The Hankyoreh (Seoul)
December 31, 2006

Circumcision reduces sexual satisfaction: study
20 percent of men report reduced sensation after procedure

A research study by a team of South Korean professors has found that circumcision could reduce the level of satisfaction in sex.

A survey of 373 men 30 years or older in South Korea was taken by Seoul National University professor Kim Dae-sik and JoongAng University professor Bang Myeong-geol. They found that men who underwent circumcision felt less sensation during orgasm while engaged in masturbation or sex than when they had been uncircumcised.

The research, which is scheduled to be posted to an academic journal in Britain in February, was conducted with 255 men who underwent circumcision after the age of 20 and 118 who did not.

According to the research, 20 percent answered that their level of satisfaction in sex fell after circumcision, compared with 6 percent who said the level rose. The remaining 74 percent said no change was seen after circumcision. For circumcised men, their average time to reach orgasm was 11 minutes. For those who have not undergone circumcision, the average time was 13 minutes.

In addition, 9 percent said they felt pain, bleeding, and/or discomfort during erection.

"Statistically, there was no meaningful difference seen in terms of sexual desire, erectile function, and the ejaculation of sperm before and after circumcision," Bang said. "However, we can make the conclusion that circumcision poses a negative impact on [enjoyment of] sex by damaging peripheral nerves."

In the meantime, research does not agree regarding the impact of circumcision on health and disease prevention. In 1999, the American Cancer Society publicly sent a letter to the American Academy of Pediatrics, saying that circumcision was not a way of preventing penile cancer, or vaginal cancer in the female partner of a heterosexual pair. In 2001, the Korean Urological Association also published a report that said there is no need to promote universal circumcision, because it poses little impact in preventing penile cancer and other diseases. However, a report published last week by the U.S. National Institutes of Health found that circumcision may reduce a man's risk of contracting HIV through heterosexual sex by half.

In addition, Korean men are often circumcised during the onset of puberty, whereas in countries such as the U.S., Canada and those in Europe, the procedure is almost always done during infancy; no information is available on what effect this practice might have had on the results of the survey.

To the abstract of the paper.

Reuters
December 22, 2006

Ugandan president rejects circumcision/HIV study

Fri Dec 22, 2006 12:25pm ET27
By Tim Cocks

KAMPALA (Reuters) - Ugandan President Yoweri Museveni has condemned a new study showing that male circumcision reduces the risk of HIV infection during sex, saying it sent out a dangerous message.

The state-owned New Vision paper on Friday quoted Museveni as saying there were many confusing messages about HIV/AIDS. "One of them is that if you are circumcised, you are less likely to catch AIDS even if you behave recklessly. Now what sort of message is that?" the paper quoted him as telling medical students in Kampala.

A study conducted in western Kenya and eastern Uganda, where circumcision is a common practice, this month by the U.S. National Institutes of Health (NIH) found it reduced the risk of infection by 48-53 percent.

[Actually two studies, and 48% and 53% respectively, although both have wide margins of error.]

Museveni rejected the study's conclusion, saying Uganda's apparent success at controlling the virus - official figures say prevalence fell from 30 percent to 6 percent in the early 1990s - was by telling youths to abstain from sex.

[That is about as likely to work as circumcision...] The study had said circumcision is to be seen as "only part of a broader HIV prevention strategy that includes limiting ... sexual partners and using condoms".

[The study has not yet been published in a scientific journal. It is not clear where the quotation comes from.]

Campaigners say Uganda's HIV/AIDS strategy has been hijacked by right-wing Christian groups, mostly from the United States, who promote abstaining from sex at the expense of condoms.

The Uganda AIDS Commission, a government body, this month said 132,000 new infections occurred in Uganda in 2005, but prevalence remained stable at between 6-7 percent. It linked failure to reduce prevalence to less condom use.

Many health workers think the official figures are too low.

© Reuters 2006. All Rights Reserved.-->

Times of India
December 19, 2006

Unsafe circumcision can kill: UNAIDS chief
[So can "safe" circumcision.]

NEW DELHI: It's well-known that circumcision cuts the risk of HIV infection but an improper surgical procedure without local anaesthesia can kill, due to excessive blood loss or systemic infection from the circumcision wound.

[The use of anaesthesia has no effect on the death rate.]

Keeping the risks in mind, UNAIDS, which endorsed three medical studies that recently confirmed that circumcision does cut the risk of HIV infection among men by 60%, will soon launch a manual to educate and make nations aware of how to carry out safe and technically correct mass circumcision programmes.

[60% is the highest of the three figures.]

UNAIDS chief Peter Piot, who has asked AIDS-stricken Southern-African nations to develop a policy of mass male circumcision to fight the disease, told TOI,"Circumcision is a surgical procedure and has side effects. It can be done only once and so has to be done properly and in a technically safe manner." According to Piot, baby boys should be targeted first but the attention should also be on adolescent boys and adult men.

[Piot seems to be on his own in wanting to target babies.]

Warning that circumcision will not protect and is not an absolute answer against the deadly virus, Piot said even if large-scale circumcision was introduced, countries should continue to promote condom use as well as abstinence.

[...but with resources sapped by spending on circumcision.]

In Ethiopia, all men are circumcised. Even then 2 million are HIV-positive. [What do they mean, "even then"? The rate in Ethiopia is 4.1%, making it 25th in the world, ahead of just about every non-circumcising country]

Piot warned that circumcision should not give men a false sense of security."If they continue to have unprotected sex, they will get AIDS," he said.

[But it will. And they will.]

UNAIDS will soon undertake studies to finalise which countries will undertake mass circumcision. It will also carry out marketing campaigns to make circumcision acceptable and fashionable.

[Not a moment spent asking whether circumcision is cost-effective!]

