Posted: Sat Dec 18, 2004 6:54 am Post subject: Circumcision
The following is a news item that appeared in today's Calgary Herald about the Dutch government stopping health insurance coverage for circumcision. Do you think it is right? Should the state underwrite the minority beliefs?
Circumcision coverage dropped
Herald News Services
Saturday, December 18, 2004
Dutch national health insurance will no longer pay for male circumcision, the Health Ministry said Friday.
The ministry decided to halt compensation following reports that up to 90 per cent of circumcisions are carried out for religious rather than health reasons, as specified in Dutch law, said ministry spokesman Bas Kuik.
Muslims and Jews routinely circumcise boys at birth. Around 8.5 per cent of children born in the Netherlands are circumcised, or about 17,000 a year. The average cost at birth, when there are no complications, is around $650 Cdn.
Female circumcision -- sometimes called genital mutilation -- is outlawed in the Netherlands, and the government plans a law that makes it possible to prosecute parents who travel to foreign countries to have their daughters circumcised.
Justice Minister Piet Hein Donner said in October the government has no plans to outlaw male circumcision, which is classified as a cosmetic surgery if not medically necessary.
CAPE TOWN, South Africa - A South African AIDS expert Saturday advocated male circumcision as the best available "vaccine" against the virus in his country, where an estimated 6 million people are infected and more than 600 people die every day.
Francois Venter told a congress of health activists in the Treatment Action Campaign that a recent survey in the Soweto township indicated that circumcised men were 65 percent less likely to contract AIDS than those who had not been circumcised. "We dream of a vaccine which has this efficacy," said Venter, clinical director of the Reproductive Health and HIV Research at the University of Witwatersrand. "The results are phenomenal."
The association between circumcision and a reduced risk of HIV was noted as early as 1987, when Dr. William Cameron of the University of Manitoba in Canada reported findings from a study in Kenya. Some researchers in early studies have said they believe cells in the foreskin may be particularly susceptible to infection.
Venter urged the Treatment Action Campaign, an influential movement of 13,000 activists, to consider promoting circumcision as a vital prevention tool, given that existing methods were failing to slow the spread of the epidemic.
South Africa has the highest number of people living with HIV/AIDS in the world. Nearly 30 percent of pregnant women are infected, according to a health department survey published in July, and in the hardest hit province of KwaZuluNatal this rises to 41 percent. The disease is now one of the main causes of death among young adults and infants.
Some traditional communities in South Africa practice circumcision, but there are calls for tighter medical controls to limit health risks from blunt and contaminated instruments."We don't want our men to go to the chop shop but have medical circumcision," said Zackie Achmat, an AIDS activist who said the congress — which meets every two years — would debate whether to encourage mass circumcision.
Achmat, who is HIV positive, said much more needed to be done on prevention. He said that even though government distribution of condoms increased from one million in 1994 to 40 million in 2004, this still only amounted to 35 condoms per sexually active male per year. He said that 73 percent of young people without the virus believed that they were not at risk of catching, and 62 percent of young people with the virus also believed there was no risk.
Achmat criticized the government's record on treatment. Of the 500,000 people who need AIDS therapy, only 76,000 are currently receiving it through the public health sector. The World Health Organization has singled out slow progress in South Africa as one of the main reasons it will likely miss its target of putting 3 million people worldwide on therapy by the end of this year.
"We are dying. We are still dying," he said. Achmat has for years attacked the government for doing too little too late against the AIDS epidemic. In a sign of the mutual antagonism, health ministry officials refused invitations to attend the congress.
"President Thabo Mbeki tragically still shows symptoms of AIDS denialism," said Achmat. Mbeki reputedly doubts the link between HIV and AIDS. Health Minister Manto Tshabalala-Msimang has repeatedly voiced doubts about the safety and efficacy of antiretrovirals, instead stressing the benefits of a diet heavy in garlic, lemon and olive oil.
The Soweto study, was conducted by French researchers between 2002 and 2005 with more than 3,000 healthy, sexually active males between 18 and 24. About half the volunteers were circumcised by medical professionals, and the rest remained uncircumcised. All the men received counseling on AIDS prevention. But after 21 months, 51 members of the uncircumcised group had contracted HIV, the AIDS virus, while only 18 members of the circumcised group had gotten the disease.
The World Health Organization and UNAIDS welcomed the results of the study, released at a conference in Brazil in July, but says that more trials should be conducted before circumcision can be recommended as a preventive method. A study conducted by the U.S. National Health Institute involving 5,000 individuals is now under way in Uganda.
Comments - Mine
We read the following Hadiths in Sahih Al Bukhari :
Volume 7, Book 72, Number 779:
Narrated Abu Huraira :
I heard the Prophet saying. "Five practices are characteristics of the Fitra: circumcision, shaving the pubic hair, cutting the moustaches short, clipping the nails, and depilating the hair of the armpits."
Volume 4, Book 55, Number 575:
Narrated Abu Huraira:
Allah's Apostle said, "Abraham did his circumcision with an adze at the age of eighty."
Of course the rejecters (Quran Only & Quran First Sects) of the Sunnah of the Prophet (saws) will tell us that circumcision has absolutely nothing to do with Islam & has been plagiarized from the Bible by the Hadith collectors & attributed to the Prophet (saws).
Cutting Arguments Leonard Glick's history of Jewish ritual circumcision is just a warm-up to his case for banning an act at Judaism's heart.
I am comfortable with the discomfort of a bris milah, the Jewish ritual circumcision. The attendees know the event is awesome. Jokes that break the tension belie the power of the moment. Nietzsche wrote, "Wit closes the coffin on an emotion." What we feel at a bris is primal, powerful, and often troubling.
Leonard Glick’s provocative book, "Marked in Your Flesh," asks: Is what happens at a bris also cruel and unwarranted?We accept that parents can make certain decisions for their children. Young children do not get to decide which city they will live in, which clothes they will wear, or which schools they will attend. But does it step over the line of parental discretion to choose surgery for your child that is not medically mandated?
