CRITICAL appraisal has dismissed World Health Organisation ( WHO)-recommended campaigns to circumcise millions of African boys and men to reduce HIV transmission as mere systemic racism and “neo-colonialism” than sound scientific research.
Published in the Developing World Bioethics, the study was conducted by VMMC Experience Project along with other legal and medical experts from the United Kingdom, United States, Cameroon, Zimbabwe and South Africa.
It examined the history and politics of these circumcision campaigns in the context of race and colonialism and found that they had been started in haste and without sufficient contextual research.
The paper concluded that the campaigns had been carried out in a manner that implied troubling assumptions about culture, health and sexuality in Africa.
“Africans were underrepresented in the decision-making process, and needed a greater voice in the planning of such an intimate health intervention,” said Max Fish, lead author and founder of the VMMC Experience Project.
“There has been a global spotlight on systemic racism and racist institutions following the death of George Floyd, an African American man, at the hands of a white police officer in May. However, unethical human experimentation on Africans and African Americans remained a pervasive problem in Western medicine that has received relatively little attention.”
“Africa was targeted and it is still being targeted,” said Cleophas Matete, a Kenyan bishop, who is quoted in the study.
“It is used as a continent to experiment. Should they introduce anything that is (morally questionable), they want to experiment in Africa. So I believe that the entire process of trying to test it in Africa was wrong from the beginning, and I say no to it.”
Arianne Shahvisi, senior lecturer in ethics at Brighton and Sussex Medical School and second author, said: “We believe the decision to implement the circumcision campaign in southern and eastern Africa was not based on robust scientific evidence, but instead assumed that the results from clinical trials would safely ‘scale’ to the real world without thinking through the cultural implications.
“We argue that as a surgically corrective measure, the present circumcision campaigns hinge on racist, homogenising assumptions about the sexuality of those who are targeted, as well as a belief that HIV risk behaviours can be appraised independently of poverty and systemic factors.”
In 2007, WHO and UNAids recommended voluntary medical male circumcision (VMMC) as critical in reducing the risk of sexual transmission of HIV from females to males by 60%.
This percentage has, however, been disputed over the years and to date no conclusive data has been found to validate the claims.
Zimbabwe adopted voluntary medical male circumcision in 2007 and began implementing it in 2009. The country immediately set itself a target of circumcising 1,3 million men by 2017.
The campaign was initially high powered with robust messaging and massive roadshows to promote the initiative. Several celebrities were roped in under the Pinda muSmart campaign.
But over the years the campaign has steamed off and last year a UNAids Zimbabwe HIV and Women report showed that Zimbabwe had the lowest coverage rates in sub-Saharan Africa, with 14,3% of men aged 15-49 circumcised as of 2017.
Messaging for the campaign has also shifted and VMMC is now referred to as an intelligent lifestyle choice rather than a medical intervention.