Officials feel circumcision could be the reason why AIDS figures in Muslim countries are extraordinarily low. While 0.92% of the adult population in India is HIV-positive, the number is 0.1% in Iran, Indonesia and Pakistan, 0.2% in Bangladesh and 0.4% in Malaysia. []

[What "officials feel" is a poor basis for making policy. There are many factors distinguishing Muslim countries from others, including polygamy, ritual washing, periodic abstentioin and seclusion of women - all of which would affect the transmission rate.]

Talking about whether India should start circumcision, Piot said,"Muslim and Jewish men are circumcised according to religious beliefs. In India, it's a religious issue. In African countries, anything that shows little promise has to be implemented. In other parts of the world, including India, circumcision is not a priority."

paper
date

UN urges circumcision in AIDS-hit southern Africa

By Kamil Zaheer | December 19, 2006 NEW DELHI (Reuters) - AIDS-stricken Southern African nations should develop a policy of mass male circumcision to fight the disease, the head of the United Nations anti-AIDS agency said on Tuesday.

Several recent medical studies have reported circumcision cuts the risk of HIV infection among men by 50-60 percent, and the findings have been backed by UNAIDS.

"These (African) countries should now prepare how to introduce circumcision on a large scale," UNAIDS chief Dr. Peter Piot told Reuters. "The science is clear."

Baby boys should be targeted first but then attention should switch to adolescent boys and adult men, said Piot, who is in New Delhi to meet Indian officials on how they plan to tackle the world's largest HIV/AIDS caseload.

[Quite apart from the ethical issue, babies will not be sexually active for more than a decade. This is madness.]

...Piot said that UNAIDS understood advocating mass circumcision was a religiously and culturally sensitive issue for many people.

"Changing that is touching very much on the core of values. That is going to make it more complicated than any other medical issue that I can think of."

[Promoting circumcision is going to encourage the same macho attitudes that are the basis of the most risky sexual behaviours.]

But he said given the grim HIV situation in southern Africa, it was important to promote the idea of widespread circumcision.

"We are faced with an absolute crisis where you have 20-40 percent of adults being HIV-positive ... you need to use every scientifically proven method to bring down the new infections."

... Piot said that even if large-scale circumcision was introduced, countries should continue to promote condom use as well as abstinence.

[Circumcising men sends them a powerful message that they are protected and don't need to use condoms.]

365Gay.com
December 16, 2006

NIH Circumcision Policy Criticized

by 365Gay.com Newscenter Staff
Posted: December 16, 2006 11:00 am ET

(New York City) A coalition of international medical experts and bioethicists who oppose circumcision generally have denounced the National Institutes of Health endorsement of circumcision as a solution to the HIV/AIDS crisis as being irresponsible.

George Denniston, MD, President of the international group, Doctors Opposing Circumcision, says "The NIH suggestion is dangerous folly. Worse, the NIH plan will permit circumcised men to claim they are immune to HIV and engage in unsafe sex. In cultures where women are obliged to submit, this is a recipe for a human rights disaster to women on a massive scale. Safe-sex education and widespread availability of condoms are the only answers before a vaccine is developed."

Critics of the plan, which include the umbrella group International Coalition for Genital Integrity, note that traditional African cutting and scarring rituals, and even modern medical care, are both proven sources of HIV infection.

Surgeries in villages where even clean water is a luxury are likely to prove risky.

The coalition, which also opposes female genital mutilation, known as FGM, is also concerned that suggesting genital surgery is the solution to the AIDS crisis, ”will sustain FGM or introduce it where it is unknown, at the same time as the World Health Organization has pronounced the practice ‘genital torture,’” says Dan Bollinger, the group’s spokesperson.

The NIH has claimed that circumcising adult men is an effective way to stop the transmission of the virus that causes AIDS.

However, even if true, this does not apply to America where the disease vectors are different and hygiene is not an issue the group said.

HIV/AIDS in Africa is spread by heterosexual transmission, while HIV/AIDS in the United States is spread by homosexual transmission and the sharing of IV drug needles.

Genital integrity groups are not the only ones questioning the NIH. Dr. Haanah Kibuuka of the Makerere University Walter Reed Project in Uganda has made the following recommendation to his countrymen, "Do not expose yourself to danger in the mistaken belief that since you are circumcised, you will not catch HIV."

Robert Van Howe, MD, Michigan State University says, “Factors such as the unknown complication rate of the procedure, the permanent injury to the penis, human rights violations and the potential for veiled colonialism need to be taken into account."

Van Howe said that based on the best estimates, mass circumcision would not be as cost-effective as other interventions that have been demonstrated to be effective. Even if effective, mass circumcision as a preventive measure for HIV in developed countries is difficult to justify, he said.

New York Times
December 13, 2006

Circumcision Reduces Risk of AIDS, Study Finds

December 13, 2006
By DONALD G. McNEIL Jr.

Circumcising African men may cut their risk of catching AIDS in half [or rather, make it twice as long before they get it], the National Institutes of Health said today as it stopped two clinical trials in Africa, when preliminary results suggested that circumcision worked so well that it would be unethical not to offer it to uncircumcised men in the trials.

[Yet it was deemed "ethical" to withhold positive test results from the men lest they be "stigmatised", and let them go out and infect others.]

AIDS experts immediately hailed the result, saying it gave the world a new way to fight the spread of AIDS, and the directors of the two largest funds for fighting the disease said they would now consider paying for circumcisions. [Instead of paying for ... condoms? education? treatment?]

"This is very exciting news," said Daniel Halperin, an H.I.V. specialist at Harvard.s Center for Population and Development, who has argued in scientific journals for years [long before there was any evidence] that circumcision slows the spread of AIDS in the parts of Africa where it is practiced.

In an interview from Zimbabwe, Mr. Halperin added: "I have no doubt that, as word of this gets around, millions of African men will want to get circumcised and that will save many lives."

But experts also cautioned that circumcision is no cure-all. It only lessens the chances that a man will catch the virus, it is expensive compared to condoms, abstinence or other methods, and the surgery has serious risks if performed by folk healers using dirty blades, as often happens in rural Africa.