These are not easy questions. Much of the time, Jews simply dismiss such concerns, because to think about them is to confront the discomfiting reality of a bris. Confronting them bring two sides of ourselves into direct conflict: on the one side are notions of autonomy, sensitivity to human pain, the stainless steel rationalism of modernity. On the other is a very ancient and sanctified tradition, one that has claimed Jewish allegiance, and even cost Jewish lives.
"Marked in Your Flesh" is part history, part medical analysis, and part intemperate polemic. Glick's anger shines through even those sections of the book that are putatively dispassionate. Throughout the book, there is a deep perplexity. The author--a cultural anthropologist with a medical degree--wonders what hold this "barbaric" ritual could have for people who in so many other ways are rational and thoughtful and even humane in their lives?
Glick thoroughly documents the history of circumcision. His research is admirable. Beginning in the Bible, Glick recounts how circumcision has changed throughout the history of Judaism and Christianity, highlighting the spirit-flesh polemic between the two faiths. (Disinterested bystanders like the Romans simply dismissed circumcision as equivalent to castration.) He indulges in some plausible and learned speculations as to the motivations of the rabbis, the medieval poskim (decisors of Jewish law) and even mythological flights relating to brit milah. He ends what is a fairly exhaustive survey by recounting bris vignettes from the writings of Philip Roth, Bernard Malamud, and even cites a "Seinfeld" episode (complete with footnotes discussing variations in the script).
Most of the time, the author refrains from launching into the polemic the reader can sense in the tension of his argument like a catapult drawn back, waiting to be launched. At certain points, however, the restraint slips a bit, and small polemical rocks shoot at the target.
For example, he writes of an "almost obsessive need to justify infant circumcision" on the part of the rabbis. Yet to anyone familiar with rabbinic literature, the redundant justification of law—that is, the rabbinic need to fashion many paths to the same conclusion--is the norm, not the exception. And although some of the rabbinic justifications are antiquated, Glick's aim is not to recast outdated answers, but a more ambitious one: to mount a cogent argument for ending the practice of ritual circumcision.
In the last few chapters, Glick unleashes his argument: Circumcision, though medical benefits have been claimed for it, is damaging and has no reliably demonstrated positive effects. He seems as thorough here as he is in recounting the ritual's religious history. A large number of doctors, publications, claims, and refutations are paraded before the reader.
To competently review all of this would take a great deal of time and probably a medical degree, but I did notice that Glick downplays the enthusiasm of those who findings he cannot ignore (such as Thomas Wiswell, the neonatologist, who conducted a large-scale study of male infants and, contrary to his initial assumption, went on to recommend circumcision). Glick also obliquely questions the motives of Jewish physicians who endorse the procedure: "...it is worth considering whether this physician has less personal investment in circumcision advocacy than is evident in the publications of Abraham Wolbarst, Abraham Ravich, Gerald Weiss, and Aaron Fink."
Although I had read other material that contradicts Glick’s conclusions, (by Dr. Samual Kunin and others), how was I to evaluate this mass of medical material?
The morning I began writing this review, there was an article in the Los Angeles Times. The report notes that circumcision rates have been falling as states have cut Medicaid funding for the procedure, "even as growing evidence suggests that the surgery may reduce the transmission of HIV and other sexually transmitted diseases." One random trial in South Africa was halted because the results were so convincing that it was thought immoral to continue the experiment. The epidemiologists who were quoted in the article (Dr. Thomas Coates of UCLA, Robert Bailey of the University of Illinois at Chicago) said nothing about ritual circumcision. They advocate the procedure not because it is God’s inscrutable mandate, but because they believe it saves lives.
Glick points out with puzzlement that even those who are estranged from the tradition cling to this seemingly antiquated and uncivilized ritual. He seems not to grasp the immense power of expressing the covenant in one's flesh. Jews do not practice circumcision because it is hygienic, but because it is one of those deep-throated, sanctified expressions of yearning and commitment. In ceremonial language, the parent says "I turn myself and my future to you, oh God, in a ritual that will forever identify my child as part of his people. In return, we ask that You help this people endure until we accomplish what we are charged to do: join together to fashion a world in which sacrifices will no longer be needed."
That is a commitment that supersedes statistics and transcends the shifting medical fads of the moment.
Circumcision legal case in spotlight Procedure draws strong opinions
Published: Friday, June 16, 2006
Groups opposed to circumcision are watching the case of an eight-year-old suburban Chicago boy whose divorced parents are fighting in court over whether he should have the procedure.
The child's mother wants him circumcised to prevent recurring, painful inflammation she says he's experienced during the past year. But the father says the boy is healthy and circumcision, which removes the foreskin of the penis, is an unnecessary medical procedure that could cause him long-term physical and psychological harm.
"The child is absolutely healthy," the father said during a break in a court hearing on the matter Wednesday. "I do not want any doctor to butcher my son."
The mother testified that her son has had five bouts of painful inflammation and cannot wear underwear or jeans during the bouts and is comfortable only in loose-fitting pyjamas.
"My child was in the bathroom crying. He asked me to come in because his penis did not look normal," she said, describing one of the episodes.
The couple's 2003 divorce decree gave the father the right to offer input on medical decisions. Earlier this year, he sued to block the surgery and Cook County Judge Jordan Kaplan ordered the mother not to have the boy circumcised until he could hear from both parents and the opinions of doctors who've examined the boy.
The Associated Press is not naming the parents to protect the child's privacy.
The case reflects a national debate over the medical necessity of circumcision. In 1999, the American Academy of Pediatrics reversed its support for routine infant circumcision, citing questionable benefits and medical and anecdotal evidence that circumcised men have less penile sensitivity.
David Llewellyn, an Atlanta lawyer who specializes in circumcision cases, is helping the father's lawyers without a fee. He called the surgery "a bizarre American custom."
Most U.S. newborn boys are circumcised before they leave the hospital. But a growing number of parents are opting against the surgery. The percentage of male babies circumcised has fallen from an estimated 90 per cent in 1970 to about 60 per cent today.
Tracy Rizzo, the mother's lawyer, said the father disagrees with circumcision because he resents the fact that his ex-wife has remarried a Jewish man.
For Jews, a ritual circumcision, or bris, is a sacred covenant with God, commanded in Genesis.
