekile Holomisa, told the Mail & Guardian that Mpofu's move had been "a good decision. We feel in the first place that some of our cultural rituals, especially this one, don't need to be flighted on television. This is a private ritual requiring the presence and participation of those directly involved."

He said the media did have a duty to expose unscrupulous operators of back-yard initiations, "as [long as] they do it in a manner that brings this ritual into disrepute. There are structures that are meant to deal with problems emanating from malpractices."

Holomisa said he had not viewed the programme before the objection had been sent to Mpofu; in fact the objection from Contralesa chairperson of the Eastern Cape Ngangomhlaba Matanzima, had been sent to Mpofu on the strength of a promotion that had been airing on television since last Friday.

When asked if this was an act of censorship Holomisa said: "It is complex, not a straightforward matter. You are talking about the media's freedom of expression. But there are other freedoms: freedom to privacy and the freedom to exercise your cultural rights." [Whose "cultural rights?" Is there a "cultural right" to die of septicaemia?]

Philippine Star
April 20, 2008

This story was published for less than 24 hours before it was removed. It is now only available as cached or archived versions. That could indicate that it is a hoax.

La Union doc aims for circumcision record

By Jun Elias

SAN FERNANDO, La Union – A doctor here aims to be the world’s fastest circumciser of the most number of patients in an hour.

Dr. Jessie Miranda, a law graduate who was once president of the La Union Gay Society, is confident of setting the record after taking only five seconds to circumcise an eight-year-old boy from Barangay San Agustin here and 66 patients in one hour.

“I think this is the first time that a doctor like me is aiming for the record and I know I was the first because I conducted research if there is such a record, but there’s none,” Miranda told The STAR during a break from foreskin cutting duties.

Miranda said he thought of the activity to establish a record for himself and for San Fernando because he will be submitting his documents to the Guinness Book of Records.

“We are thinking then of an event that will establish a record for San Fernando, so this is what we thought of,” he said.

Miranda’s longest circumcision did not exceed a minute.

Starting at 8:15 a.m. Miranda circumcised boys from different barangays of San Fernando City, who lined up at the City Health Office yesterday.

Miranda took a break at 9:15 a.m. to check how many of his more than 700 patients have already been circumcised.

Using a laser machine, Miranda occupied a 4x10-meter air-conditioned room at the health office.

He was positioned between two beds, a patient in each of them, and was assisted by six health workers – three for each bed – to apply betadine and place surgical plaster on the penis of each patient.

The circumcision starts with each patient being injected with anesthesia in a separate room after which they line up for Miranda’s room.

Inside the room, a patient lies down on the bed and the health workers prepare him before Miranda places the tip of his laser to the skin of the penis.

The laser will cut and burn the skin, bloodless and painless, and the operation needs no stitches.

San Fernando City Mayor Pablo Ortega helped Miranda organize the medical event, which coincided with Ortega’s “Operation Tuli” project spearheaded by the CHO under Dr. Eduardo Posadas and several non-government organizations.

Aside from the record, Miranda said he also wants to share his knowledge with his townmates, particularly those who cannot afford the medical expenses of circumcision in hospitals.

“I know that some cannot afford the P3,000 to P5,000 expenses so I offered this activity,” he said.

“I’ve been doing this for more than 10 years now and this is only the first time that it was properly documented,” he said.

Ortega thanked Miranda, a former city councilor who is now the supervisor of the Auxiliary Wet Market here, for conducting the activity free.

“I hope for his success and I’m glad that this activity was conceived because this is for hygiene purposes especially for the young boys,” Ortega said.

Ortega said Miranda initially scheduled the activity as a gift for his birthday celebration on April 3, but it was moved yesterday due to his load of activities.

The final number of circumcised patients was not yet available as of press time.

[If this story is true, it is appalling malpractice. A doctor who raced to break a record for any other operation would be struck off. The Guinness Book of Records does not award records to risky activities, and it is to be hoped that it withholds any from this one.]

