In the following 2012 article by Robert O’Hara we learned of Hilliary Rodham Clinton’s attitude toward male circumcision. We bring it to you again as a refresher on her views toward genital integrity as she runs for office – Eds. [Trigger warning: may cause castration anxiety].

Secretary of State’s Africa tour to promote male genital mutilation; U.S. news media is silent

(AVFM News Sunday August 19, Washington D.C.) – On Wednesday, August 15th,at 11:00am U.S. Secretary of State Hillary Rodham Clinton met with USAID Administrator Rajiv Shah, Counselor Sheryl Mills, United States Global AIDS Coordinator Ambassador Eric Goosby, and Director of the Centers for Disease Control and Prevention (CDC) Thomas Frieden, at the Department of State. The meeting was closed to the press and the assortment of individuals representing this combination of agencies is unusual for a State Department hearing as the CDC normally does not concern itself with international political affairs. However, given the recent activities of the Secretary Clinton in the past several weeks opponents of Male Genital Mutilation would have reason to be concerned with developments that could result from this meeting.

Last Friday, August 10th, Secretary Clinton wrapped up a tour of Sub Saharan Africa in Ghana which began on the 31st of last month in Senegal traveling through South Sudan, Uganda, Kenya, South Africa and Malawi. The State Departments Press release only mentioned U.S. efforts to deal with the AIDS epidemic in Africa once and never mentioned Male Circumcision. The trip was not extensively covered by the national media with the Washington Post releasing only one article outlining her journey and providing whimsical reports of dancing with native women, dodging swarms of bees and braving a deadly outbreak of Ebola. As in the State departments press release, male circumcision as a means to stop the spread of AIDS was never once mentioned.

Indeed, not one major U.S. news source has covered what is perhaps the biggest initiative ever to halt the spread of HIV AIDS; an initiative being spearheaded by the World Health Organization, the U.N. and the U.S. government.

As reported previously by AVFM News (see previous articles listed below) the W.H.O. in concert with the U.N., the World Bank, the President’s Emergency Plan for AIDS Relief (PEPFAR) and several other very well funded and influential N.G.Os are funding, supporting and administering a multinational effort to circumcise over 28 million men in Sub Saharan Africa by 2015. This initiative has gained the overwhelming support of the State Department as well as the U.N. in spite of mounting evidence that the RCTs (randomized controlled trials) performed in 2005 in Africa, which concluded that men who underwent circumcision were 60% less likely to contract HIV, were seriously flawed and administered largely by unqualified individuals with both financial and ideological conflicts of interest.

Since AVFM last reported on this topic there has been even more outrage coming not only from anti circumcision activists but from the medical community at large. In a recent opinion piece in Open Salon penned by Judy Mandelbaum entitled “Africa’s male circumcision crusade: Boon or boondoggle?” an interview with a Dr. Ronald Goldman of the Circumcision Resource Center in Boston was featured giving a critique of the campaign currently underway in Africa.

Excerpt:

Mandelbaum: Dr. Goldman, a number of sub-Saharan African nations have begun a crash adult circumcision program aimed at drastically reducing the incidence of HIV/AIDS among their populations. Their leaders, encouraged by foreign governments and NGOs, have apparently convinced themselves that a circumcised penis is practically immune to the virus. What effect do you think the mass circumcision of African men will actually have on suppressing the illness? Dr. Goldman: Many professionals have questioned the reliability and validity of studies claiming that circumcision reduces HIV transmission. African national population surveys in eight countries found a higher rate of HIV infection among circumcised men compared to men who were not circumcised. There are at least 17 observational studies that have not found any benefit from male circumcision in reducing HIV transmission. Therefore, I do not expect a reduction in HIV transmission. It’s even possible that the incidence of HIV transmission will increase because the mistaken belief of protection from circumcision will result in more risk-taking sexual behavior.