Kosovo rite binds two villages
By Nicholas Wood The New York Times
MONDAY, JULY 31, 2006
GORNJE LUBINJE, Kosovo It is hard to place the inhabitants of this unusual village in the web of identities that make up the Balkans.
They are neither Serbs nor Albanians, the main ethnic groups vying for control of the internationally administered province of Kosovo.
Perhaps the closest match would be to call them Bosnians, which is how these Slavic-speaking Muslims who form a minority here in Kosovo describe themselves.
But the language spoken here, a mixture of Serbian and Macedonian, with a few Turkish words thrown in, is not the same as any other in the Balkans, including Bosnia. And Gornje Lubinje's customs, as well as those of its neighboring village, Donje Lubinje, are unlike those of any other people in Kosovo.
Every five years, the inhabitants of the two villages, high in the Shar mountain range, close to the boundary with Macedonia, come together for an extraordinary festival - its version of a Muslim rite of passage. For three days, upward of 3,000 people gather here to feast, sing and dance and take part in traditional Turkish sports like wrestling. In a region sharply divided along ethnic lines, Gornje Lubinje's festival this year has attracted Serbs, Albanians and members of Kosovo's diaspora from as far away as Switzerland and Germany.
But the distinguishing feature of this festival is the ceremony of Sunet, or circumcision, that takes place in one day for all of the host village's boys age 5 or under - 111 of them this year in Gornje Lubinje. (Donje Lubinje will perform the rite next year.)
The tradition, whose origins date from beyond living memory, is viewed by almost all residents with almost universal pride as it has come to symbolize this place's special identity.
"It gives us a sense of unity," said Rafik Kasi, a local journalist from Gornje Lubinje, whose nephew was being circumcised.
Zaber Kaplani, who had traveled from Donje Lubinje, farther down the Zupa Valley, to join the ceremonies, said: "When parents have a boy, they spend months and years preparing for this ceremony. This is one of the greatest traditions we have."
Some parents chose to send their children to be circumcised at the village's clinic, where this year, on Saturday, two surgeons and a doctor performed operations on 24 boys under local anesthetic. But the vast majority opted to put their children in the care of the nimble hands of Zulfikar Shishko, 69, who normally works in the Ekspres barber shop in the nearby city of Prizen.
For €25, or about $32, each, Shishko performed the operation in the boys' homes, without anesthetic. He was accompanied by two burly assistants dressed in red aprons whose task it was to restrain the boys during the operation. ("We have a special technique," said Hajrulla Osmani, one of the assistants.)
With a scalpel, a bottle of iodine and some scouring powder to help clean his hands after each operation, Shishko had the air of a man possessed as he proceeded to circumcise 87 boys in just over 12 hours Saturday.
At that pace, Shishko spoke hardly a word as he scurried from house to house. "I would work even faster if they let me," he said, explaining that too many people wanted to talk to him.
Villagers here say the performing of all the circumcisions on one day has a simple explanation: poverty.
"It dates from a period of crisis when people had no money," said Kasi, the local journalist. "It was simpler for everybody to come together and share the expenses."
Nobody here could say when the ceremonies were first held in such large numbers.
But villagers said they had on occasion been interrupted, by the Balkan wars of 1912 and 1913 and then World War I.
There are other Bosnian Muslim villages in the Zupa Valley that once held mass Sunet ceremonies, but now only Gornje Lubinje and Donje Lubinje keep the custom going.
In each house the scene was virtually identical. Shishko entered and was followed by his assistants and a young imam. In the next room, the mother, grandmother, aunts and sisters stood dressed in white dresses and waistcoats embroidered in gold and waited for the operation to finish.
When the job was done, a Romany band struck up outside, and relatives squeezed their way to give money to the boy, who was lying covered on the floor or a bed.
Screams of pain and pulsating music punctuated the day, but Kasi said, "Our trust in God gives the boys strength to overcome the pain."
It was hard to find anyone to criticize the pace or the skill of the practitioner. "He's better than a surgeon," said Ibrahim Bilibane, a construction foreman from Donje Lubinje.
In the Bajrami household, Sehizada Bajrami, 23, was visibly distressed as Shishko entered and approached Selhan, her 30-month-old son. With tears running down her cheeks, she whimpered, "I can't decide what I feel."
But her father-in-law, Advi Bajrami, 83, intervened. "She's full of joy," he said.
Circumcision may curb HIV
Challenge is getting men to do it: Clinton
CanWest News Service
Wednesday, August 16, 2006
Circumcision could have a "staggering" effect on the control of HIV worldwide, but the challenge will be convincing men to have it done, former U.S. president Bill Clinton said Tuesday.
Scientists at the world's largest AIDS gathering in Toronto reported more evidence that removing the male foreskin appears to dramatically reduce the risk of HIV infection.
An ongoing study of tea plantation residents in Kericho, Kenya, found dramatically lower HIV rates among circumcised men versus uncircumcised males after two years of follow-up.
Other researchers reported that circumcision would cost $181 for every HIV infection averted and that 32,000 to 53,000 infections could be prevented in Soweto alone over the next 20 years if more men were circumcised. And, despite serious concerns men who are circumcised would adopt more risky sexual behaviours, a study of 324 recently circumcised men in Kenya found no excess of reported risky sex.
Clinton told delegates that, if it works, circumcision could be a powerful means to reduce the devastating global burden of HIV. "We should all be prepared for a green light that could have a staggering effect on the male population."
A randomized controlled trial in South Africa was halted prematurely last year when researchers discovered circumcision appeared to reduce the risk of female-to-male HIV transmission by 61 per cent.
Women appear to benefit as well. A study based on 300 couples in Uganda found that male circumcision reduced by 30 per cent the likelihood that the female partner would become infected.
In the ongoing study in Kenya, the HIV infection rate after 24 months of follow-up was 0.78 per 100 person-years in the circumcised men, versus 2.48 in uncircumcised males. This means that, for example, if 100 men were followed up for one year, there would be 2.48 infections in the uncircumcised group.
The cells in the foreskin are thought to be more susceptible to HIV infection.
But, critics wonder how men who refuse to wear condoms will be convinced to undergo a circumcision.
Studies to date show removing foreskin doesn't provide complete protection and there are fears a massive scale-up of circumcision programs could lead to diminished condom use.
