Kenya plans to offer all men the snip, in an effort to reduce HIV transmission. It’s a brave move in a country when circumcision status is a badge of ethnicity and differences in ethnicity are reason enough for rioting, looting and murder.
According to a report in The Nation Kenya’s Ministry of Health has published a new policy on male circumcision (the policy hasn’t made it on to the MoH website yet.) The country aims to provide circumcision for any man who wants it. It’s not a radical decision in terms of public health. Although the anti-circumcision ring-masters continue to rail against the data, most public health professionals are convinced by studies suggesting that a man without a foreskin is 60% less likely to contract HIV than a man with a foreskin. Uganda and Rwanda have already decided to try and circumcise as many men as are willing. The controversy comes, rather, from people who are worried about two things: behaviour and culture.
The behavioural worry is this: if men think they can’t get infected if they are circumcised, they won’t bother with condoms. Possibly. But the reason a third of adults are infected with HIV in some parts of Kenya is that men aren’t bothering with condoms in any case. If you can reduce the likelihood that those men will contract the disease, how is that a bad thing?
The cultural worry comes from the “in some parts of Kenya” thing. HIV is much higher among some of Kenya’s tribes than among others. It is notably higher among the non-circumcising Luo, for example (22%), than among the circumcising Kikuyu (5%). Nationwide, HIV among non-circumcised men is 13%, compared with 3% among men who have had the snip. Current president Mwai Kibaki is Kikuyu. Raila Odinga, who believes he should be president following December’s disputed election, is Luo. There’s an uneasy truce between the two at the moment, but just a couple of months ago being a member of one group or the other was enough to get you burned out of your house or slaughtered. In these circumstances, markers of tribal identity such as a foreskin take on a significance that goes way beyond a concentration of HIV-susceptible cells. Circumcising everyone would remove that badge of identity. In my mind, that another reason for circumcision, not against it.