The article also provides links to two studies from Pandos Eastern Africa, an NGO operating in the region promoting various forms of development, and the Australian Journal of Law and Medicine questioning not only the effectiveness of circumcision as a tool to prevent the spread of HIV but also warning that compensatory behavior by circumcised men would be a matter of grave concern. “In the Ugandan male-to-female trial, there appears to have been a 61% relative increase in HIV infection among female partners of HIV-positive circumcised men. Since male circumcision diverts resources from known preventive measures and increases risk-taking behaviors, any long-term benefit in reducing HIV transmission remains uncertain.” the authors concluded. Also featured in Open Salon article are the Ugandan male circumcision promotional posters showing an attractive woman locked in an astonished downward gaze clasping her face in her palms with the title “You mean your not circumcised!” and subtitle: “Stand proud get circumcised.”

While news outlets in the U.S. have been eerily quiet concerning both the circumcision drive in and Secretary Clinton’s recent visit news sources in Africa have been afire with increasingly strong criticism along with macabre tales of forced circumcision conducted by angry street mobs.

On July 8th Peter Nyoni of Zimdiaspora, a news source in Zimbabwe, reported that HIV infections were up among circumcised participants of the ZHDS (Zimbabwe Health Demographic Survey) and strongly implied that the current drive for male circumcision was a factor.

Excerpt:

“The HIV prevalence rate among circumcised males between the ages of 15 and 49 in Zimbabwe is higher than that of the uncircumcised males owing to the misconception that circumcision completely shields people from HIV infection. According to the latest Zimbabwe Health Demographic Survey (ZHDS 2010/2011), the prevalence rate among the circumcised is 14 percent while that of the uncircumcised is 12 percent. The circumcision status of participants was established during pre-test counseling.

However, the country’s overall prevalence rate for the same age group declined to 15 from 18 percent, according to the same survey. National Aids Council (Nac) public health officer Dr Blessing Mutede said authorities were concerned about the high rate of infection among the circumcised.

He said it was largely a result of “risk compensation behaviors”. Most men, after circumcision, harbor the false impression that they have been equipped with an invisible condom, he added. “It is a worrying development that at a time when we are promoting male circumcision as a preventive measure to combat HIV, we are recording a high prevalence rate amongst the group that has been circumcised largely due to uninformed risky compensation behaviors,” he said.”

Just a six weeks earlier in Zimeye, a publication much more critical of the W.H.O.’s circumcision and Zimbabwe’s acceptance of it, published an article named “Zimbabwe still falsely claiming that circumcision defeats HIV/AIDS” by an unnamed correspondent.

Excerpt:

“Zimbabwe is still falsely claiming that the surgical circumcision operation defeats the deadly HIV/AIDS virus. This comes after more than 5 months of media coverage exposing the method’s weakness as a competent measure. Several US medical practitioners have in the past few months warned third world countries upon whom the United Nations suggested the method, that they should not have their citizens deceive on circumcision and its supposed benefits. The ministry of health is deceiving people by announcing to them that once they are circumcised, they become immune to HIV/AIDS effectively encouraging them to engage in promiscuity. Instead of reducing the risk, circumcision has been tested through behavior change to actually be a protagonist of HIV transmission, critics state. One recent randomized controlled trial carried out in South Africa into male-to-female transmission actually demonstrated a 54% higher rate in the group where the men had been circumcised.”

The article does not cite the source of the “recent study” , however, there is a clear suggestion that empirical evidence shows the program to circumcise a large proportion of men in Sub Saharan Africa has already resulted in the unnecessary infection of HIV in circumcised individuals.

Most disturbing are reports from Uganda where hysterical mobs are performing crude circumcisions upon unwilling random men in the streets in order to quell fears of HIV infection among their womenfolk. On June 20, The Africa Report published an article by Godfrey Olukya titled “Storm Brews over Forced Circumcision in Uganda” which documented an incident in which an angry group of men chased down a man in order to forcibly remove his foreskin simply because he was suspected of having sex with a female member of their tribe.

