Circumspection on Circumcision – Lessons for India

Circumcision May Help Protect Against HIV – washingtonpost.com

Getting circumcised may reduce men’s risk of acquiring HIV, according to a study conducted in Africa. “Our study shows that circumcised men had 53 percent fewer HIV infections than uncircumcised men,” lead study author Robert Bailey, professor of epidemiology at the University of Illinois at Chicago (UIC), said in a prepared statement.

This study, published in The Lancet (registration and kidney donation required!) adds to the growing body of research suggesting that circumcision significantly reduces the incidence of HIV infection. The doubts on circumcision as a protective factor against HIV are falling away.

But, is this a viable public health strategy? In context, the US health and human services reports an 85% reduction in HIV risk through condom usage. This is probably a conservative estimate. There’s no indication yet that the gains from circumcision and condom use together are multiplicative.

Let’s look at India, for instance. Circumcision is not practiced among Hindus. There is no history of circumcision, and when I was growing up, it was clear that circumcision was for Muslims and Muslims only. It was often laughed about and there was a sense of superiority about not having to mutilate. It was a clear distinction setting difference between “us” and “them”. This article by Jaishanker and Haldar provides some perspective on Hindu-Muslim identities.

Apart from that, the other important identity of Muslim males is circumcision. It is found in many riots that Muslims were victimized based on their religious identity. In the riots if the perpetrators or the police are not able to identify victims with their religion they forcefully remove the pants of the victims to check whether they are circumcised or not. Once they find that the victim is circumcised he is targeted without further analysing which community he belongs to.

For example in Bombay riot (1992) there is a case of man who was frisked by the police for assessing whether he was a Muslim. However, out of fear he gave his name as Raju (a Hindu name) the officer made him take out his trousers and, noticed that he was a circumcised Muslim, and fired at him.

No Hindu parent in their right mind would circumcise their male child. It’s that simple. It’s part of the ingrained Hindu psyche that having an uncut member sets us apart from our Muslim brethren.

Nothing has changed about AIDS prevention strategies. But it’s boring to study the same variables all the time, let’s recap them one more time, shall we!

Education and awareness: Look at this picture from India (from the NFHS Survey):
Now tell me that increasing awareness among women and empowering them is not the most important thing you can do!

Condom use = 85% risk reduction

Nothing more to say. Continuing to improve access to condoms is important. Avert indicates that condom use is very state dependent, especially among sex workers, with Tamil Nadu having an 80-90% use rate and Mysore in neighboring Karnataka having a 9% use rate.

Access to antiviral therapy

India is in a lucky position here with a very well established pharmaceutical industry. So, drugs are likely to be available (patent issues notwithstanding). The issue however is with infrastructure, getting the drugs to the right people at the right time. This 2004 paper from the Indian Journal of Medical Ethics indicates that coverage is spotty at best. India’s National AIDs Control Organization (NACO) recognizes this, but in my opinion does not go far enough to provide free/affordable drugs to infected people, especially to prevent mother-child transmission.

So, to cut a long story short, circumcision in India is not likely to be a factor in the pantheon of choices available. We have a long way to go with our other major AIDS prevention challenges, and I hope this circumcision issue does not become an increasing distraction.

41 comments for “Circumspection on Circumcision – Lessons for India

  1. Sean
    February 25, 2007 at 9:48 am

    I hope circumcision will become an increasing solution for the extremely serious AIDS problem that India has.

  2. February 25, 2007 at 10:15 am

    Nice piece on circumcision, HIV and India: I stumbled upon it today AFTER writing something on the issue on my own blog (I am a bioethicist with an interest in the use of circumcision as HIV prevention strategy). And I live in Chapel Hill!

  3. February 25, 2007 at 11:28 am

    Stuart:

    Thanks, and nice article on your part.

    “The foreskin has geopolitical significance”

    That’s funny and has all kinds of visualization potential! My concern is that this particular debate is too toxic to be touched in India right now, and it detracts from all the other major infrastructure building India has to do to combat the epidemic. I do not want AIDS prevention efforts to be derailed by the circumcision debate. Believe me, words don’t adequately describe how most Hindus feel about this. It is almost like making one eat beef!

  4. amin
    September 16, 2007 at 2:39 pm

    i think female doc or nurse should not perform in circumcision.in ind there have many muslims.n there hav enough lady doctors who can perform circumcise.max r hindus.so it should be avoideded by muslims to go hindu lady docs

  5. pallab
    December 14, 2007 at 7:38 am

    right said by amin.

