David Wilton: Opportunists exploit African suffering

David Wilton has participated in intactivist events in the U.S. and abroad. Through his Male Circumcision and HIV blog and twitter account, David acts as a major conduit of information to help keep intactivists organized and knowledgeable.

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Stephen Lewis of the Stephen Lewis Foundation solicits funds to enforce genital mutilation on infant boys in Africa.

In his YouTube videos, Lewis claims [that] male circumcision is an “inspired preventive technology” to reduce the spread of AIDS.

Stephen Lewis calls opponents of circumcision “male sexists”.

[Because] Mr. Lewis refuses to accept criticism in the form of comments or video responses, this video is dedicated to open conversation of male circumcision and HIV.

David Wilton

[A person becomes] active [on] any issue [because the issue] crosses some line in [the person's] own life. I [have] had a real issue with autonomy (self-determination, making decisions for myself, etc.), and circumcision—particularly [childhood circumcision] as it's done in the United States—is something that just completely goes against that.

For me, [what crossed the line in my life is] just the very idea that someone cut from my body a piece of flesh that I may have wanted; I think that's really what got me going about it.

I've always been interested in HIV, because I have a personal risk factor [for that disease]: I'm a gay man. So, I've always had an interest in HIV and how it's transmitted, and the progress being made towards either a cure or prevention technology such as a vaccine. When [people began really pushing this notion that HIV can be prevented with circumcision], it was sort of natural for me to want to study up on it.

The whole circumcision [controversy] really at base is about human rights; it's about choice—it's about an individual making a choice for himself. HIV is also, in a sense, about choice; you can't make people refrain from high-risk activities—all you can do is give them the information.

I think it's important to recognize what the [randomized controlled] trials [(RCTs)] in Africa did and did not do; I think they did show that there is some efficacy in circumcision to reduce the risk of HIV [NOTE: Even that is now heavily disputed; also, see here], but that's very different from saying that this is going to be an effective measure in the prevention of HIV.

Efficacy is a term of art in epidemiology, and what that means is that under the very narrow confines of a [randomized controlled] trial, [the researchers'] hoped-for and expected outcome was in fact realized—at least within the 18 months or 22 months in the case of one of the trials. The problem here is that efficacy and effectiveness (another term of art in epidemiology) aren't the same thing.

[There are studies by] Michel Garenne and [John R. Talbott] which [show] that the effectiveness of circumcision [is] not likely to be seen [if deployed across large populations]: Demographically, you roll this out and you aren't going to get the protective effect that you seem to see in the RCTs.

  • [According to Garenne], when you look at [the population scale], you don't see the protective effect, and I think he named [at least 6] of 13 of the southern African countries where circumcised men [have] higher rates of HIV than intact men:

    • Camaroon
    • Ghana
    • Lesotho
    • Malawi
    • Rwanda
    • Swaziland
  • John Talbott said that if you control for sex-workers (the number of sex-workers, the levels of infection, [etc.]) you would ultimately find that the protective effect in the countries where circumcised men [have] lower rates of HIV would essentially disappear.

You can trace all of [the HIV] researchers who focus on [promoting] circumcision to prior efforts to promote circumcision; most of them—if not all of them—had no prior interest in HIV until they figured out [that] they could hang their promotion of circumcision on [this new] cause.

I think it's also important to realize that there are massive amounts of money being injected into the HIV arena, and this is an area where [these researchers] can get—and have gotten, actually—massive amounts of money to promote [their] singular interest [in circumcision].

When WHO and UNAIDS recommended circumcision, they did so for adults—and only adults—emphasizing such things as:

  • Needing to make [circumcision just one facet of] a comprehensive [solution].

  • Needing to make sure that there's informed consent [from the patient].

  • Trying to dissuade individuals from believing [that] they're immune [to HIV] after [circumcision].

Clearly, that is not what happened immediately after; what you heard [instead] were calls for infant circumcision [not just in Africa, but also in the U.S.], and clearly those people calling for infant circumcision are doing it from a very opportunistic point of view.

I'm [reminded] of this one particular doctor: Neil Pollock in Vancouver, Canada. [As I understand it], at a time when there was a child's death there [due to circumcision]—a child by the name of Ryleigh McWillis—he used that opportunity to pitch his services, [claiming] to have a bloodless, painless circumcision technique. [He has claimed] to be a specialist in infant circumcision. [This] guy—who [had] never [before shown] any interest whatsoever in HIV—[was] suddenly flying off to Africa to teach this technique, and claiming in his own promotional materials that he's saving Africa.

I think [that] is an example of the rawest form of opportunism. If you make claims of being some great savior for a disease that you hitherto never really had any interest in until it intersected with your particular interest in infant circumcision, I think that's just going way over the top.

[Moreover], I just don't see how there could be any bloodless, painless technique of infant circumcision; you're essentially slicing off a portion of a child's penis. How could that be painless? and how could that be bloodless? That's sloganeering; that's coming up with this slogan to sell your services—it's not doing anything to promote the protection of individuals from HIV.

[Intactivism] is about choice. It's about not allowing circumcision of infants, because that's wrong: It violates their rights to choice. It's about allowing adults to make decisions for themselves, and also to be able to judge the evidence for themselves. This [choice] is something that I don't think the pro-circumcision lobby really would like to be out there; I don't think they want that information available to the layman in layman's terms.

Ultimately, you [must still] wear condoms [to effectively prevent HIV even after being circumcised]. [Therefore], why put up with the deficits that [circumcision] causes? I think that's really the other issue.

To understand the push to circumcise Africa, follow the money [and follow religion].

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