February 4, 2008
Male Circumcision No Aid to Women in Study
By LAWRENCE K. ALTMAN
BOSTON — A number of studies showing that circumcision among men reduces their risk of infection from the AIDS virus has raised the hope that the procedure would also benefit their female sexual partners.
But the expectations were challenged Sunday by a new study showing that male circumcision conferred no indirect benefit to the female partners and, indeed, increased the risk if the couples resumed sex before the circumcision wound was fully healed, usually in about a month.
The study did confirm the benefit of male circumcision in lowering the incidence of herpes and other genital ulcers among men.
Findings of the study, which was conducted in an area of high incidence of H.I.V., the AIDS virus, were reported at the 15th Conference on Retroviruses and Opportunistic Infections. Although the findings did not reach statistical significance, they still underscore the need for more effective education among men who undergo circumcision and their female partners, the authors of the study said.
The study — conducted by the same team of researchers from Johns Hopkins and Uganda who had shown circumcision’s benefits among men in earlier studies — is believed to be the first clinical trial to provide scientific data on the effects on women of circumcision in their male partners.
For many years, epidemiologists observed that the incidence of AIDS was higher in areas of Africa where men were not circumcised and lower in areas where men were circumcised. But many scientists were skeptical that circumcision played a role in acquiring H.I.V. Then in recent years, three scientifically controlled studies in Kenya, South Africa and Uganda convinced the skeptics by showing that male circumcision could reduce the risk of H.I.V. infection by 50 percent to 60 percent.
Although circumcision is no cure-all, the World Health Organization endorsed the procedure last year, increasing demand for it among men in many areas of Africa. When trained workers performed the procedure, the incidence of infection and mishap is much lower than when traditional ritual circumcisers perform it.
Male circumcision took on new importance because of the failure of scientists to develop a vaccine to prevent AIDS. The success rates of male circumcision were high enough for many AIDS experts to call the procedure a virtual “vaccine.”
Some AIDS experts also said there were strong indications that male circumcision of infected men also protects their sexual partners.
“Some infected men inevitably will seek circumcision because it leaves a physical mark” that would remove the stigma of being infected, Dr. Maria Wawer of Johns Hopkins, a co-author of the study, said at a news conference.
Also, if fewer men became infected because they got circumcised, that could provide a benefit to their sexual partners, said another author, Dr. David Serwadda of Makerere University in Kampala.
In the study reported here, all the men and women agreed in writing to participate after they were informed about other ways to prevent H.I.V. infection, wound care and abstention from sex after the surgical circumcision. The men were offered free condoms and the couples were counseled and tested for H.I.V. There were 1,015 H.I.V.-infected men who agreed to having circumcision immediately or waiting two years for purposes of a scientific control group. The timing was chosen at random, researchers said.
The 770 married men were asked to invite their spouses to participate in the study, and 566 did. Among the women, 245, or 43 percent, were not H.I.V. infected. The analysis focused on the 161 couples who enrolled at the same time and in which the men were infected but their spouses were not.
There were 93 couples in the group where the man had an immediate circumcision and 68 in the control group where the man delayed having the procedure for two years. In both groups, the incidence of infection was highest in the first six-month follow-up period, 27.3 in the immediate group and 17.8 in the delayed one.
The incidence declined for the rest of the study period, 5.7 in the immediate group compared with 4.1 in the delayed group.
The higher incidence was found among the couples who resumed sexual intercourse more than five days earlier than a trained health professional certified the circumcision wound had healed fully compared with the couples who resumed intercourse within five days of certified circumcision wound healing.
Dr. Wawer said in an interview that because the numbers in the study were small and the results not statistically significant, additional studies were needed to determine more precisely potential benefits among men and women as well as ways to reduce potential risks associated with early resumption of sex.
Rates of condom use, vaginosis (a bacterial vaginal infection), vaginal discharge, painful urination and infection of the genital-urinary tract were about the same among women in each group.
Jews and Muslims find a common cut
By Andrew Jack in London
Published: July 10 2009 19:15 | Last updated: July 10 2009 19:15
A joint interest in limiting the spread of HIV in Africa has triggered a pioneering partnership between Jews and Muslims to share their expertise of circumcision.
Five specialists from Senegal, which is predominantly Muslim, this week attended a seminar in Jerusalem organised by Operation Abraham, a group of Israeli-based Jewish experts, signalling the start of joint programmes to train doctors across sub-Saharan Africa in adult circumcision.
The action adds African Muslims to Operation Abraham’s own efforts over the past two years to train doctors in Swaziland, with other formal agreements already signed with Lesotho and Uganda, and interest from half a dozen other countries.
It comes amid growing evidence that circumcision sharply reduces the transmission of HIV, the virus that causes Aids, while also being culturally acceptable in many African countries at high risk from the infection.
It signals a fresh engagement between the two religions at a time when international public health specialists have tried to accelerate cooperation between different faiths in efforts to better tackle life-threatening diseases including HIV and malaria.
In his previous trip to Cairo and his current visit to Africa, US President Barack Obama has been urged to tap the influence of faith-based organisations to fight malaria. Proponents argue they could offer a fresh way to reinvigorate both American efforts to engage Muslims and tackle a disease where there are few disagreements between the faiths.
Religious and moral sensitivities have in the past limited united efforts to use religious organisations tackle HIV through programmes such as the distribution of condoms or discussion around safer sexual practices. But the shared practice of circumcision offers common ground for Islam and Judaism.
Inon Schenker, one of the organisers, said: “Abraham brought [Jews and Muslims] together with circumcision 3,000 years ago. Now we have opened an avenue for US funding after President Obama’s calls in Cairo to bring Islam together with America.”
Israel has probably the world’s most extensive experience of 100,000 adult male circumcisions since the arrival of previously uncircumcised Jews from the former Soviet Union and Ethiopia in the 1980s.
A delegation of five surgeons and public health specialists from Senegal concluded a four-day workshop on Friday following a formal agreement between Senegal’s ministry of health and its medical association with the Jerusalem Aids Project, a backer of Operation Abraham.