Excerpt:

“The Ugandan town of Mbale was brought to a standstill on Tuesday afternoon, as a naked man ran through the streets, with more than 50 men in pursuit. He was fleeing a forced circumcision. Only identified as Deo, the man sought sanctuary from the Resident District Administrator, as the men and a local scalpel-wielding surgeon gave chase.

Deo survived the forced circumcision after guards at the administrator’s office were able to disperse his assailants, but that was not before other men had fallen victim to the enforced surgical operation. More than 40 men of various ages have been subjected to the cut in the last two days, as the town goes through a general circumcision programme, but this has faced widespread protests.”

Even more disturbing is a June 20 report by Paul Watala from News Vision, claimed to be Uganda’s leading news daily news source, which describes scenes of police having to use teargas in order to disperse angry mobs who are carrying out forced circumcisions. A photograph in the article shows a man undergoing such a procedure being videotaped by a participant in the mutilation.

Excerpt:

“Police in Mbale have fired teargas and deployed heavily to disperse hooligans forcefully circumcising people on the streets including non-Bamasaba. The District Police Commander, Michael Angucia Wednesday vowed to crack down the hooligans who are causing insecurity in the town. “I am not trying to fight the culture of the Bamasaba but the way the practice is handled may cause tribal conflicts. Several people have fled the town, property robbed and business is being paralyzed,” Angucia said. “We have deployed on the streets to arrest the hooligans,” Angucia added. He said that several groups of such people have taken advantage of the cultural festival of the Bamasaba to force whoever they suspect to have not been circumcised. Angucia said that due to public outcry from the people and local leaders, police had no alternative but to provide security on the streets to restore serenity in town, adding that some people have fled town and abandoned business in Mbale main garage. It is estimated that a total number of about 220 people have been circumcised from the time the exercise began date.”



As mentioned above not one major U.S news source has bothered to mention the growing criticism of circumcision as a tool to prevent the spread of HIV or the State Department’s gusto in supporting such efforts. The only U.S. based news organization that covered Secretary Clinton’s efforts to support the drive for Male Genital Mutilation in Africa was All Africa, a Washington D.C. news source that covers African news exclusively.

A July 25 article by Roselyne Sachiti (published shortly before her African trip) entitled “Clinton Hails Legislators’ Circumcision” covers Clinton’s speech at the 19th annual international AIDS Conference held in Washington with 20,000 attending. In the speech she praised 40 parliamentarians in Zibabwe who underwent circumcision in order to promote the WHO.’s circumcision drive.

Excerpt:

“She described the team as true leaders who should be applauded for their role in the HIV and Aids fight. Addressing 20 000 delegates gathered here for the XIX International Aids Conference, Mrs. Clinton said Zimbabwean lawmakers were a good example of political leadership’s commitment in the HIV and Aids management. She said they supported more than 400 000 male circumcision procedures since last December alone and hoped to do more through different grants. “. . .We want the world to know that this procedure reduces the risk of female-to-male transmission by more than 60 percent and for the rest of the man’s life, so the impact can be phenomenal. “In Zimbabwe, some male lawmakers wanted to show their constituents how safe and virtually painless the procedure is, so they went to a mobile clinic and got circumcised.

“That’s the kind of leadership we welcome. And we are also seeing the development of new tools that would allow people to perform the procedure with less training and equipment than they need today without compromising safety,” he said. Mrs. Clinton challenged other countries to support the Global Fund in the fight against HIV and Aids, TB and malaria. She announced an additional US$80 million to support innovative approaches that ensure HIV positive pregnant women get treatment they need to protect themselves, their babies and partners. “An additional US$15 million for implementation research to identify the specific interventions that are most effective for key populations, US$20 million to launch a challenge fund that will support country-led plans to expand services for their key populations and US$2 million investment in the Robert Carr Society Service Network Funds to bolster the efforts of civil society groups in addressing key populations,” she said.”