L A Times "Babylon & Beyond
[April 19], 2008

YEMEN: Parliament upholds female circumcision

After a heated debate in parliament this month, Yemeni women's rights advocates lost their battle to ban female circumcision, according to a report in the Yemen Times.

The parliament in recent days voted against a bill that would have outlawed female genital mutilation, a practice that is believed to affect almost 25% of Yemeni women.

Opponents claimed that the issue remains too sensitive among Yemeni and that no legal measure could be taken as long as there was no consensus among religious scholars against the practice.

Female circumcision is a widespread practice in the Middle East and Africa. Many Muslims believe that removing a girl's clitoris to tame her libido is a religious obligation.

Top Muslim clerics, including the Grand Sheik of al-Azhar Mosque, the world's oldest Sunni Muslim religious institution, have repeatedly decried the practice as purely traditional and without basis in Islamic scriptures.

Yet the scholars’ declarations have not been able to end to the centuries-old practice.

Egyptian lawmakers have been embroiled in a similar debate. A draft bill calling for the criminalization of the practice has been dismissed by Islamic lawmakers in Cairo as a Western ploy to demonize Islamic traditions.

— Noha El-Hennawy in Beirut

[Yemen is also noteworthy for the most severe form of male genital cutting.]

AIDSmap
April 10, 2008

HIV prevention studies in Africa: it's important to ask about anal sex

Michael Carter
Individuals enrolled on HIV prevention trials in Africa should be asked if they have had anal sex, suggest investigators in a article published in the online edition of Sexually Transmitted Infections. Their study found that 18% of women enrolled in their study had recently had receptive anal sex and that undiagnosed anal sexually transmitted infections were present in many of these individuals.

Studies into sexual behaviour in Africa have often neglected to enquire about anal sex, and sex between men. There has either been an assumption that such behaviour was not prevalent, or a sensitivity to cultural taboos and prejudices means that investigators are reluctant to enquire about such behaviour. But studies are now suggesting that anal intercourse is common in Africa in both heterosexual and homosexual contexts and is an important mode of HIV transmission.

The study also showed that relying on patient report of symptoms will lead to many sexually transmitted infections remaining undiagnosed, and that simple microscope examinations of genital and anal swabs can lead to more infections being diagnosed.

Numerous HIV prevention studies are underway around the world. Investigators involved in one such study in Mombasa, Kenya, wanted to demonstrate the value of introducing routine sexual health screens involving basic laboratory tests, and the value of asking individuals about anal sex so that they could be offered appropriate tests and treatment.

The study ran between 2005 and 2007 and recruitment was focused on individuals with a high risk of HIV, including 334 commercial sex workers, 316 men who have sex with men, 169 individuals with multiple sexual partners, 59 patients with recent symptomatic sexually transmitted infections, and 28 HIV-negative individuals with an HIV-positive partner.

Initially the investigators did not ask about receptive anal intercourse. It was only in 2006, after the study had been running for over a year, that questions about anal intercourse were included because participants were frequently reporting this behaviour or symptoms suggestive of a sexually transmitted infection in the anus.

...

Another important finding of the study was a high prevalence of receptive anal intercourse, which was reported by 36% of the men who have sex with men and by 18% of the women. Most (89%), but not all of these women were sex workers. Symptoms suggestive of an anal infection were reported by a third of patients reporting receptive anal sex. A total of 69 patients agreed to have an anal examination using a proctoscope, and 20% of these patients had visible discharge, 20% inflammation, and 7% ulcers. Proctitis was diagnosed in 7% of patients after microscope examination of rectal swabs.

Amongst men, recent receptive anal sex was strongly associated with HIV infection (adjusted odds ratio, 3.8; 95% CI, 2.0 – 6.9), however this was not the case in women. But the investigators did note that two-thirds of syphilis cases in women were in individuals reporting anal sex (adjusted odds ratio, 12.9; 95% CI: 3.4 – 48.7).

The investigators also found that men infected with HIV were also more likely to have anogenital ulcers and warts and have urethritis. HIV infection in women was associated with anogenital warts and pelvic inflammatory disease.

