UN To Set Global Circumcision Quota: 25 Million by 2020

By Stefano Gennarini, J.D. | June 2, 2016

NEW YORK, June 3 (C-Fam) The UN may set a global quota of 25 million “voluntary medical male circumcisions” by 2020 as it debates a new global framework to tackle the HIV/AIDS epidemic.

After a decade of research and advocacy, circumcision is one of the most hyped HIV prevention strategies. It is being touted as a game changer, alongside pre-exposure prophylaxis through anti-retroviral drugs.

Now the UN General Assembly may not only endorse circumcision as a main component of global HIV/AIDS prevention strategies, it may set circumcision quotas for the entire world.

According to the World Health Organization, “[t]here is compelling evidence that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%.” But the WHO also cautions that it “provides only partial protection” and condoms are still necessary to improve the chances of preventing HIV transmission. WHO limits the effectiveness of circumcision to transmission of HIV from women to men.

Circumcision, like pre-exposure prophylaxis, is a risk-reduction strategy, as opposed to risk avoidance strategy. Both are promoted alongside proper condom use. They appear to be among the highest priorities in UN programming. Circumcision is said to be effective to prevent female to male transmission, and pre-exposure prophylaxis is recommended especially for male-to-male transmission.

Like previous global HIV/AIDS strategies they do not involve any change in behavior. This remains controversial.

When Ebola was ravaging West Africa, the only way to stop the spread of the virus was to change the way entire communities went about their daily lives, even changing deeply engrained religious and cultural practices associated with burial.

No such behavior change strategy has ever been proposed to tackle HIV/AIDS, even though certain behaviors are highly hazardous in the context of the HIV/AIDS epidemic, particularly anal sex.

According to studies commissioned by the prestigious Lancet medical journal the probability of transmitting HIV/AIDS through anal sex is 18-times greater than that which has be en estimated for vaginal intercourse because of biological factors alone. The biological risk of anal sex is further compounded among those leading homosexual lifestyles because of the high incidence of promiscuity, “barebacking” (defined as “intentional condomless anal sex in HIV-risk contexts”), drug and alcohol abuse, and transactional sex.

There is evidence that individuals at higher risk of HIV/AIDS transmission behave recklessly even when they have the knowledge and the means to do otherwise. According to the U.S. Center for Disease Control and Prevention men who have sex with men, account for upwards of 70% of all new HIV infections, and 57% of all persons living with HIV/AIDS in the U.S. are men who have sex with men.

Epidemiological studies show that the prevalence of HIV/AIDS among men who have sex with men is leading to greater genetic variation in infection, including resistance to treatment, higher viral loads, faster spread in networks, and clustering of HIV infections in high-transmission bursts.

Even so, the medical community does not recommend behavior change as a viable policy and recommends “structural” change instead, meaning social acceptance of homosexuality through the force of law. But this is not certain to cause any improvements.

A recent partnership of the Lancet with the UN program on HIV/AIDS recognized how the HIV/AIDS epidemic among men who have sex with men is growing in Europe and America “despite an increasingly open and tolerant attitude toward homosexuality.”

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