Sex education messages to young men need to make it clear that "this does not mean that you have an absolute protection," said Dr. Anthony S. Fauci, an AIDS researcher and director of the National Institute of Allergy and Infectious Diseases, which sponsored the trials. Circumcision should be added to other prevention methods, not replace them, he said.

The two trials were carried out among nearly 3,000 men in Kisumu, Kenya, and nearly 5,000 men in Rakai, Uganda. None were infected with H.I.V., the virus that causes AIDS;

[Yes, all were volunteers, so they had more than average interest in protecting themselves, and they begin the trial HIV-negative in regions where AIDS is rife, suggesting

• Their sexual behaviour is more cautious than most (also evidenced by their volunteering for the trial)
• They have some natural immunity.

New Straits Times online (Malaysia)
December 3, 2006

Most unkind cut on 10-year-old boy

03 Dec 2006

JOHOR BARU: A slip of the scalpel resulted in a 10-year-old boy’s penis being sliced at a private clinic in Mersing.

Muhamad Shahbuddin Zainalabidin was at the clinic for his circumcision when the medical assistant sliced off more than the foreskin on Thursday.

Shahbuddin’s father, Zainalabidin Ahmad, 46, a chief clerk in Felda Nitar, Mersing, said he was shocked when the medical assistant ran to him and apologised that he had accidentally severed his son’s penis.

A doctor then retrieved the sliced tip and put it on ice and rushed the boy in an ambulance to Sultanah Aminah Hospital. The tip was re-attached after a five-hour operation.

The father is keeping his fingers crossed as it will only be known tomorrow whether the surgery was successful.

Zainalabidin said Shahbuddin and his twin brother, Zaid Abidin, were among seven scheduled to be circumcised at 10am that day.

"Zaid was supposed to go first, but chickened out and convinced Shahbuddin to go first.

"But, after the incident, the doctor cancelled the remaining appointments and closed the clinic," Zainalabidin added.

The boy’s mother, Zunaidah Abd Rahman, 41, said although it was an accident and the doctor had offered to foot the medical expenses, she was afraid the traumatic experience would continue to affect her son.

Associated Press
November 24, 2006

Muslim scholars rule female circumcision un-Islamic

A Egyptian conference of Muslim scholars from around the world declared female circumcision to be contrary to Islam and an attack on women, and called today for those who practice it to be punished.

The conference, organised by the German human rights group TARGET, recommended that governments pass laws to prohibit the tradition and that judicial bodies prosecute those who mutilate female genitals.

"The conference appeals to all Muslims to stop practicing this habit, according to Islam's teachings which prohibit inflicting harm on any human being," the participants said in their final statement.

Egypt's two top Islamic clerics, Mohammed Sayed Tantawi, the Grand Sheik of Al-Azhar, the foremost theological institute in the Sunni Muslim world, and Grand Mufti Ali Gomaa, attended the conference, which drew scholars from as far afield as Russia.

Tantawi's and Gomaa's edicts are considered binding.

Female circumcision, which involves cutting the clitoris, continues to be practiced in many parts of sub-Saharan Africa as well as Egypt, Yemen and Oman, despite numerous campaigns against it.

Those men who support the tradition believe it lowers a girl's sexual desire and helps maintain her honour. They also believe it is required by Islam.

The scholars said circumcision inflicts physical and mental harm on women. Furthermore, they said, Islam considers it to be an aggression against women. Those who perform it should be punished.

"The conference reminds all teaching and media institutions of their role to explain to the people the harmful effects of this habit in order to eliminate it," the scholars said in their recommendations.

"The conference calls on judicial institutions to issue laws that prohibit and criminalise this habit ... which appeared in several societies and was adopted by some Muslims although it is not sanctioned by the Quran or the Sunna," the scholars said, referring to Islam's holy book and the sayings and deeds of Prophet Muhammad.

Although many countries have outlawed female circumcision, the law is poorly enforced and prosecutions are rare.

In the 1950s, the Egyptian government tried to stop midwives from performing the custom, while allowing doctors to do so - fearing that otherwise families who insisted on circumcising their daughters would have the operation carried out in unsafe conditions. But in 1996, the health minister imposed a total ban on the practice.

AP

New York Times
November 28, 2006

Vital Signs
Outcomes: Circumcision May Reduce Risk of S.T.D.'s

November 28, 2006
By NICHOLAS BAKALAR

Men who are circumcised may have a significantly reduced risk of acquiring a sexually transmitted disease compared with those who are not, a New Zealand study has found.

...

David M. Fergusson, the lead author of the study and a professor of medical psychology at Christchurch School of Medicine, warned that the results were not conclusive. "We are cautious about the findings," he said. "They depend on self-reports, and not all [not even most] studies agree with ours. But our results definitely suggest that circumcision may reduce rates of S.T.D.'s. We think we're correct, but it's best not to be dogmatic about it."

Dr. Fergusson declined to offer advice to parents. "Decisions to circumcise children [or not] should not be made on the basis of one study," he said. "They should be based on all the evidence. There is certainly evidence of benefit, but the complicated decision parents face is weighing the benefits against the risks of a surgical procedure. Even if we assumed all the evidence favored circumcision, most children wouldn't benefit from it. We estimate that you would have to circumcise 20 boys to prevent one case of sexually transmitted disease."

[It was critics of this study who made that estimate. In earlier stories, Prof. Fergusson was not so cautious. These pages critique the study here.]

Reuters
November 29, 2006

Surgeon's knife may offer hope in African AIDS fight

Wed Nov 29, 2006 8:18am ET144
By Andrew Quinn

MAPUTO (Reuters) - With almost 25 million Africans infected, 2.8 million new infections last year and 2.1 million deaths, the statistics are as grim as ever as Africa readies for World AIDS Day on December 1.

But after years of relentlessly negative news about HIV/AIDS in Africa, health experts this year are nursing hopes that at long last there may be a simple step doctors can take to fight the epidemic -- male circumcision.

