Stop where you are!! This is the foreskin police!!

Alright....I'm going to TRULY blog some opinions now...so be warned----but the point of these blogs is to generate discussion, right? So here we go...

I recognize this is a controversial issue and I may stand alone---but I have to confess I'm both frustrated and challenged by the focus on circumcision as a "new wave biomedical intervention" at this conference. As we enter the final day of the conference I have attended one workshop and one plenary at which circumcision as a US intervention has been highlighted---and I've seen it mentioned multiple other times throughout the program book.

Now let me put out a couple disclaimers first. I understand the data that's being presented....and I've seen the same reports on the three most prominent trials out of Africa that everyone else has. I understand that nobody is recommending circumcision as "silver bullet." And I also confess that I was at least relieved that in the plenary session on the topic this morning Dr. Peter Kilmarx of the CDC acknowledged that multiple studies have established that circumicision does not provide significant protection for gay, bi, and other men who have sex with men. (But even that fact is contradictory to the information shared by his colleague, Dr. Samson, in a workshop on Monday where she made the clear assertion that circumcision DID reduce HIV risk in MSM.)

But even understanding all of that, I still have some real concerns about the attention we're giving this issue. Beyond the specific issue of just where MSM fit into this dialogue....aren''t there larger criticisms we can really be creating here?

Like:

***Doesn't it seem like much of what we're being offered as data to suggest efficacy in the USA is extrapolated from studies done in Africa---and that far too often the necessary and critical distinctions between the two aren't made?

***If circumcision is REALLY such a critical issue in HIV prevention then how is it that the USA, understood to be the MOST circumcised nation on the planet, still has such a high seroprevalence? Wouldn't it stand to reason that other countries, including almost every European country, would necessarily have much higher prevalence than we do if foreskin is such a danger?

***Why doesn't it ever really feel like the question about the difference between ADULT circumcision and INFANT circumcision has been adequately addressed?

***And most importantly----How can we not be having a much larger discussion about how race factors into this issue? How is it in a field where we should necessarily be anlyzing and considering cultural differences and ethics in public health, that the "cultural controversy" about circumcision is so often presented as an afterthought? (I mean literally it was listed BELOW financial considerations on a slide from the plenary...when in fact I think it should be the FIRST thing we think about!)

The funny thing is...if you'd told me 10 years ago I'd be emerging as a foreskin-warrior, I'd probably never really have believed it. But as we continue to focus on this issue I'm forced to wonder where do we find that balance between what's ethical and what we think will have an effect? And at what point does the phrase "offering circumcision as just one option in the menu of prevention" become just another way to rationalize an "intervention" that is riddled with issues of inequity and stigma and disallowing men to value their bodies in the way they feel best?

Alright people----Discuss amongst yourselves......*smile*