Yet the practice is universal in the worlds of Judaism and Islam and is widespread across the United States, Canada and Australia. In a tiny number of cases, circumcision is effected for medical reasons (which is never true of female genital mutilation) but, like FGM, its primary purpose is to signify membership of a tribe or caste - usually felt by its members to be the elect of God. The WHO recommends circumcision in some parts of Africa as a means to diminish the spread of HIV (a policy which is itself controversial) but, otherwise, no major medical organisation promotes circumcision for heath reasons.