"This would be the first intervention shown by the highest levels of science to prevent HIV infection," Daniel Halperin, an AIDS expert at the Harvard School of Public Health, told a U.N. AIDS seminar in Maputo,

"We're not saying don't do condoms. [Maybe not, but "circumcision protects against HIV" is the more potent message] But there is a missing element, and part of that appears to be circumcision."

The rising interest in circumcision as a tool against AIDS is based primarily on one study conducted in Orange Farm, a poor township outside Johannesburg, that found circumcised men were about 60 percent less likely to contract HIV.

Doctors say the most likely explanation is that cells on the inside of the foreskin, the part of the penis removed in circumcision, are particularly susceptible to HIV infection.

The Orange Farm study was so conclusive that it was halted ahead of time and all participants offered circumcision on the grounds that it would be unethical to deny them surgery which could [perhaps - or perhaps not] save their lives. [Yet it was considered ethical to test men for HIV and let them go on having unprotected sex without telling them they had it - denything them treatment that would prolong their lives.]

Two more studies are now under way in Kenya and Uganda. Officials say they may stop as early as December if early results are as persuasive as those from Orange Farm. [So they may go on promoting circumcision on the basis of incomplete tests, that might show null results if allowed to run their courses.]

UNAIDS, the United Nations organization devoted to the global fight against AIDS, says publicly it must await the results of the two studies before launching a campaign to promote circumcision among African men.

But U.N. officials are laying the groundwork for just such a campaign, quizzing African doctors and government officials on exactly what would be needed to roll out a major drive on male circumcision across the continent.

MIXED MESSAGES?
On the surface, male circumcision would appear to be an almost tailor-made defense against Africa's AIDS pandemic: a cheap, simple one-off surgery which makes it more difficult to contract and pass on HIV, the virus which causes AIDS.

A World Health Organization study [No, a wild extrapolation from the Orange Farm study, some of whose authors work for WHO, and including the main author of the Auvert study] said circumcision could prevent nearly 6 million new HIV infections and save 3 million lives in sub-Saharan Africa over the next 20 years -- making it one of the most promising interventions against a disease for which there remains no cure and no imminent hope of a vaccine.

...

But there are also fears that any widespread campaign to promote circumcision may undercut other HIV/AIDS prevention messages, chief among them telling people to use condoms and have fewer sexual partners.

"Being circumcised does not mean men are wholly protected from HIV," the Treatment Action Campaign, South Africa's most vocal AIDS activist group, said in a statement.

"Even if circumcision reduces the risk of infection during any one sexual encounter, risky behavior such as sex with multiple partners without using a condom is likely to lead to HIV infection."

THE KINDEST CUT?
Any circumcision campaign in Africa would also have to navigate complicated ethnic terrain. Some tribal groups use traditional circumcision to mark the transition to manhood, others reject it.

In Lesotho, where traditional circumcision is widespread but AIDS is rampant, some doctors worry that traditional surgeries are not thorough enough to convey the medical benefits of modern hospital procedures. [How to glide past a glaring counter-example: the Orange Farm study used "the forceps-guided method" which is very similar to a tradtional "pull-forward-and-chop" style of circumcision that removes less skin than US styles, yet it is the basis of the claim that "circumcision prevents HIV".]

In South Africa, dozens of young men die in traditional circumcision schools every year because of unhygienic equipment and botched surgeries.

Nevertheless, the hopeful [or rather, wishful] news about medical circumcision is beginning to spread.

Swaziland, with no tribal tradition of circumcision, has seen a leap in the number of men requesting the operation which local doctors attribute to the news from Orange Farm.

Dr. Martin Smith, chief of surgery at Soweto's Chris Hani Baragwanath Hospital outside Johannesburg, said they had thus far not seen any major increase in requests for circumcision but would expect to do so if UNAIDS begins publicly promoting it as an AIDS strategy.

...

"Some people say it is too slow, let's do it now. Others said we had to wait until there is more scientific data," said Chiwene Chimbwete, a Malawian demographer at UNAIDS who has helped coordinate the preliminary work.

But Chimbwete said as far as he was concerned, the evidence was overwhelming. "I've been so convinced about it I myself was circumcised about two months ago." [So is he announcing that he is in the habit of having unprotected sex with partners of unknown HIV status?]

NY TImes
November 21, 2006

Traditional Ways Spread AIDS in Africa, Experts Say

By ELISABETH ROSENTHAL

NKOLONDOGO, Cameroon - When Innocent Zamba Manga was born this summer, doctors advised his mother, Marise, who is H.I.V. positive, not to breast-feed, because nursing can pass the virus that causes AIDS from mother to child. Mother and baby left the hospital with bottles and formula supplied by a Catholic charity.

But the very next week, the proud parents took their baby to the father's village in the south of Cameroon, to take part in a traditional birth and naming ceremony. Custom required the new mother to nurse little Innocent, so she did. And she continued for two weeks.

...

As researchers spend more time studying Africa's overwhelming pediatric AIDS problem, they are finding that the routes of transmission may be different than in the industrialized countries, and that strategies for preventing the disease's spread must be adapted to local realities.

...

In scarification ceremonies for ethnic identification and cutting for ritual healing, blades are used in sequence again and again. There is also the practice of communal breast-feeding a single baby by numerous women, common in many tightly knit villages.

...

In Africa, there is one medical doctor for every 40,000 people, but one traditional healer for every 500.

In one small survey, 50 percent of ritual healers were H.I.V. positive, doctors at the International Reference and Research Center for H.I.V.-AIDS in Yaoundé said.

"We're used to saying this is all about sexual intercourse, but now we have to remind people it can be elsewhere in the body, and there are other dangers as well," said Bertrice Mabule, who started the Children's Education and Health Foundation to promote H.I.V. awareness in Batié.

In much of rural Cameroon, tiny scars are made to identify members of different ethnic groups, with large numbers of children scarred simultaneously.

If just one child in a village had H.I.V., a common blade could spread the virus to dozens who come after him. The same is true for group circumcisions. ...

