Male Circumcision Reduces Risk for HIV by 60%

For the past few decades, there has been a growing movement to give up male circumcision as an outmoded, misguided, socio-religious, cruel relic of the past. In many cases, claims of male circumcision reducing risk for disease have proven so minimal as to make arguing, from their standpoint, a losing proposition. However, findings of research in both South Africa and Kenya have recently shown that being circumcised has the potential to reduce a male's risk for contracting HIV by 60%. With these findings, surely every parent would want their male child circumcised - or would they?

The ethical problems, associated with circumcision, revolve not on whether it is advantageous to circumcise males, so much as when to circumcise them. Should they be circumcised as infants? Should they be circumcised as young teens, before they become sexually active? Should they be circumcised as adults, if they find themselves in a situation where they know they will be at risk of being exposed to HIV? These are serious questions that revolve around autonomy and consent.

A baby cannot give consent to be circumcised. This is not an emergency, life-saving surgery. If that were the case, then it would be perfectly alright for his parents to give consent and for the physician to conduct the surgery. In fact, this is elective surgery and there is every possibility that a vaccine for HIV will be found before the child reaches an age where he will be at risk for contracting HIV. Should his parents take that chance? Should they insist on the circumcision? Is it ethical for the physician to conduct this kind of surgery, knowing it is not medically necessary?

What if the parents and physician decide to wait until the baby is in his early teens before presenting their case and obtaining his consent. How is a preteen boy going to feel about this kind of surgery? Will he think he is at risk? Or will he, like every other teen, honestly believe that he will always be careful and will never contract HIV? How will the parents feel, and how will the physician feel, if they are unable to convince the young teen to be circumcised and then, later, he does develop HIV? Will it help for them to tell themselves that, even with the circumcision, he would still have had a 40% chance of developing the disease?

What if the parents and physician wait until the baby is an adult to try to convince him to be circumcised? At that point, is what he does with his own body any of their concern? How many adult men are willing to be circumcised? While this might be the optimum age for obtaining consent from an autonomous individual, what if it is too late? Is a 60% reduction in his risk for developing the disease enough for his parents and physician to have overruled him as an infant?

These are hard questions to answer, but it is 2007 now and the parents of male children are being presented with new information. If they have already chosen not to circumcise their sons, then they have a huge job of HIV/AIDS awareness education before them. If they have a new baby boy, then they might want to reconsider. Whatever they decide, society must respect their decision because it is a personal decision. No one else can make it for them and no one else can live with the consequences for them either.

Reference:

Rennie, S., Muula, A.S., & Westreich, D. (2007). Male circumcision and HIV prevention: ethical, medical and public health tradeoffs in low-income countries. Journal of Medical Ethics, 33: 357 - 361.