Male circumcision and HIV prevention

Ethical, medical and public health tradeoffs in low-income countries

By: Rennie S, Muula AS and Westreich D
Published in: Journal of Medical Ethics. 33:357-361, 2007
Via: Docuticker

If male circumcision is to be promoted in regions of high HIV prevalence, the following basic ethical conditions must be put in place: sufficient material and human resources to perform circumcisions safely; careful monitoring of the quality of follow-up care; international and national committments to low-cost circumcisions to facilitate equitable access; flexible policies informed by concerns of local communities regarding if, when, where and how circumcisions should be performed; careful attention to the consent process and sustained condom promotion to minimise the risk of behavioural disinhibition; monitoring of circumcision promotion messages to ensure that prospective clients are aware of potential benefits and limits; education of women and girls about male circumcision initiatives to combat potentially tragic misconceptions; and conformity of circumcision policies with international norms (such as the Siracusa principles) limiting the extent to which individual rights can be infringed to promote the public good.

Future initiatives to promote male circumcision as part of comprehensive HIV prevention policies are likely to lose public trust and effectiveness if they are not grounded in respect for persons, social justice, human rights and community values. Without an open-minded dialogue on these ethical challenges between the Western medical establishments and international organisations promoting male circumcision, and the people and governments for whom the intervention may be most appropriate, a potentially vital contribution to the fight against HIV/AIDS could be squandered.
(http://jme.bmj.com/cgi/content/full/33/6/357)