Reuters
November 18, 2006

Ethiopians protest against U.S. circumcision jailing

ADDIS ABABA (Reuters) - Hundreds of Ethiopians took to the streets of Addis Ababa on Saturday calling for a retrial of an Ethiopian jailed in the United States for circumcising his daughter. ADVERTISEMENT

In what was believed to be the first such case in the United States, a Georgia judge sentenced Khalid Adem to 10 years in prison this month for removing his two-year-old daughter's clitoris with scissors in 2001.

The jailing has fuelled a passionate debate across Africa, with some approving the punishment but others opposing it.

Carrying placards such as "Free Khalid Adem - He is innocent," about 300 people marched across the Ethiopian capital on Saturday demanding a retrial.

"The trial against my brother was partial, biased and based on insufficient provisions of information. The judge heard only three of 10 defense witnesses before he passed his guilty verdict," 25-year-old relative Adel Adem told Reuters.

"The fact that his little daughter is circumcised does not prove his guilt. There is no strong hard evidence against him. This was just a nasty divorce fight that ended up in Khalid being framed by his wife for something he did not commit."

During the trial, Khalid and the victim's mother, blamed each other for the circumcision.

Adel said his brother's supporters were calling for a new trial at a different venue in the United States.

Earlier story.

Pediatrics
November 22, 2006

Responses to Post-Publication Peer Reviews: Circumcision and Sexually Transmitted Infection
...Recent correspondence to the journal has highlighted the fact that our findings are not consistent with cross- sectional studies of the linkages between circumcision and the more common forms of STI (including Chlamydia, genital warts, genital herpes, gonorrhea, and non-specific urethral infections). Of particular relevance is a recent Australian survey of 10,000 male respondents (2), and the preliminary findings from the Dunedin study (3). These discrepancies with our findings are too large to be disregarded, and we are of the view that it would be premature to use our findings to promote the view that circumcision reduces risks of less severe forms of STI, until further research clarifying this issue is conducted. ...

David M. Fergusson,
Professor and Executive Director, Christchurch Health and Development Study
Christchurch School of Medicine and Health Sciences,
Joseph M. Boden, and L. John Horwood

IOL online
November 14, 2006

Swaziland to endorse male circumcision

Di Caelers
November 14 2006 at 09:31AM

Swaziland is set to lead the way internationally with blanket male circumcision, after South African evidence that pointed to HIV risk reduction of up to 75 percent if men were circumcised.

Not only is the tiny country training new staff in its attempt to address the expected demand for the procedure in the state health sector, but is also preparing a countrywide register of circumcision.

[This is alarming. If the supposed protective effect of circumcision is epidemiological, not individual, what is the point of this register? What safeguards of privacy will it have? We predict vigilante groups, stigmatising of intact men, and forcible circumcisions under unhygienic conditions.]

The question of circumcision in the battle against the HIV and Aids pandemic is often controversial, but a urology conference in Cape Town heard on Monday that Swaziland is set to become "an international example".

Researcher Adam Groenewald, director of the department of urology at Mbabane Government Hospital in Swaziland, told delegates to the World Urology Congress at the Cape Town International Convention Centre this week, that although the prevalence of male circumcision in the country was low, popular demand for the procedure was growing fast.

Swaziland is set to become 'an international example'.
"Swaziland has the highest HIV prevalence in the world and many Swazis are increasingly becoming aware of the growing body of scientific evidence suggesting that male circumcision should become an important HIV prevention tool," Groenewald said.

Canvassing attitudes to male circumcision of Swazi men, the researchers found that an overwhelming majority - 87 percent - would want circumcision if it reduced the risk of HIV.

[Clearly these men do believe it offers individual protection to themselves, not just a statistical collective effect, and will neglect other safe sexual practices accordingly.]

Almost all - 93 percent - of the 400 men surveyed in the Manzini region in January this year said male circumcision would indeed be acceptable in Swaziland if it reduced HIV.

At 40 percent, Swaziland has the world's highest adult HIV rate, and one of the world's lowest circumcision rates.

[It would be interesting to see the actual figure - it could hardly be lower than Scandinavia.]

In the late 1800s, Swazi King Mswati II banned the procedure for fear that recovering from the surgery would distract young warriors.

[Some ] Scientists believe that the value of circumcision may be that the foreskin tissue which is removed includes cells that HIV seems to infect very easily.

Groenewald said they were anticipating that current randomised trials in Uganda and Kenya were likely corroborate the 2005 South African findings that circumcision results in HIV risk reduction of between 60 percent and 75 percent.

[So much jumping of the gun! And once the juggernaut has started, it will be hard to stop - hard to say to early adopters of mass circumcision, "Sorry, you had your foreskin cut off in vain."]

The Swazi government, the World Health Organisation, Unicef and other organisations in Swaziland had "shown interest" in including male circumcision as part of HIV prevention measures in the country.

Among the challenges was the fact that, like South Africa, most Swazis cannot afford private health care, and the bulk of demand for circumcision would have to be carried by the public health sector.

[...while funding of proven measures like condoms is far behind that in the First World.]

Standardisation of all aspects of male circumcision was "high priority", and new formats for patient evaluations, consent, post-operative instructions and follow-up had been introduced for use in all Swaziland's circumcision facilities.

Groenewald and his colleagues admitted it would still be important to continue emphasising to the public that circumcision would neither cure Aids, nor immunise them against HIV.

[An impossibly mixed message.]

AP
November 1, 2006

Father Convicted in Genital Mutilation

Nov 01 5:07 PM US/Eastern

By ERRIN HAINES
Associated Press Writer

LAWRENCEVILLE, Ga.

An Ethiopian immigrant was convicted Wednesday of the genital mutilation of his 2-year-old daughter and was sentenced to 10 years in prison in what was believed to be the first such criminal case in the United States.

Khalid Adem, 30, was found guilty of aggravated battery and cruelty to children. Prosecutors said he used scissors to remove his daughter's clitoris in his family's Atlanta-area apartment in 2001. The child's mother, Fortunate Adem, said she did not discover it until more than a year later.