The meeting was the culmination of many months of discreet work to build interfaith links between Jewish and Muslim medical specialists keen to apply their skills collectively while seeking to avoid inflaming any political and religious sensitivities.
An Israeli-based Muslim surgeon last year accompanied Jewish specialists on Operation Abraham’s third trip lto Swaziland, which has one of the highest rates of HIV in the world.
Copyright The Financial Times Limited 2009
July 20, 2009
South Africa Is Seen to Lag in H.I.V.
Fight By CELIA W. DUGGER
ORANGE FARM, South Africa — Young men have flocked by the thousands to this clinic for circumcisions, the only one of its kind in South Africa. Each of them lies down on one of seven closely spaced surgical tables, his privacy shielded only by a green curtain.
“I’ve done 53 in a seven-hour day, me, myself, personally,” said Dr. Dino Rech, who helped design the highly efficient surgical assembly line at this French-financed clinic for cutting off foreskins.
Circumcision has been proven to reduce a man’s risk of contracting H.I.V. by more than half. Yet two years after the World Health Organization recommended the surgery, the government here still does not provide it to help fight the disease or educate the public about its benefits.
Some other African nations are championing the procedure and bringing it to thousands. But in South Africa, the powerhouse country at the heart of the epidemic, the government has been notably silent, despite the withering international criticism the country has endured for its previous foot-dragging in fighting and treating AIDS.
“Countries around us with fewer resources, both human and financial, are able to achieve more,” said Dr. Quarraisha Abdool Karim, the first director of South Africa’s national AIDS program in the mid-1990s under President Nelson Mandela. “I wish I understood why South Africa, which has an enviable amount of resources, is not able to respond to the epidemic the way Botswana and Kenya have.”
Even without government involvement, demand for the surgery, performed free under local anesthetic, has surged over the last year here at the Orange Farm clinic. The men are counseled to continue using condoms since circumcision provides partial, though substantial protection.
Men waited nervously one recent chilly morning for their turn. Most were hoping the procedure would help them stay healthy here in the nation with more H.I.V.-positive people than any other.
But some said they were also drawn by a surprising, if powerful, motivation: They had heard from recently circumcised friends that it makes for better sex. You last longer, they said. Your lovers think you’re cleaner and more exciting in bed.
“My girlfriend was nagging me about this,” said Shane Koapeng, 24. “So I was like, ‘O.K., let me do it.’ ”
As new H.I.V. infections have continued to outpace efforts to treat the sick in Africa, there is growing concern about the ballooning costs of treatment for an ever-expanding number of patients who need medicines for the rest of their lives. Almost two million people were newly infected in 2007 in sub-Saharan Africa, bringing the total of those living with H.I.V. in the region to 22 million, according to United Nations estimates.
The major international donors to AIDS programs, including the United States and the Global Fund to Fight AIDS, Tuberculosis and Malaria, are ready to pour money into male circumcision, but the countries have to be ready to accept the help.
“You can’t impose it from the outside, particularly such a sensitive intervention,” said the Global Fund’s executive director, Dr. Michel Kazatchkine.
Public health doctors agree that circumcising millions of men will be no simple task. Africa has a severe shortage of doctors and nurses, and circumcision is potentially a political and cultural minefield in countries where some ethnic groups practice it but others do not.
Still, some countries are showing it can be done. In Botswana, circumcision was largely stopped in the late 19th and early 20th centuries by British colonial-era administrators and Christian missionaries.
But Festus Mogae, who was president from 1998 to 2008, provided a critical endorsement of male circumcision just before he stepped down.
Over the past year, the government has trained medical teams to do circumcisions in all its public hospitals and aims by 2016 to have circumcised 470,000 males from infancy to age 49, which is 80 percent of the total number in that group.
Public awareness is being raised through advertisements on radio and television. Billboards have sprouted across the country featuring a star of the national youth soccer team.
“Men have started to flock to the hospitals,” said Dr. Khumo Seipone, director of H.I.V./AIDS prevention and care in Botswana’s Ministry of Health.
In Kenya, where the Luo do not generally practice circumcision, Prime Minister Raila Odinga, himself a Luo, encouraged the procedure and lobbied elders. The H.I.V. infection rate among Luo men is more than triple that of Kenyan men generally — 17.5 percent versus 5.6 percent.
“Anything that could help save lives needs to be tried,” Mr. Odinga said, adding that he had been circumcised.
So far, more than 20,000 men in Kenya have been circumcised in hospitals, dispensaries, village schools, social halls and tents. Teams of doctors, nurses and counselors have even taken boats to islands in Lake Victoria to circumcise Luo fishermen.
“If the Luo Council of Elders and local politicians had been against it, the government would not have dared endorse circumcision,” said Robert Bailey, the principal investigator on the Kenya male circumcision clinical trial.
In sharp contrast, male circumcision has no political champion here in South Africa, where the largest ethnic group, the Zulus, have generally not practiced it since the early 19th century, when it was abandoned due to protracted warfare, according to Daniel Halperin, an epidemiologist and medical anthropologist at Harvard University.
Thabo Masebe, a spokesman for President Jacob Zuma, said the Health Ministry must first set a policy on circumcision before Mr. Zuma, who took office in April, can take a position. Mr. Zuma is Zulu. The province of KwaZulu-Natal, the Zulu heartland, has the highest adult H.I.V. prevalence rate in the country, 39 percent, according to Unaids.
“The president gets involved when decisions are made,” Mr. Masebe said. “If the president spoke now, and when the time comes to make a policy, a different decision is taken, it wouldn’t sound good.”
The new health minister, Aaron Motsoaledi, spoke at length about AIDS in a recent speech to Parliament but made no mention of male circumcision. Dr. Yogan Pillay, a senior official at the National Department of Health, said a policy was being drafted and would be put forward for discussion by the end of the month.
In March 2007, the World Health Organization concluded from rigorous clinical trials in Kenya, Uganda and here in Orange Farm township that male circumcision reduced female-to-male H.I.V. transmission by about 60 percent.
“This is an important landmark in the history of H.I.V. prevention,” the W.H.O. said at the time.
