the Circumcision Debate

The thing about Africa is that every day is a challenge; sometimes in wonderful ways, sometimes in disappointing, frustrating, and heart-heavy ways. Can I generalize like that, saying "Africa" instead of just "Malawi?" I think so. Because the general sentiment I've discovered here, as have many people living, visiting, or working in African countries will tell you, is an incredible co-existence of pain and beauty. Which is mystifying in and of itself. Though most are happy, life is tough. Tough situations, problems, questions. It certainly doesn't stop people from living , but there's no real way to escape it all, even in the beautiful moments.

A hike in Dedza with some friends the other week quickly unfolded as a perfect example of this. Sweating, tired and in awe with where we were, a debate about circumcision and HIV rapidly unfolds. With a beautiful view like this:

How could a heavy topic not come up in conversation? Of course, we're in Africa.

The Great Circumcision Debate. According to the CDC and UNAIDS, studies indicate that male circumcision can reduce the risk of contracting HIV by almost 45% because:

Dedza, Malawi. Photo by: Katy Lackey

1.  foreskin is more concentrated with cells susceptible to HIV transmission
2. foreskin is more likely to tearing during sex
3. higher rates of some STIs exist among uncircumcised men

 The CDC also reports that in countries where 80% of men or more are circumcised, HIV prevalence rates lower by 20% for the entire population. Male circumcision leads to a reduced HIV infection in female partners as well.

So what's the debate? Where do I start... First, circumcision can have complications, and (not that I would know), painful! Some are arguing the Malawi government should mandate male circumcision. Many are against such a mandate for religious or cultural beliefs. And others feel something like that is simply a personal choice. The other afternoon Chikabachi, a WC translator, and I were discussing the significantly higher rates of HIV in southern Malawi. He spoke of a clinic that performed 200 free circumcisions; apparently almost all the men who went for the procedure agreed to be tested for HIV as well! Those who tested positive were referred to a VCT clinic where they were supplied with free counseling and ARV treatment; those who tested negative learned about proper condom use to further prevent transmission.

Among the mind boggles: Should a government be allowed to make circumcision mandatory? What about in a country where HIV rates are 1/5 or higher? If so, should there be an age at which males should be circumcised?  When there is such abhorrence towards female circumcision concerning human rights, violence, and personal choice, is it fair to mandate male circumcision?  Although circumcision does not guarantee prevention of HIV transmission, in places where HIV prevalence rates are astronomically high, is it a necessary first step, especially when it is so difficult to change behavior (e.g. multiple sexual partners, unprotected sex. etc.)?

SO much to consider. What do you think?

As you struggle and debate through these ideas, just make sure you have a view of something to remind you that, amidst all the suffering and questions and tough stuff, the world is still a beautiful place:

Taslani bwino (stay well),
Katy and World Camp in Malawi
WC Program Coordinator