The money that Secretary Clinton has pledged is in addition to the already estimated half billion that the WHO and other organizations have already dedicated to the circumcision drive.

On a stop to Uganda during her African trip the Independent, another Ugandan News source, covered an August 3 stop to Reach Out Mbuya Parish HIV/AIDS Initiative (ROM), a center for AIDS outreach in that country in an article entitled “Tackling HIV diferently”. Her apearence followed a visit with President Yoweri Museveni in which she presented the UPDF Special Forces with 12 Raven unmanned aircraft for use in Somalia where Uganda is participating in an effort to pacify that country. The article describes a crowd of people waiting to listen to Clinton address the clinic where she talked about retro-viral therapy and other methods to stop the spread of AIDS . Also waiting in line were a group of young men who were there to undergo circumcision.

Excerpt:

“Another client, Jasper Magezi, had come for something else. Magezi had been told that circumcision could save him from contracting HIV. On the day of Clinton’s visit, he was among those lined up for circumcision. During the pre-circumcision counseling session, Magezi said, he was told that in case he were to be exposed to HIV during sex after circumcision, he stood chances of escaping getting infecting. He was also told, however, that he would still need to continue using condoms and stick to one sexual partner. But one thing kept nagging him; was the pain he was about to suffer worth it?”

A ROM official identified only as “Talisuna” spoke of a program funded by the CDC named the “Discordant Couples Intervention.” A program mentioned by recipients of circumcision funding all over Africa which encourages the circumcision of married men in order to curb the spread of HIV and bring men into a so called clinical setting so they can be “educated” about domestic violence. The rational behind the program ties the prevalence of HIV to male perpetrated domestic violence and the supposed out of control infidelity of African men. No scientific studies have been conducted to support such an association between male perpetrated domestic violence and HIV infection and there are no studies that quantify the supposed infidelity of African husbands.

AVFM will be covering developments at the State Department and the CDC in regards to any developments concerning circumcision as a means to prevent the spread of HIV both in Africa and the U.S.

Sources:

http://www.state.gov/r/pa/prs/appt/2012/08/196467.htm

http://en.wikipedia.org/wiki/Rajiv_Shah

http://en.wikipedia.org/wiki/Cheryl_Mills

http://www.pepfar.gov/press/125262.htm

http://www.state.gov/r/pa/prs/appt/2012/08/195635.htm

http://www.state.gov/r/pa/prs/ps/2012/07/195785.htm

http://www.washingtonpost.com/world/africa/hillary-clintons-africa-trip-dodges-disease-bees-even-features-a-bit-of-snow-and-dancing/2012/08/10/d7017ce0-e317-11e1-89f7-76e23a982d06_story.html

http://www.avoiceformen.com/featured/politics-money-and-ideology-whos-circumcision-plan/

http://www.avoiceformen.com/featured/28000000-african-men-to-be-coerced-by-u-n-to-make-the-cut/

http://open.salon.com/blog/judy_mandelbaum/2012/07/27/africas_male_circumcision_crusade_boon_or_boondoggle

http://www.panosea.org/index.php?page=article&type=news&i=25

http://www.salem-news.com/fms/pdf/2011-12_JLM-Boyle-Hill.pdf

http://www.zimdiaspora.com/index.php?option=com_content&view=article&id=8811%3Ahiv-infection-rate-higher-on-circumcised-men&catid=38%3Atravel-tips&Itemid=18

http://www.zimeye.org/?p=53896

http://www.theafricareport.com/index.php/20120620501813944/east-horn-africa/storm-brews-over-forced-circumcision-in-uganda-501813944.html

http://www.newvision.co.ug/news/632168-forceful-circumcision-in-mbale-police-fire-teargas.html

http://allafrica.com/stories/201207250538.html

http://www.independent.co.ug/news/news-analysis/6258-tackling-hiv-differently