That same year, a committee of scientists, advocates and others advising the South African government recommended offering circumcisions as quickly as possible, perhaps by contracting with private doctors while public health workers were trained. Instead, the government set up a task force to study the issue, said Dr. Abdool Karim, a committee member.
The surgical methods developed in Orange Farm are now being copied in the region. Population Services International, which provides counseling at the Orange Farm clinic, is putting them into practice in Zimbabwe in collaboration with the Health Ministry there. It also received $50 million from the Bill and Melinda Gates Foundation to work with the governments of Zambia and Swaziland in the hope of circumcising some 650,000 men in those two countries.
South Africa has made strides in recent years, and now provides antiretroviral therapy to more people with AIDS than any other developing country.
But this is not the first time its policies have lagged behind. The country delayed for years providing antiretroviral medicines to treat AIDS under its former president, Thabo Mbeki, who denied the scientific consensus about the viral cause of the disease. Harvard researchers estimated that the government would have prevented the premature deaths of 330,000 South Africans earlier in the decade if it had provided the drugs.
“South Africa has no shortage of scientists,” said Olive Shisana, chief executive officer of South Africa’s government-financed Human Sciences Research Council. “We have a shortage of people willing to take the evidence that exists and use it for public health.”
August 24, 2009
Officials Weigh Circumcision to Fight H.I.V. Risk
By RONI CARYN RABIN
Public health officials are considering promoting routine circumcision for all baby boys born in the United States to reduce the spread of H.I.V., the virus that causes AIDS.
The topic is a delicate one that has already generated controversy, even though a formal draft of the proposed recommendations, due out from the Centers for Disease Control and Prevention by the end of the year, has yet to be released.
Experts are also considering whether the surgery should be offered to adult heterosexual men whose sexual practices put them at high risk of infection. But they acknowledge that a circumcision drive in the United States would be unlikely to have a drastic impact: the procedure does not seem to protect those at greatest risk here, men who have sex with men.
Recently, studies showed that in African countries hit hard by AIDS, men who were circumcised reduced their infection risk by half. But the clinical trials in Africa focused on heterosexual men who are at risk of getting H.I.V. from infected female partners.
For now, the focus of public health officials in this country appears to be on making recommendations for newborns, a prevention strategy that would only pay off many years from now. Critics say it subjects baby boys to medically unnecessary surgery without their consent.
But Dr. Peter Kilmarx, chief of epidemiology for the division of H.I.V./AIDS prevention at the C.D.C., said that any step that could thwart the spread of H.I.V. must be given serious consideration.
“We have a significant H.I.V. epidemic in this country, and we really need to look carefully at any potential intervention that could be another tool in the toolbox we use to address the epidemic,” Dr. Kilmarx said. “What we’ve heard from our consultants is that there would be a benefit for infants from infant circumcision, and that the benefits outweigh the risks.”
He and other experts acknowledged that although the clinical trials of circumcision in Africa had dramatic results, the effects of circumcision in the United States were likely to be more muted because the disease is less prevalent here, because it spreads through different routes and because the health systems are so disparate as to be incomparable.
Clinical trials in Kenya, South Africa and Uganda found that heterosexual men who were circumcised were up to 60 percent less likely to become infected with H.I.V. over the course of the trials than those who were not circumcised.
There is little to no evidence that circumcision protects men who have sex with men from infection.
Another reason circumcision would have less of an impact in the United States is that some 79 percent of adult American men are already circumcised, public health officials say.
But newborn circumcision rates have dropped in recent decades, to about 65 percent of newborns in 1999 from a high of about 80 percent after World War II, according to C.D.C. figures. And blacks and Hispanics, who have been affected disproportionately by AIDS, are less likely than whites to circumcise their baby boys, according to the agency.
Circumcision rates have fallen in part because the American Academy of Pediatrics, which sets the guidelines for infant care, does not endorse routine circumcision. Its policy says that circumcision is “not essential to the child’s current well-being,” and as a result, many state Medicaid programs do not cover the operation.
The academy is revising its guidelines, however, and is likely to do away with the neutral tone in favor of a more encouraging policy stating that circumcision has health benefits even beyond H.I.V. prevention, like reducing urinary tract infections for baby boys, said Dr. Michael Brady, a consultant to the American Academy of Pediatrics.
He said the academy would probably stop short of recommending routine surgery, however. “We do have evidence to suggest there are health benefits, and families should be given an opportunity to know what they are,” he said. But, he said, the value of circumcision for H.I.V. protection in the United States is difficult to assess, adding, “Our biggest struggle is trying to figure out how to understand the true value for Americans.”
Circumcision will be discussed this week at the C.D.C.’s National H.I.V. Prevention Conference in Atlanta, which will be attended by thousands of health professionals and H.I.V. service providers.
Among the speakers is a physician from Operation Abraham, an organization based in Israel and named after the biblical figure who was circumcised at an advanced age, according to the book of Genesis. The group trains doctors in Africa to perform circumcisions on adult men to reduce the spread of H.I.V.
Members of Intact America, a group that opposes newborn circumcision, have rented mobile billboards that will drive around Atlanta carrying their message that “circumcising babies doesn’t prevent H.I.V.,” said Georganne Chapin, who leads the organization.
Although the group’s members oppose circumcision on broad philosophical and medical grounds, Ms. Chapin argued that the studies in Africa found only that circumcision reduces H.I.V. infection risk, not that it prevents infection. “Men still need to use condoms,” Ms. Chapin said.
In fact, while the clinical trials in Africa found that circumcision reduced the risk of a man’s acquiring H.I.V., it was not clear whether it would reduce the risk to women from an infected man, several experts said.
“There’s mixed data on that,” Dr. Kilmarx said. But, he said, “If we have a partially successful intervention for men, it will ultimately lower the prevalence of H.I.V. in the population, and ultimately lower the risk to women.”
Circumcision is believed to protect men from infection with H.I.V. because the mucosal tissue of the foreskin is more susceptible to H.I.V. and can be an entry portal for the virus. Observational studies have found that uncircumcised men have higher rates of other sexually transmitted diseases like herpes and syphilis, and a recent study in Baltimore found that heterosexual men were less likely to have become infected with H.I.V. from infected partners if they were circumcised.