Adem, who had no criminal record, could have been sentenced to up to 40 years in prison. He held his face in his hands and wept loudly after the jury's verdict was read.

During her father's trial, the girl, now 7, clutched a teddy bear as she testified on videotape that her father "cut me on my private part."

"This child has suffered, will suffer, the rest of her life," Judge Richard Winegarden told Adem during sentencing.

Federal law specifically bans the practice of genital mutilation, but many states do not have a law addressing it. Georgia lawmakers, with the support of the girl's mother, passed an anti-mutilation law last year. But Adem was not tried under that law since it did not exist when his daughter was cut.

During the trial, Adem testified he never circumcised his daughter or asked anyone else to do so. He said he grew up in Addis Ababa, the capital of Ethiopia, and considers the practice more prevalent in rural areas.

Adem's attorney acknowledged that the girl had been cut, but implied that the family of the girl's mother, who immigrated from South Africa, may have been responsible. The Adems divorced three years ago, and attorney Mark Hill suggested that the couple's daughter was coached to testify against her father by her mother, who has full custody of the child.

Adem, who cried throughout the trial and during his testimony, was asked what he thought of someone who believes in the practice. He replied: "The word I can say is 'mind in the gutter.' He is a moron."

The practice crosses ethnic and cultural lines and is not tied to a particular religion. Activists say it is intended to deny women sexual pleasure. In its most extreme form, the clitoris and parts of the labia are removed and the labia that remain are stitched together.

Knives, razors or even sharp stones are usually used, according to a 2001 department report. The tools are frequently not sterilized, and often, many girls are circumcised at the same ceremony, leading to infection.

It is unknown how many girls have died from the procedure, either during the cutting or from infections, or years later in childbirth. Nightmares, depression, shock and feelings of betrayal are common psychological side effects, according to a 2001 federal report.

Since 2001, the State Department estimates that up to 130 million women worldwide have undergone circumcision.

[Since 2001, we estimate that more than 40,000,000 boys worldwide have undergone circumcision, six million of them in the U.S.]

ajn.com (Australian Jewish News)

NATIONAL (OCTOBER 25, 2006)
Orthodox block bar mitzvah over ‘non-kosher’ circumcision

Dan Goldberg

A TRAUMATIC row over a bar mitzvah boy’s circumcision forced a Sydney mother to move her son’s simcha [celebration] from an Orthodox shul to a Progressive temple at the 11th hour last week.

The bar mitzvah boy had been scheduled to read from the Torah at Chabad Double Bay last Shabbat, but rabbis from the Sydney Beth Din (SBD) ruled on the previous Monday that his circumcision was not kosher.

Rabbi Moshe Gutnick and Rabbi Yoram Ulman, two judges at the Jewish court, were at the mikvah in Bondi preparing to draw a drop of blood from the boy to symbolise his Orthodox conversion when they noticed that his brit milah, conducted by a Jewish doctor in 1993, was incomplete.

“We immediately called one of the mohelim to check, and he confirmed a further circumcision needed to be done,” Rabbi Gutnick said.

He said he told the boy’s mother, journalist and author Ros Reines, that her son could either be operated on under local or general anaesthetic, and that “hundreds of boys” – many from the former Soviet Union – have undergone this procedure in Australia prior to their bar mitzvah.

“In order to become Jewish he has to be [properly] circumcised there’s nothing we can do about it. We feel terrible; it’s devastating,” Rabbi Gutnick said.

“I didn’t want my son to have that trauma [of another circumcision],” she told the AJN this week. “It’s not true he wasn’t circumcised; it’s a question of degree.”

“I spent the week in tears,” she said.

“To me it didn’t sound very compassionate. I just feel a sense of sorrow because perhaps we don’t really fit in — that feeling of being an outcast again.”

The single mother, who had an adult bat mitzvah following her Progressive conversion, said she had to inform the 100 or so guests of the change of venue “due to a technical problem” just days before the simcha.

... She said the pain had been magnified because her son had a brit milah, conducted in the presence of Rabbi Kamins, eight days after he was born.

“You don’t take your 13-year-old son four days before his bar mitzvah and give him a general [anaesthetic]. He didn’t want to do it. Just imagine if there had been an infection,” she said.

... But Rabbi Gutnick told the AJN the temple was “fooling the child” into believing he is Jewish.

“Unless the child goes to the mikvah and is circumcised according to Jewish law, pretending the child is Jewish is ultimately doing a disservice to the child,” he said.

...

[The debate following this item runs the full gamut from "The guy's jewish end of story" to "The facts are the facts. The boy is not Jewish" but the view that circumcision is not necessary to be Jewish is not canvassed. ]

Chicago Tribune
October 24, 2006

Judge rules against boy's circumcision

By Judy Peres
Tribune staff reporter
Published October 24, 2006, 10:48 AM CDT

In a case that has been closely watched by anti-circumcision groups nationwide, a Cook County judge today ruled that a 9-year-old Northbrook boy should not be circumcised against his will.

The court battle pitted the boy's divorced parents against each other, with the mother and her new husband claiming that the operation was necessary to prevent recurrent irritation and infection. The boy's father sought an injunction to bar the circumcision.

...

In a written opinion handed down today, Circuit Judge Jordan Kaplan found that "the evidence was conflicting and inconclusive as to any past infections or irritations that may have been suffered by the child."

"Moreover," he continued, "this court also finds that medical evidence as provided by the testimony of the expert witnesses for each of the parties is inconclusive as to the medical benefits or non-benefits of circumcision as it relates to the 9-year-old child."

The case was a clear victory for the growing number of so-called "intactivist groups" across the country that have argued that circumcision is harmful and violates the rights of children who are not old enough to consent to the irreversible medical procedure.

Kaplan, who also cited the irreversible nature of the operation, said his order would remain in effect until the boy turns 18, when he can decide for himself whether or not he wants to be circumcised.

...