...

This study raises some significant issues about the design and robustness of HIV prevention studies in Africa. In particular, it is notable that although this study recruited men who have sex [with] men from the outset, the study protocol did not initially include questions on anal sex. It was only after the study had been running for over a year that reports of anal sex from participants lead to a change in the protocol and the inclusion of questions about anal intercourse.

Furthermore, there is a continuing reluctance in some African contexts to acknowledge the prevalence of anal intercourse in both heterosexuals and homosexuals. The investigators note, “questions on receptive anal intercourse in the recently conducted national AIDS survey in Kenya were rejected as being too offensive to ask…unfortunately, data on the general population practice of anal sex in Kenya remains elusive."

Reference: Grijsen MA et al. Screening for genital and anorectal sexually transmitted infections in HIV prevention trials in Africa. Sex Transm Infect: published online, March 28th, 2008.

Tamil Star
April 8, 2008

Uncircumcised Might Fare Better Against Genital Warts

Uncircumcised seemed to fare better against genital warts, according a US survey. Nearly 6% of sexually active people surveyed suffered from the problem, it being acute among women in 25-34 age group.

The National Health and Nutrition Examination Survey looked at 8,849 sexually active men and women aged 18 to 59 from 1999 to 2004.

... Circumcision appeared to have an effect on rates of genital warts:

4 1/2% of circumcised men reported having genital warts

2.4% of uncircumcised men reported having genital warts

Genital warts, a common sexually transmitted disease in the United States, are caused by the human papillomavirus (HPV). Researchers say more than 90% of genital warts are brought on by two strains of HPV, types 6 and 11, WebMD says.

...

The survey appears in the April issue of Sexually Transmitted Diseases.

Nation Media (Kenya)
April 10, 2008

Government adopts male cut as strategy in fight against HIV

NEWS EXTRA

Story by ARTHUR OKWEMBA

It is now official. A new circumcision policy for men aimed at reducing HIV infection rates has been published by the Government.

The policy, stipulating how all willing Kenyan men, irrespective of their age, will undergo circumcision, sets into motion the use of the surgical procedure as a standard HIV prevention strategy for the country.

Health personnel from Government health facilities at various levels are to undergo in-service training to hone their skills on the new procedure.

A Male Circumcision Task Force that will guide male circumcision in Kenya will be set up soon.

Titled Policy on Male Circumcision in Kenya 2008, the document also wants circumcision to be promoted and delivered to males of all ages in a manner that is culturally sensitive to minimise the stigma that may be associated with an uncircumcised person.

In the past, fears been raised over the possible conflict between this policy and the traditions of some of Kenya’s communities, which, as a custom, do not practise circumcision.

While some Kenyan communities invoke religious, cultural or social reasons for circumcision, others like the Teso, Luo, Turkana, and a few groups in the Coast undertake other rites of passage, which do not include circumcision.

Circumcision involves the removal of the foreskin of the male member.

Studies have shown the skin’s inner mucosal surface to be the breeding ground for the virus. This is because compared to the external surface, more of its cells are vulnerable to HIV infection. [This is pure speculation based on studies of foreskins taken from dead bodies. Other studies show the foreskin cells have a protective effect.]

Circumcisers will, therefore be required to counsel males and use techniques that reduce or eliminate the pain associated with such a surgical procedure so as to encourage more men to opt for circumcision.

Says the policy: “Ensure that male circumcision is performed by well-trained practitioners in antiseptic settings under conditions of informed consent, confidentiality, risk reduction counselling and safety.” ["Informed consent" should mean no babies, but will it?]

Health facilities from the dispensary to the district hospital levels are to be strengthened to ensure that they cope with the expected demand from men seeking to be circumcised.

Those implementing the policy will be required to put in place appropriate laws, regulations and supervisory mechanisms that are going to ensure that circumcision services are accessible and provided safely without any discrimination.