Should circumcision be outlawed? It just might be in San Francisco
Adriana Barton, VANCOUVER
Before the year is up, parents in San Francisco may no longer have the option of getting a boy snipped.
A group against circumcision of male children has gathered enough signatures to have a proposed ban on the foreskin-cutting procedure included in the November ballot, the Associated Press reports.
If the ban is approved, circumcision of minors would be punishable by a fine of up to $1,000, or up to one year in jail.
No exceptions for Jewish families or parents who simply want a son’s willy to look like Dad’s.
“Guardians have to do what’s in the best interest of the child. It’s his body. It’s his choice,” anti-circumcision activist Lloyd Schofield told reporters.
But Jewish leaders said the measure could violate First Amendment protection of religious freedoms.
“For a city that's renowned for being progressive and open-minded, to even have to consider such an intolerant proposition ... sets a dangerous precedent for all cities and states,” said Rabbi Gil Yosef Leeds, a certified “mohel” who performs ritual circumcisions.
The World Health Organization recommends circumcision to reduce the spread of HIV, especially in AIDS-ravaged African countries. But according to the Associated Press, studies have shown that circumcision doesn’t protect against HIV in gay men, the main population in which the virus spreads in the United States.
In Canada, parents must pay up to $300 out of pocket to have the procedure done.
Infant circumcision rates dropped to 32 per cent in 2006 from 47 per cent in 1973, The Globe and Mail reported. And the Canadian Paediatric Society has indicated that circumcision is “not medically necessary.”
“Intactivists”- individuals who vocally oppose male infant circumcision - couldn’t agree more.
But here’s hoping a ban doesn’t result in a booming business for dodgy circumcisionists.
June 4, 2011
Efforts to Ban Circumcision Gain Traction in California
By JENNIFER MEDINA
SANTA MONICA, Calif. — When a group of activists proposed banning circumcision in San Francisco last fall, many people simply brushed them aside. Even in that liberal seaside city, it seemed implausible that thousands of people would support an effort to outlaw an ancient ritual that Jews and Muslims believe fulfills a commandment issued by God.
But last month, the group collected the more than 7,100 signatures needed to get a measure on the fall ballot that would make it illegal to snip the foreskin of a minor within city limits. Now a similar effort is under way in Santa Monica to get such a measure on the ballot for November 2012.
If the anticircumcision activists (they prefer the term “intactivists”) have their way, cities across the country may be voting on whether to criminalize a practice that is common in many American hospitals. Activists say the measures would protect children from an unnecessary medical procedure, calling it “male genital mutilation.”
“This is the furthest we’ve gotten, and it is a huge step for us,” said Matthew Hess, an activist based in San Diego who wrote both bills.
Mr. Hess has created similar legislation for states across the country, but those measures never had much traction. Now he is fielding calls from people who want to organize similar movements in their cities.
“This is a conversation we are long overdue to have in this country,” he said. “The end goal for us is making cutting boys’ foreskin a federal crime.”
Jewish groups see the ballot measures as a very real threat, likening them to bans on circumcision that existed in Soviet-era Russia and Eastern Europe and in ancient Roman and Greek times. The circumcision of males is an inviolable requirement of Jewish law that dates back to Abraham’s circumcision of himself in the Book of Genesis.
They say the proposed ban is an assault on religious freedom that could have a widespread impact all over the country. Beyond the biblical, there are emotional connections: checking for circumcision was one of the ways Jewish children could be culled from their peers by Nazis and the czar’s armies.
“People are shocked that it has reached this level because there has never been this kind of a direct assault on a Jewish practice here,” said Marc Stern, associate general counsel for the American Jewish Committee, an advocacy group. “This is something that American Jews have always taken for granted — that something that was so contested elsewhere but here, we’re safe and we’re secure.”
Mr. Hess also writes an online comic book, “Foreskin Man,” with villains like “Monster Mohel.” On Friday, the Anti-Defamation League issued a statement saying the comic employed “grotesque anti-Semitic imagery.”
Jena Troutman, the mother of two young boys who is promoting the ballot measure in Santa Monica, said she did not think of herself as a crusader against religion. Instead, she views her work as a chance to educate would-be parents against a procedure that “can really do serious damage to the child.”
“I am just a mom trying to save the little babies,” Ms. Troutman said. “I’d rather be on the beach, but nobody is talking about this, so I have to.”
Ms. Troutman has run the Web site wholebabyrevolution.com for two years, and she is fond of rattling off sayings like “Your baby is perfect, no snipping required.” Well versed in the stories of circumcisions gone awry, she said the recent death of a New York City toddler who was circumcised at a hospital convinced her that she should push for the ballot measure.
Ms. Troutman, who has worked as a lactation educator and a doula, said she often approached women on the beach to warn them about the dangers of circumcising, but she has declined to answer questions about her own children.
Although precise numbers are not known, several studies have indicated that circumcision rates have been declining in the United States for the past several years and now range from 30 percent to 50 percent of all male infants.
Many medical groups take a neutral approach, saying that the practice is not harmful and that there is not enough scientific evidence to conclude that it is necessary, and leave the decision to parents and their doctor. Several studies have linked circumcision with a reduction in the spread of H.I.V. Roughly half of the 694 baby boys born in the Santa Monica-U.C.L.A. Medical Center and Orthopaedic Hospital in 2010 were circumcised before they left the hospital, officials there said.
Dr. David Baron, a family physician, certified mohel — someone who performs ritual circumcision — and former chief of staff at Santa Monica-U.C.L.A., said that he would not press any parent to circumcise a son but that he viewed the effort to ban the procedure as “ridiculous and dishonest.”
“To say it is mutilation is wrong from the get-go,” Dr. Baron said. “It is a perfectly valid decision to say that it is not what you want for your child. Any doctor who says it is needed is not being honest, but to say that it needs to be banned is shocking.”
If the ballot measure passed, it would certainly face legal challenges. But several legal experts said it was far from certain that it would be struck down in a court. Ms. Troutman said she considered putting religious exemptions in the measure, but then decided, “Why should only some babies be protected?”
Rabbi Yehuda Lebovics, an Orthodox mohel based in Los Angeles who says he has performed some 20,000 circumcisions over several decades, said he often had to soothe nervous mothers.