The parents divorced in 2003. The mother has custody of the boy, but under a parenting agreement reached as part of the divorce was obligated to consult her ex-husband regarding any non-emergency medical care for the child.

Kristeligt Dagblad
October 19, 2006

Ban on female circumcision puts end to adult sex operations

Ministry of Justice puts cosmetic genital surgery on same footing as female circumcision; plastic surgeons break law by offering labia reduction surgery.

By Karin Dahl Hansen

The increasing number of fashion-conscious young women who want smaller labia, to fit better into a string-bikini or look better after a "personal shave," must henceforth go abroad if they wish to have an operation on their sex organs.

Adult women are subject to the section of the Penal Code adopted three years ago to protect (for instance) Somali girls against culturally motivated circumcision.

The Ministry of Justice has just advised the National Board of Health that all operations on the female sexual organs which aren't therapeutically motivated are criminal offences.

--Operations must not be performed on the female genitalia, if the goal is purely cosmetic and there are no medical reasons, says the senior registrar of the National Board of Health, Torben Hærslev.

Forbud mod pigeomskæring sætter stopper for voksnes kønsoperationer

Justitsministeriet sidestiller intimkirurgi med omskæring af piger. Dermed bryder plastikkirurger straffeloven, når de tilbyder kvinder at reducere deres kønslæber

Af Karin Dahl Hansen

Det stigende antal modebevidste unge kvinder, der ønsker mindre kønslæber, for at de skal passe bedre i et par g-strengs-trusser eller tage sig bedre ud efter intimbarberingen, må fremover tage til udlandet, hvis de ønsker at få opereret deres køn.

De voksne kvinder bliver ramt af den omskæringsparagraf i straffeloven, der blev vedtaget for godt tre år siden for at beskytte blandt andre somaliske småpiger mod kulturelt betinget omskæring.

Justitsministeriet har netop fastslået over for Sundhedsstyrelsen, at alle indgreb på de kvindelige kønsorganer, der ikke er terapeutisk begrundede, er strafbare.

– Man må ikke operere...

Corriere della Sera
October 18, 2006

Turin hospital offers ritual circumcision
- but doctors object

Corriere della Sera, Italy's biggest daily newspaper, reports that ritual circumcision has been made available at a pediatric hospital in Turin on a trial basis. The experiment is intended as a bridge-building exercise with the city's Muslim community. To the embarrassment of the organizers, however, most of the surgeons at the hospital have refused to participate, claiming conscientious objection. The Turin medical licensing authority has ruled that the conscientious objection should be respected, but has also said that male circumcision is a legitimate procedure.

TORINO — Nella camera celeste del reparto di day surgery arriva prima Ilias, quindici mesi. Dorme, nella classica posizione da angioletto: braccia alzate e pugni chiusi vicino alle orecchie. Tempo mezz'ora e dalla sala operatoria portano anche suo fratello Nadir, lui piange ma poco convinto, è disposto a smettere in cambio del suo trattore rosso e giallo. La mamma, marocchina-torinese da sei anni, non parla e non capisce la nostra lingua ma interpreta bene il sorriso dell'infermiera: l'intervento è andato bene. Ilias e Nadir hanno fatto la circoncisione rituale all'ospedale Regina Margherita di Torino. Sono il terzo e quarto paziente di una sperimentazione della Regione Piemonte che è andata di traverso all'opposizione, come da copione, ma anche, a sorpresa, ai dottori dell'ospedale pediatrico. Hanno aderito quattro chirurghi su venti. Motivazione del rifiuto: obiezione di coscienza. L'Ordine dei medici di Torino a cui questi dottori si erano rivolti dopo l'approvazione della delibera si è espresso a favore dell'obiezione ma anche della circoncisione, come aveva già fatto il comitato bioetico in passato legittimando la circoncisione maschile. «I colleghi chiedevano se su queste pratiche ci fosse liceità deontologica, la risposta è che non ci sono controindicazioni né dal punto di vista etico, né deontologico — spiega il presidente Amedeo Bianco — Ma il diritto all'obiezione di coscienza va rispettato. Chi ha portato avanti questo progetto forse ha sottovalutato l'impatto sulla nostra categoria».

OBIETTORI — Esatto. Il centrosinistra, sponsor del progetto, aveva messo in conto le barricate dell'opposizione ma non si era preparato alla rivolta dei camici bianchi. Era caduta nel vuoto la provocazione della Lega nord (Oreste Rossi: «La asl pagherà anche l'infibulazione?») e la contestazione di Forza Italia (Mariangela Cotto: «In Sanità c'erano altre priorità, per esempio l'epidurale»). Ma imbarazzante è l'astensione dei dottori, secondo l'assessore alla Sanità Mario Valpreda: «È un progetto a favore dell'integrazione che incide in misura minima sull'organizzazione dell'ospedale e sulle risorse: costa 120 mila euro e dura un anno, è per 300 bambini». Il primo secco no è arrivato dal primario di Urologia Marco Bianchi: «Non è una patologia ma un rito quindi né io né alcun medico del mio reparto partecipiamo alla sperimentazione». Ma mentre si formava il partito degli obiettori al Regina Margherita e negli altri ospedali di Torino si costituiva quello dei vo lontari, disponibili a fare le circoncisioni. Fra le autocandidature c'è quella del primario di Neuro-urologia dell'ospedale Maria Adelaide, il professor Roberto Carone: «Mi rendo disponibile. Primo, perché l'intervento non ha controindicazioni, anzi. Secondo, perché questi bambini lo farebbero comunque ma in condizioni rischiose, quindi c'è una responsabilità nel negare l'intervento. Se alcuni colleghi fanno obiezione, mi metto a disposizione». I maschietti delle famiglie ebree e musulmane vengono circoncisi, comunque. Nella comunità ebraica spesso ci pensano i rabbini. I musulmani invece o aspettano di tornare nel loro Paese o trovano un pediatra disposto a giustificare l'intervento per «fimosi» o si rivolgono a specialisti privatamente. E c'è ancora un preoccupante fai da te, vedi il neonato quasi evirato dalla madre nigeriana, una badante di Padova, qualche mese fa. Più il gran numero di piccoli pazienti che in ospedale arrivano per curare infezioni post intervento.