The Government’s move to adopt the policy comes at time when results from HIV vaccine trials indicate that circumcised volunteers had a lower risk of HIV infection compared to their uncircumcised counterparts.

Scientists are trying to investigate this development further to see if there is any correlation between the HIV vaccine and circumcision. [Which sounds like the circumcisors are getting ready to keep circumcising when circumcising alone has failed and an effective vaccine has been found.]

Likewise, the policy is also being implemented at time when there are fears that the number of males being circumcised may be reducing.

According to the 2003 Kenya Demographic and Health Survey, close to 72 per cent of men aged between 15 and 19 years were circumcised compared to 84 per cent above this age. However, the survey does not analyse HIV prevalence in regions that predominantly circumcise compared to those which don’t. [In Kenya, HIV is high among the non-circumcising Luo primarily because they are fishermen on Lake Victoria with a "wife" in every port, who relies on them for fish supplies and rewards them with (unprotected) sex.]

The new policy has generated excitement and disquiet among members of the public who talked to Nation, with some praising it and others saying it will worsen the vulnerability of women to HIV infection as men are likely to refuse to have protected sex.

Unprotected sex
“Circumcising every male is good because it will reduce chances of HIV infection,” says 25-year-old Brian Okila from Westlands in Nairobi.

But Ruth Njeri, an anti HIV/Aids campaigner, fears that the idea behind the new policy may make circumcised men engage in unprotected sex thinking they are safe.

“Men who have been using condoms or those who have been faithful to their spouses will now opt for unprotected sex,” Ms Njeri says.

In Kisumu, for instance, there have been reports of circumcised males engaging in unprotected sex and then ending up with HIV infection.

Such tendencies are bothering the Ministry of Health as well.

In the proposed policy, the Government says those promoting circumcision should ensure it does not replace the known effective HIV prevention methods and that it should always be considered as part of a comprehensive prevention package.

The policy further states: “Community and individual education programmes provide sufficient and correct information on the partial protection provided by male circumcision and the continuing need for other HIV and sexually transmitted infection prevention measures.”

Fourth component
This means circumcision will be treated as the fourth component of the popularly known ABC – Abstinence, Being faithful to one’s partner, and Condoms — methods of prevention. As such, health providers and communicators are now going to adopt the ABCC slogan, with the last C representing Circumcision.

“What we are trying to pass across is that a circumcised man who either uses a condom or is faithful to his partner has a reduced risk of HIV infection,” says Prof Alloys Orago, the director of the National Aids Control Council.

The other issue the Government has to grapple with is the cost of circumcision. While it acknowledges that the intervention is expensive, it does not specify where resources for implementing it are to come from.

It just calls on the Ministry of Health to “strengthen health systems to ensure that male circumcision programmes do not interrupt or divert resources from other primary healthcare services”.

To achieve this, the Ministry is required to integrate the management of reproductive, sexual health and HIV prevention programmes to provide male circumcision services.

Strengthening the services through monitoring and evaluation to guarantee quality control and planning purposes are other issues that are to be addressed before the programme gets fully underway. [Will any monitoring be done to determine whether circumcision does actually reduce the rate of HIV transmission?]

The proposed Male Circumcision Task Force is expected to help the Government confront these challenges. Some of its functions include:

• Advise the Ministry of Health on plans and development programmes for expanding safe, accessible and sustainable male circumcision services for the country.
• Guarantee professional, technical and administrative excellence as male circumcision services are expanded.
• Ensure accurate and appropriate dissemination of information to individuals, communities and the media regarding male circumcision services.
• Make certain that male circumcision is promoted within the context of the overall improvement of healthcare services.

World Health Organisation and UNAIDS have already issued a strong recommendation calling for increased male circumcision rates in countries where HIV infections are high.

Kim Dickson, the coordinator of the joint WHO/UNAIDS team that came up with the recommendations, is quoted in the March 2007 edition of New Scientist magazine as saying: “We reviewed all the evidence, and it is compelling.” [This is simply not true.]