“I am now doing the sons of the boys I did 30 years ago,” Rabbi Lebovics said. “So I turn to the new mother and ask, ‘Do you have any complaints in the way it turned out?’ ”
A court in Cologne, Germany, recently ruled that parents could not have boys circumcised unless there is an urgent medical need.
Should other jurisdictions follow this example, with laws to delay the procedure until boys can decide for themselves and give informed consent? Or would that infringe on Muslims, Jews and others who consider infant or childhood circumcision important?
August 27, 2012
Benefits of Circumcision Are Said to Outweigh Risks
By RONI CARYN RABIN
The American Academy of Pediatrics has shifted its stance on infant male circumcision, announcing on Monday that new research, including studies in Africa suggesting that the procedure may protect heterosexual men against H.I.V., indicated that the health benefits outweighed the risks.
But the academy stopped short of recommending routine circumcision for all baby boys, saying the decision remains a family matter. The academy had previously taken a neutral position on circumcision.
The new policy statement, the first update of the academy’s circumcision policy in over a decade, appears in the Aug. 27 issue of the journal Pediatrics. The group’s guidelines greatly influence pediatric care and decisions about coverage by insurers; in the new statement, the academy also said that circumcision should be covered by insurance.
The long-delayed policy update comes as sentiment against circumcision is gaining strength in the United States and parts of Europe. Circumcision rates in the United States declined to 54.5 percent in 2009 from 62.7 percent in 1999, according to one federal estimate. Critics succeeded last year in placing a circumcision ban on the ballot in San Francisco, but a judge ruled against including the measure.
In Europe, a government ethics committee in Germany last week overruled a court decision that removing a child’s foreskin was “grievous bodily harm” and therefore illegal. The country’s Professional Association of Pediatricians called the ethics committee ruling “a scandal.”
A provincial official in Austria has told state-run hospitals in the region to stop performing circumcisions, and the Danish authorities have commissioned a report to investigate whether medical doctors are present during religious circumcision rituals as required.
Officials with the Centers for Disease Control and Prevention in Atlanta, which for several years have been pondering circumcision recommendations of their own, have yet to weigh in and declined to comment on the academy’s new stance. Medicaid programs in several states have stopped paying for the routine circumcision of infants.
“We’re not pushing everybody to circumcise their babies,” Dr. Douglas S. Diekema, a member of the academy’s task force on circumcision and an author of the new policy, said in an interview. “This is not really pro-circumcision. It falls in the middle. It’s pro-choice, for lack of a better word. Really, what we’re saying is, ‘This ought to be a choice that’s available to parents.’ ”
But opponents of circumcision say no one — not even a well-meaning parent — has the right to make the decision to remove a healthy body part from another person.
“The bottom line is it’s unethical,” said Georganne Chapin, founding director of Intact America, a national group that advocates against circumcision. “A normal foreskin on a normal baby boy is no more threatening than the hymen or labia on your daughter.”
In updating its 1999 policy, the academy’s task force reviewed the medical literature on benefits and harms of the surgery. It was a protracted analysis that began in 2007, and the result is a 30-page report, which includes seven pages of references, including 248 citations.
Among those are 14 studies that provide what the experts characterize as “fair” evidence that circumcision in adulthood protects men from H.I.V. transmission from a female partner, cutting infection rates by 40 to 60 percent. Three of the studies were large randomized controlled trials of the kind considered the gold standard in medicine, but they were carried out in Africa, where H.I.V. — the virus the causes AIDS — is spread primarily among heterosexuals.
Circumcision does not appear to reduce H.I.V. transmission among men who have sex with men, Dr. Diekema said. “The degree of benefit, or degree of impact, in a place like the U.S. will clearly be smaller than in a place like Africa,” he said.
Two studies have found that circumcision actually increases the risk of H.I.V. infection among sexually active men and women, the academy noted.
Other studies have linked male circumcision to lower rates of infection with human papillomavirus and herpes simplex Type 2. But male circumcision is not associated with lower rates of gonorrhea or chlamydia, and evidence for protection against syphilis is weak, the review said.
The procedure has long been recognized to lower urinary tract infections early in life and reduce the incidence of penile cancer.
Although newborn male circumcision is generally believed to be relatively safe, deaths are not unheard of, and the review noted that “the true incidence of complications after newborn circumcision is unknown.”
Significant complications are believed to occur in approximately one in 500 procedures. Botched operations can result in damage or even amputation of parts of the penis, and by one estimate about 117 boys die each year.
Anesthesia is often not used, and the task force recommended that pain relief, including penile nerve blocks, be used regularly, a change that may raise the rate of complications.
Posted: Wed Jan 30, 2013 6:33 pm Post subject: [b]The reasoning is yours[/b]
This issue of circumcision in Islam is similar to that of the hijab, in that there is no such requirement in the Qur’an. Nor does the Ismaili constitution or any questions during child “bayat” or acceptance of a new Ismaili (or by other Muslim) require circumcision, the authority is silent on the issue during this form of inauguration.
It is simply a tradition, and in modern times the argument that it is hygienic is not valid. On the other hand there may be an argument that circumcision takes away from natural sexual function, and probably also reduces sensitivity.
On the other hand consider the following Ayahs of the Qur’an:
He created everything in exact measure; He precisely designed everything (25:2)
He designed you, and designed you well. (40:64)
He created the heavens and the earth for a specific purpose, designed you and perfected your design. (64:3)
He created man in the best design. (95:4)
Which makes circumcision unnatural and prohibited?
Now, contrary to the above, circumcision is a practice (tradition) since Prophet Ibrahim. So consider the Quranic Ayahs that follows.
Circumcision was also practised apparently by all prophets; Prophet Ibrahim establishes an Islamic connection to the ritual, in the Qur'an we are asked to follow the religion of Ibrahim:
Then We inspired you: 'Follow the religion of Ibrahim, the upright in Faith'." (16:123)
Prophet Muhammad (peace be upon him) said: "The Prophet Ibrahim circumcised himself when he was eighty years old." (Related by Al-Bukhari, Muslim and Ahmad).
The choice is yours, follow your own reasoning. Certainly, the state should not be making that decision.
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