Why the U.S. Is Spending Millions to Circumcise African Men

A quick snip cuts the risk of HIV transmission.

(Photo: Courtesy PSI.org)

Jul 17, 2014· 2 MIN READ
Vince Beiser has reported from more than two dozen countries for Wired, Harper’s, The Atlantic, Rolling Stone, and others. In 2014 he won the Media for Liberty Award.

As the parents of any newborn boy will tell you, the question of whether to circumcise the little guy is deeply fraught and often divisive. In sub-Saharan Africa, however, the American government is pouring millions of dollars into convincing adult men to have their foreskins snipped off.

There’s a simple reason for that. Painful though it may be to contemplate, circumcision is a cheap and effective way to cut the risk of HIV transmission. The foreskin, it turns out, is highly susceptible to infection. Three clinical trials in three African countries in recent years have shown that surgically removing it cuts the odds of a man acquiring HIV during vaginal sex by up to 60 percent.

That’s an issue of overwhelming importance in sub-Saharan Africa, by far the region of the world hardest hit by HIV. As much as 5 percent of the adult population, some 25 million people, are living with the virus.

Small wonder, then, that the United States, the United Nations, the World Health Organization, and many international charities and African governments have launched a massive campaign to circumcise 20 million adult men in 14 countries. More than $100 million has so far been invested in the effort.

Health officials are using every tactic they can think of. Billboards, TV ads, and radio spots tout circumcision as the healthy and responsible thing to do. In Botswana, health workers recruited a local Olympic silver medal–winning runner to push the program in schools. In Zimbabwe, musicians and soccer stars who have given up their foreskin encourage others to follow their example. Population Services International (a group you can learn more about in this clip from our sister show, TakePart Live) is distributing portable circumcision kits in several countries.

“In Uganda they are going to extraordinary lengths to drum up business,” wrote Jeremy Laurance in The Independent last year.

On a dusty field in the village of Kakuuto, 200km south west of the capital Kampala, a crowd of 600 was gathered, seated on benches and chairs under marquees, around a bus belting out deafening music.…

In the centre of the arena dancers and comedians performed, and men were urged to compete for prizes—a power generator, a bicycle and the star prize of 10 corrugated iron sheets worth $100—but only if they agreed to undergo circumcision.

The DJ hosting the proceedings called out 'Who will be the most Stylish Man?' to roars from the crowd, while glamorous young female dancers gyrated on stage and then mingled with the crowd looking for recruits.

All of this is paying off. According to a U.N. report released this week, the number of circumcised men in the 14 key African countries has tripled in recent years, reaching 5.8 million. Still, that’s a long way from the 20 million target.

Aside from the painfully obvious reason many men balk at the idea of circumcision, cultural factors are slowing the campaign. In northern Uganda, there are rumors that the operation diminishes men’s sexual power. Many African tribes and ethnic groups have practiced their own ritual circumcisions for centuries and see the modern medical version as an encroachment on their cultural identity. Some tribes that have never circumcised don’t want to start.

In the Western world, a small but impassioned collection of activists has for years attacked circumcision as a traumatic, painful, and unnecessary assault on children—despite the overwhelming medical evidence of its benefits. (Aside from lowering the risk of HIV infection, circumcision also helps protect men from getting a variety of other STDs and urinary tract infections.) Nonetheless, the Parliamentary Assembly of the Council of Europe, a gathering of legislators from 47 countries, passed a nonbinding resolution last October calling ritual circumcision—practiced by Jews and Muslims alike—a “violation of the physical integrity of children.” Outright bans have been proposed in the last few years in the cities of San Francisco and Santa Monica, Calif. All of which helps explain why the proportion of newborns circumcised in hospitals has dropped from 64.5 percent in 1979 to 58 percent in 2010.

Of course, the decision of whether to snip that particularly sensitive bit of skin is a personal one. But in Africa, it’s also an urgent one. As Kenya’s former prime minister, Raila Odinga, reportedly told reluctant fellow members of his non-circumcising Luo tribe in 2008, “We don’t lead with our foreskins—we lead with other faculties. This is a medical issue.”