  6. rahul
    September 15, 2008 at 1:03 pm

    khatna zaroori hai or bharat me bhi ise lagoo hona chahiye agar aids se bachna hai to

    • YUGANTAR
      October 8, 2009 at 12:37 pm

      APNI MAA YA BEHEN KIYE THE KYA BHODRI KAY,MADHARCHOD…………….

  7. rahul
    September 15, 2008 at 1:05 pm

    hindu log bina wajah khatna se dar rahe hai khatna ke baad penis kafi achcha dikta hai aur mahilao ko khatna purush zyada pasand haote hai ye mai ek sarve ke baad keh raha hoo

  8. rahul
    September 15, 2008 at 1:08 pm

    khatna ek bahut hi saral surjery hai or 5 ya 6 din baad zakhm bhar jata hai or zindagi bhar ke lie life aids se siqure ho jati hai to friends be circumsied and save your life , just like me

  9. ravi
    September 15, 2008 at 1:15 pm

    khatna ke baad ling pehle se jada behtar ho jata hai kyunki bina khatna ling ke niche jo bandh hota hai usse bahut dikkato ka samna karna padta hai meri girl friend mujhe ab pehle se jada pasand karti hai

    • vipul
      August 9, 2011 at 2:26 pm

      khatna kis doctor ke pas karaya tha.eska bichar kaise aaya

  10. pankaj
    September 15, 2008 at 1:30 pm

    pata nahi bharat me hi kyu log khatna ke fayde nahi jaante america jaise desh me to har aadmi khatna hai , bina khatna ke waha majaak udaya jata hai

  11. vijay
    September 21, 2008 at 2:52 pm

    i think circumcision should be must for every man in india, it is the best option fo decrees the rate of hiv aids, and it solved all penis problen

  12. shashank
    September 21, 2008 at 2:55 pm

    i dont understand , why are indian not being circumcision they are accepting h.i.v but not circumcision

  13. priya
    October 31, 2008 at 11:36 am

    India should adopt infant circumcision at the time of birth for Boys. This will help to fight against HIV.

    • indians
      May 16, 2009 at 12:35 am

      what a bunch of idiots..blurting some nonsense ….”india should adopt infant circumcision for boys”.

  14. November 13, 2008 at 7:05 pm

    Indian Govt must adopt infant circumcision for boys to curbe HIV and it must be encourage by religious leaders of Hinduism.
    Otherwise unwantedly accepting hiv and dying is not a good thing.

  15. saloni
    November 16, 2008 at 8:02 pm

    khatna har boy ka hona chahiye kyunki dheeli , latki hui skin achchi nahi lagti

  16. rehana
    December 15, 2008 at 1:12 pm

    saloni right.kismat ke badqismati jo aik bar how khatana…jo bar bar hota to kitna nokdar hota

  17. true indian
    March 6, 2009 at 6:25 am

    I believe in science than any religion and i wont circumcise my son just to be different from Muslims. There are many advantages of keeping the skin intact our bodies have evolved many millions of years to be what we are and its just the way nature made us. As far Aids and STD’s are concerned just practise safe sex that will provide you 90% immunity .Even if i was circumscised i wont have risky sex the risk chances are far too great.Remember that the % is for only one intercourse. If a circumscised man has two intercourses then then he is equally probable to get Aids

  18. April 15, 2009 at 6:07 am

    The topic is quite trendy on the Internet right now. What do you pay the most attention to when choosing what to write ?

  19. goorirai
    April 17, 2009 at 9:22 am

    mai

  20. goorirai
    April 17, 2009 at 9:29 am

    Mai ek Hindu larki hu maine ek muslim larke se shadi ki hai jub maine usko dekha to uska ling different laga maine poocha to usne subkutch bataya SUTCH ME LING KHATNE KE BAAD BAHUT SUNDER HO JATA HAI.Aur oral sex me bahut anand aata hai, parantu ye prakiriya me kast bahut hota hai.

  21. amit kumar singh
    October 1, 2009 at 10:39 am

    I want more information about Circumcision(Khatnay) in Indian Muslim women?

  22. December 4, 2009 at 11:47 am

    I loved reading it. I require to read more on this issue…I am admiring the time and effort you put in your blog, because it is plainly one great place where I can find lot of useful info..