PONTI E BARRIERE — «Il progetto sulla circoncisione è un segnale di apertura, l'obiezione di coscienza dei medici stupisce — dice Antonino Boeti, consigliere diessino, dottore e "padre" della sperimentazione —. In una società multietnica abbiamo bisogno di ponti, non di barriere». La comunità islamica a Torino apprezza e ringrazia. «Lo chiedevamo da anni, siamo molto riconoscenti — spiega Hmoud Kholil, medico e rappresentante dell'Unione araba — Nelle famiglie di religione islamica la circoncisione ai bambini si fa e qui soprattutto clandestinamente. Noi siamo molto contrari alla clandestinità: è un intervento medico che va fatto in ospedale». A Madih il padre di Ilias e Nadir, in Italia da otto anni, ambulante con banchetto di frutta e verdura in corso Spezia, la notizia era arrivata prima dell'estate, un volantino scritto in arabo riassumeva le istruzioni: permesso di soggiorno, residenza a Torino, niente ticket, operazione in day hospital, età da 1 a 12 anni. E lui quel volantino l'ha conservato. «A me l'hanno fatta a casa la circoncisione, trent'anni fa usava così, veniva l'hagiam: niente anestesia, niente bisturi, due forbici comuni. Oggi si sta diffondendo anche in Marocco l'abitudine di andare in ospedale, l'operazione lì costa da 100 a 300 euro. Ma non tutti sono pronti a questo cambiamento. L'anno scorso mio padre ha voluto che due nipoti fossero circoncisi in casa sotto i suoi occhi». Lui però per Ilias e Nadir ha scelto il chirurgo — non obiettore — del Regina Margherita.
Federica Cavadini
13 ottobre 2006

The Raw Story
October 17, 2006

Germany fines circumciser for initiation of 7 boys

dpa German Press Agency
Published: Tuesday October 17, 2006

Dusseldorf- A 77-year-old Turkish national who performed ritual circumcisions on seven boys was convicted Tuesday in Germany of causing dangerous bodily harm and fined 2,100 euros. Prosecutors told the state court in Dusseldorf that circumcision was only allowed in Germany for medical reasons and could only be performed by surgeons. Traditional Turkish Muslims practise circumcision on boys aged 6 to 11 as a manhood initiation ritual.

The accused did not attend the trial, a re-hearing in an appeal court, two years after he had been fined the same amount.

At the original trial, the accused agreed he had performed the circumcisions at the request of parents in several cities. Police who seized the surgical instruments at his home described them as dirty and university scientists said he did not follow hygiene rules.

© 2006 dpa German Press Agency

W H O homepage
October 12, 2006

UN Secretary-General’s study reveals full range and scale of violence against children

12 OCTOBER 2006 | NEW YORK -- Much violence against children remains hidden and is often socially approved, according to the United Nations Secretary-General’s Study on Violence against Children presented yesterday to the UN General Assembly. For the first time, a single document provides a comprehensive global view of the range and scale of violence against children.

Bush Radio 89.5 FM
October 13, 2006

Initiation principal pays R50 for each teen abducted

By Tarryn Le Chat
13 October 2006

Young people were often hired as agents to abduct peers and take them to initiation schools, police revealed during public hearings this week on circumcision rites in the Free State.

The Cape Argus reported that the heads of the schools pay R50 for every kidnapped child.

Police were able to rescue twenty-two kidnapped children[;] unfortunately, they were unsuccessful in their attempts to arrest the principal.

According to the report, police have, however, arrested offenders responsible for deaths in initiation schools, [but] there were difficulties in convicting them due to a lack of co-operation between the police and the Department of Justice. Public hearings were set up to focus on the deaths and injuries of initiates at these schools.

posted by Bush Radio 89.5fm Newsroom @ 2:04 PM

New York Times
October 14, 2006

Swaziland: U.S. Circumcision Funds Termed an Error

The United States Agency for International Development mistakenly financed a program in Swaziland that promoted circumcision to prevent the spread of H.I.V., a spokesman said. The spokesman, David Snider, said the Family Life Association of Swaziland received about $150,000 in agency funds last year and circumcised 328 men. Financial support has not been renewed this year. He said the agencys policy is not to finance circumcisions until results are in from two major American-financed studies into whether male circumcision helps to prevent H.I.V. transmission. World Health Organization experts are also awaiting the results of those studies before deciding whether to recommend circumcision as a way to fight AIDS.

Jerusalem Post
19 Tishrei 5767 (October 11, 2006)

Wanted haredi extremists flee country

Oct. 9, 2006 22:18 | Updated Oct. 10, 2006 9:18

By ETGAR LEFKOVITS

A group of haredi extremists suspected of being part of a pirate circumcision network that carried out illegal circumcisions on dozens of Russian teenagers in Jerusalem has fled the country and remains at large, police said Monday.

The haredi zealots allegedly performed the illicit circumcisions on the 16-17-year-old youths in a private city apartment in exchange for presents and without the consent of their parents.

The affair came to light after the mother of one of the teens discovered what had happened to her 16-year-old son and filed a complaint with police, Jerusalem police spokeswoman Sigal Toledo said.

Jerusalem police subsequently raided a city apartment where the suspects allegedly carried out the circumcisions, but the suspects had already fled the country, she said.

According to police, the alleged cell leaders would solicit teens, most of whom were Russian-born and had not undergone circumcision as babies, in schools outside of Jerusalem and cajole them into undertaking the operation in exchange for gifts.

They would then be driven to Jerusalem during the night for the operation.

The complainant gave police a copy of a videotape she found in her son's room, in which the whole illegal circumcision procedure was documented.

Police said the circumcisions were carried out in the apartment without basic sanitary conditions.