The human rights group Attorneys for the Rights of the Child (ARC) (http://www.arclaw.org) has today criticized a proposal to continue the so-called voluntary medical male circumcision (VMMC) program in Africa, though only on boys mostly 15 years of age and older. The proposal was made in draft guidelines released in late November 2019 (https://www.state.gov/wp-content/uploads/2019/11/2019-11-25-COP20-Guidance-Full-Consolidated_Public-2-1.pdf) by the US President's Emergency Plan for AIDS Relief (PEPFAR). ARC claims that as applied to youths 15 years of age and older, Section 6.2.5.1 of the guidelines, focusing on VMMC, unconscionably distort medical evidence and violate medical ethics and federal law, not to mention basic economics.

The human rights group Attorneys for the Rights of the Child (ARC) (http://www.arclaw.org) has today criticized a proposal to continue the so-called voluntary medical male circumcision (VMMC) program in Africa, though only on boys mostly 15 years of age and older. The proposal was made in draft guidelines released in late November 2019 (https://www.state.gov/wp-content/uploads/2019/11/2019-11-25-COP20-Guidance-Full-Consolidated_Public-2-1.pdf) by the US President's Emergency Plan for AIDS Relief (PEPFAR). ARC claims that as applied to youths 15 years of age and older, Section 6.2.5.1 of the guidelines, focusing on VMMC, unconscionably distort medical evidence and violate medical ethics and federal law, not to mention basic economics.

ARC Executive Director J. Steven Svoboda said in a comment ARC co-submitted today to PEPFAR that circumcision is not the most cost-effective way to reduce males' risk of HIV acquisition. He commented, "The VMMC program has failed in its goal to circumcise Africa despite advertising and other publicity that his misled African youths into thinking circumcision is a safeguard from contracting HIV." ARC co-submitted its comments with colleagues Antony Lempert, M.D. and Michel Garenne, Ph.D.

At the same time, Svoboda expressed ARC's appreciation for the guidelines' recommendation that the VMMC program be discontinued for most African youths 14 years of age and younger.

Svoboda said, "Regarding those 15 years of age and older, the most critical aspects of the guidelines lie in what PEPFAR leaves out. A basic principle of medicine described in the Hippocratic Oath requires that all doctors, ‘Do no harm.' Medical ethics require doctors to use the most effective, least invasive treatment for any condition. For HIV prevention, this remains condoms."

Svoboda stated, "The time is right to stop this ill-conceived, Western-centric program. We call on the guidelines to cancel the VMMC program for all ages before further harm occurs and to divert the funds that are thereby saved to programs of proven effectiveness. The law and medical ethics require no less."

The world HIV crisis is now under control and HIV is considered a chronic illness. Thus the emergency mentality that has in the past driven the VMMC program is no longer needed and indeed, is overridden by paramount ethical and legal principles. Amputating healthy body parts in a misguided attempt to stop it is a massive misdirection of effort, particularly when those body parts are taken from people not providing fully informed consent. VMMC participants were not properly informed that circumcision does not completely protect anybody, but at most reduces the probability of transmission, which is quite different.

Attorneys for the Rights of the Child is a non-profit organization founded in 1997 to protect children from unnecessary medical procedures to which they do not consent. ARC is currently working with the United Nations in response to UN requests for its expertise regarding human rights law.

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