  23. Natasha
    January 18, 2010 at 9:53 pm

    I do believe that circumcision is more of a hygienic practice. It helps to stop HIV, STDs, and more importat cervical cancer aong women. I would recommend it to eveery mom having a male child.

  24. Dr.Radheshyam
    February 26, 2010 at 11:17 am

    I think circumcision not make people Hindu or Muslim.Today i want to say to all people that they pramote this in hindu’s men and boyes.It is necessory today to prevent many sexual transmited disease as AIDS GONORRHIA SIPHILIS BREAST CANCER ect.it is simple sergery.Never affraid done it. i am hindu but circumcise.but it not mean i made a Muslim.from this penis make so cute .It also remove the your condom coating problem.which is caused by long prepus.

  25. Akash
    April 9, 2010 at 5:23 pm

    The question is not values of circumcision, the question is Are hindus aware of it? I am a hindu, while I was a child I had a typical disorder called “Phimosis”, in which the foreskin was tightly attached to my penis. The result was I had fever every month. I was always sick. Upon inspection it was found that bacterial and fungul infections occur when I urinate causing fevers.

    As a child more than me my parents and panel of doctors wanted to save me than hink about religion or other invaluable things in their world. I was circumcised to be saved. Honestly after that I grew to be a healthy boy.

    As for sex, masturbation and erectile functions, I can assure I am as much sexually active as my friends.

    Now, so whats the fear? During riots, like it happened in mumbai, I can be shot. And everyone might think I am muslim. There lies the answer, we hate muslims and they hate us.

    Facts show that circumcised penis not only decreases sexual transmitted disease risks but also acts as a pain comforter while having sex, i never had any pains while having sex. The reason is while intercourse sometimes the foreskin turns over which doesn’t happen if circumsised.

    Also female counterparts are less in agony due to less friction.

    Also a question arises here, is India scientifically backward? I love my India and am sure it’s much more developed than it was in past. We dont talk about circumcision because it’s a ritual common in muslims. But if it’s based on medical surgery, we should not have a problem. As long as we don’t enlighten ourselves without fearing our religious leaders … anyway we are brain dead, what’s the use?

    Think about it, today i can die being shot at by some religious slave (chance is rare though, unless communal riot occurs) after he opens my pant (again a rare chance) who thinks I am a muslim. But again if I was not circumsised, I would have already been dead by the age of 13-14 with bacterial infections and sexually transmitted diseases.

    Thank heavens, I am healthy and I am still living.

    • Amit
      September 17, 2012 at 3:34 am

      Akash it’s the same case with me. No one in my family is cut. I try to hide my penis while peeing in public good to know that i have a cut hindu friend(you). Plz reply soon

      • Manishankar
        September 21, 2012 at 9:39 am

        Hi Amit. I’m also hindu and circumcised, nobody in my family knows except parents and brother (he is not circumcised). I had same condition of tight foreskin, and when i pulled it back it always bleed around top and bottom, (didnt pull back hard) but could be contributed to my birth. My parents told me the doctor accidentally cut my penis when cutting the cord. I was born in India.

        Anyways I was circumcised in America where I live so I don’t feel that bad. But I always wonder what Hindu women may think about my story?

  26. May 12, 2010 at 1:23 am

    mughe aapni ek kidney bechna hai . jo aachha paisa de sake jaldi email kare mughe paiso ki sakht jarurt hai. mukesh mo-9540587746

  27. vinod
    July 5, 2010 at 5:56 pm

    i think khatna male ko to karani chahiye par female ko bhi karani chahiye isse uski vagina kasha aur bhara bhara sa dikhta hai. aur ye jaruri honi chahiye. kyonki bina khatna ke vagina latki aur ghin sa dikhta hai. maie apni aur apni girfriend ko khudse khatna kar di. ab use bhi achchha lagta hai aur mujhe bhi. aur sex mein bhi bahoot maza aata hai

    so femal ko bhi khatna karni chahiye.

    • Nandini
      August 28, 2010 at 4:36 pm

      To Vinod,
      You must be crazy to think that females should get circumcised as, just because you like the way the vagina looks after the process, that doesn’t mean that you should have told your girlfriend to get circumcised. The vagina is made that way for certain reasons, and if you think that ur girlfriends vagina is loose and hanging, buy her some kind of vaginal cream. I hope you know what complications can be faced for a women if she is circumcised. Just for your pleasure and enjoyment you cannot ask anyone to be circumcised.