In the South African study, circumcision was found to reduce HIV infection rates by more than 60 per cent in a group of 3,000 HIV-negative men

Of the 1,546 circumcised men, 20 became infected with HIV, while 49 of the 1,582 uncircumcised men were infected. [An absolute risk reduction of 1.55%]

Funded by the French Agence Nationale de Recherches sur le Sida (ANRS), the study sent a strong message in 2005 on the effectiveness of circumcision in HIV prevention.

Buoyed by results
Buoyed by these results, South African scientists supported large-scale male circumcision as a possible strategy for preventing two million HIV infections and 300,000 deaths in their country during the next 10 years. [These beautiful numbers are simply made up by multipying those 25 "protected" men by the population of South Africa.]

In December 2006, the Data Safety Monitoring Board that was overseeing the Kenyan and Ugandan male circumcision trials announced that the operation was a safe and effective way to reduce HIV infections among men.

The two-year trials in Kisumu and Rakai, Uganda, involved adult HIV-negative heterosexual male volunteers who were randomly divided into two groups — one group was circumcised and the other wasn’t.

In the Kisumu trial, circumcision reduced the chances of getting infected with HIV by 53 per cent. Similar results were registered in the Rakai trial in Uganda. [Except that twice as many men - 4996 - were involved in Uganda, but fewer non-circumcised men there contracted HIV thancircumcised men in Kenya - probably because of Uganda's "zero grazing" policy.]

When these trial results came out, National Institute of Allergy and Infectious Diseases (NIAID) director, Anthony S Fauci, whose organisation supported and conducted the studies, said: “We now have confirmation showing definitively that medically performed circumcision can significantly lower the risk of adult males contracting HIV through heterosexual intercourse.” [- but not of women - who are at more risk - contracting HIV through heterosexual intercourse, or men through homosexual intercourse. Condoms protect both.]

Manila Standard Today
April 2, 2008

Are we there yet?
by Bong Austero

A very public circumcision

It’s either of two things: Dumb luck or brilliant marketing strategy.

It is possible that the people behind ABS-CBN’s “Pinoy Big Brother Teen Edition Plus” simply stumbled into the circumcision issue and made an on-the-spot decision to make a big thing out of it. But it is also possible that they knew about it beforehand and that, therefore, this whole frenzy about circumcision is simply a well-calculated marketing campaign designed to attract attention and audience share.

The latter of course puts ABS-CBN’s screening process for housemates in question. I don’t think it is ethical to ask applicants highly intimate questions such as whether they are circumcised or not. At the same time, deliberately putting the spotlight on a minor for being supot, regardless of the willingness of the adolescent in question to bare it all, hardly qualifies as ethical. Or even fair.

But I would like to give ABS-CBN people the benefit of the doubt. Although I know that PBB’s ongoing focus on circumcision is primarily motivated by business concerns, I am willing to grant that the quest for ratings can be pursued alongside nobler goals.

It’s actually about time that a public discussion on something that is an integral part of our culture be conducted. It is high time that we have an intelligent and open discussion about circumcision. After all, it is a practice that majority of Filipino males submit to; and mostly without any comprehension or appreciation for the practice, or even choice on the matter. It’s just a surgical procedure we submit to because it’s part of our culture. And for many, it is a traumatic experience.

Oh, in case you don’t watch PBB and you are happily unaware about what’s happening in that very public fishbowl, one of the male teen housemates admitted on public television that he is uncircumcised. The 18-year-old housemate, Alex Anselmuccio, has a Filipina mother and an Italian father but he grew up in Italy—where circumcision is not the norm. The uncircumcised housemate has since then declared his intention to undergo circumcision inside Big Brother’s House—to become Filipino! Of course, the whole thing will be broadcast on television although no one knows yet exactly how the coverage will be handled. In the meantime, ABS-CBN has launched a gimmick to drum up more interest in Alex Anselmuccio’s rite of passage. They will conduct free circumcision to the first 100 boys to register at ABS-CBN today.