      • Amit
        November 18, 2012 at 7:06 am

        Nandini i support u. I am too vehemently against female circumcision. But i am a circumcised hindu male. Do u like a circumcised penis? Do u think a hindu girl will like me?

  28. indian teen 17 year
    July 30, 2011 at 8:51 am

    if it is so necessary then y dont u practise it on both gender its lyk trimming the ears of ur child so he cant wear spectacles it means if a person dont have ears dn he cant wear spects so his eyesight is perfect. It sud b considered as genetial mutilation. if circumscion in gals is considered as mutilation dn y not in boys .it is most disgusting practise ever. it is the reason y men needs viagra in usa cause these deformed mens cant manage a erection themselves due numbness of their glans. If u r doin a circumcision to a male then also ripp off a girl clit and labia cause it will drop her sexual desire and she will never cheat thus aids rate will also decrease and circision trends are decreasin in usa their r a lot complications wid it. Pls dont deform ur child. ab bakchodo hindi me ata hu ye btao agar kat do lund ko bachega kya waise bhi india me hygeine rate low hm angrenjo ki tarah garm pani ke bath tub nange let ke lund nhi dho sakte hain. Foreskin amare lund ko guard krti hai dirt and bacterial infection se nami bana ke rkhti hai warna lund sookh gya to ghanto chuswaoge to bhi khada nhi hoga dats y oral is popular i america . arey bakchodo tm ye sab sirf islie krna chahte ho kyo ki usa me krte hai arey usa me shit sex popular hai to kya sex ke nam pe goo bhi khaoge. Ar maderchodo kisi lund kat ke jindgi kyo barbad kr rhe ho.ar jo ldkia kahti hai kata lund khoobsurat hota hai to jake apni choot ke all external organ hatwa lo badi chikni aur saaf lgegi .usa me gaand merna islie popular ke sale lund pe feel kr nhi pate choot ki tightnees ko islie gand me dale hain extra tightness ke lie india na hi aise facility hain safely kia ja sake ye sb ar agar galti ho gyi to kisi ke bap victim ko apna lund udhar nhi denge ar ye natural hi rhne do. kal ko ldkia apne woobs remove krwa le nhi to ldke attract honge unsafe sex hoga aids rate high ho jayenge. Betichodo free me nirodh milta hai, nhi to aukat ho luxury condome le lo lund katne ki kya jarrorat hai hiv se bachne ke lie?

    I m feeling proud dat i have n intact one not a deformed and mutilated.

  29. Westernguy
    September 20, 2011 at 10:33 am

    There is NO formal evidence that circumcision prevent HIV or other STDs. 75% of the HIV positive men in the US were circumcised as this is a routine practice in big parts of USA. Someone will contract HIV regardless if they are mutilated at birth or not intact if they don’t show cautiousness. The only way to securely avoid HIV is to wear contraception and also test before entering a relationship with someone new. If we stay faithful to our loved one, get tested and engaging in safe sex. Mutilating our children will NOT prevent diseases.

    This is propaganda from the medicine industry to justify their barbaric approach towards infants and children. If someone by the age of 18 decide to do this by own free will or it is medically necessary (such as phimosis treatment, skin infection etc) then its a whole different story. Don’t fix something that’s not broken.

    Let humankind be born the way they are born by the grace of god. Just because Abraham was 99 years old and had a “call from god” to circumcise himself, his sons and every other male i think it’s time to think about the CONS if circumcision as well. In islam it’s more a cultural thing over a religious thing.

  30. radheshyam
    September 28, 2011 at 5:19 pm

    india me circumcision turant chalu karna chahiye .aur aids ke prati iske faede se avagat karay jana chahiye.hum samagh dar hai.mai samaghta hun har hindu circumcise hona chahata hai.mai hindu hun aur aids se aur std disease se bachav ke liye maine circumcision karvaya. aur aage iseke badhane ki hardam kosis karunga

  31. Rahul
    November 22, 2011 at 1:48 pm

    Crcumcision has not only advantages but a lot of disadvantages also.Mutilation of a very sensitive and useful body part causes the loss of a large number of nerves and blood vesseles.Erectile dysfnction of the penis is more among circumcised as seen in literatures and uncircumcised people enjoy sex better.That is why in UK and USA infant circumcision rates are rapidly declining.The Govt of Canada and Germany are thinking about banning unnecessary circumcision..
    I was circumcised for medical reasons but dont find anything great out of it.

  32. imran
    October 5, 2012 at 4:55 am

    plz tell me circumcision men how many percent save by hiv