As can be expected in a country where hypocrisy is still prevalent, the censors who go by the name Movie and Television Review and Classification Board, have already sent a warning to ABS-CBN that they are closely monitoring the situation. In response, ABS-CBN executive Lauren Dyogi went into defensive mode justifying PBB’s decision to tackle the circumcision issue by trumping up the “culture” argument. In so many words, ABS-CBN believes that because circumcision is part of Philippine culture, there is nothing inherently wrong with discussing it on television or even showing footages related to the practice.

Actually, ABS-CBN is not the first television show to discuss circumcision in public television or to show footages of the practice. It’s something that news reporters regularly cover during summertime when most boys submit themselves to the practice.

In the final analysis, however, it really boils down to the kind of coverage given to the issue and what kind of footage is shown on television. Offhand, I don’t think that showing the circumcision procedure is objectionable per se as long as they are careful about the way pain and trauma is presented. The last thing we need is to traumatize young viewers. [And being circumcised doesn't traumatise young boys?] Obviously they also have to safeguard the privacy of the housemate in question. This means they have to be careful about showing body parts. [But a sanitised item would fool people into thinking it is bloodless and painless.]

What I liked so far about the way ABS-CBN is handling the issue is the way they have been trying to do away with the stigma directed at uncircumcised males. The bullying and the teasing that uncircumcised males receive are facts of life in our culture. Kids can be cruel, particularly after they’ve been circumcised and it becomes their turn to bully younger playmates or classmates who still have to submit to the rite of passage. I know—been there, done that. I’ve had my share of being bullied in grade school. So when I finally got circumcised in Grade 5, it was payback time and I did more than my share of bullying others.

The show has gone out of its way to explain to viewers that contrary to myth, circumcision is not a global norm and that in many countries it is a choice given to males. But the reaction of the other male housemates is more telling and encouraging. They’ve expressed empathy and understanding rather than ridicule or tease the uncircumcised housemate. They’ve also shown great maturity in terms of discussing openly the various social and cultural issues around circumcision.

ABS-CBN has also shown footages of the surgeon-father of one of the teen housemates explaining the official stand of the College of Surgeons, which is that circumcision is not anymore encouraged or considered a “requirement.” There are in fact many doctors all over the world who are against the practice particularly neonatal circumcision (i.e., circumcising an infant upon delivery). According to them, circumcision violates the Golden Rule and the first tenet of the medical practice, which is “First, do no harm.” Others see circumcision as a form of mutilation, one that deprives people of a basic human right—the right to an intact body.

In some countries, circumcision is a religious practice. There are passages in the Bible that are interpreted by many as endorsing circumcision. The Philippines may be predominantly Catholic but in our country, circumcision is not associated with religion but with culture. In other words, Filipino men and boys don’t submit to the process to adhere to some religious beliefs but because in our culture, a man has not yet transitioned to adulthood if he has not gone through this process. In fact, one is never a complete man if he is uncircumcised. [Huh?]

And then of course, there are the many myths around circumcision. I was told, for example, that unless I submitted to the practice, I would stop growing. Experts of course say that the perceived relationship is purely coincidental since the growth spurt happens around the age bracket when a boy is ready for circumcision.

The only compelling argument that supports circumcision is hygiene. But then again, hygiene is a purely personal thing. One can be circumcised but continue to be a total slob anyway, or conversely, one can be uncircumcised but be very diligent about hygiene. Some experts cite medical benefits including lesser vulnerability to HIV infection. There is an ongoing debate on the issue, but in the end, it is really safer sexual practices that eliminate the risk of HIV transmission.

Many among us don’t want to talk about circumcision because it involves private parts and we’ve all been conditioned to think that that part of our body is taboo. It’s unfortunate of course that the current discussion is happening amidst a very artificial and seemingly contrived context, one that is fueled by commercial considerations, but if that’s what it takes to bring home the point then we should be thankful for small dividends.

According to blogs, another Pinoy Big Brother contestant, Kevin Flood, has also been exposed as intact, but he is refusing to be circumcised, despite considerable pressure.

To more about the movement to question pagtutuli and support supét.