What’s wrong with VMMC?
- Imposes on centuries of African tradition (cultural imperialism).
- Coercion of poor and vulnerable populations.
- Money and food stamp bribes.*
Lack of informed consent
- Targets children without parental consent.
- Exposes subjects to unnecessary surgical risks, including rare accidents and death.
Human rights concerns raised by its subjects
- No ethical regulations in place.
- Ethical uncertainties around the circumcision of children.
- Based on questionable clinical and scientific research.
- Hinges on a contentious political process.
- Pre-surgical HIV testing is inconsistent and unregulated.
There is no surgical follow-up
- Patients must monitor complications and pay for treatment.
- Patients must remove their own stitches.
- Lack of adequate pain relief.
- Lack of ice or other means to control swelling.
- Lack of clean water for proper wound care.
- High rate of wound infection due to unsanitary conditions.
- Lack of clinic transportation access in the event of complications or emergencies.
- Long healing period (6–12+ weeks in our sample).
- Unacceptably high unmanaged pain levels.
- Leads some subjects to drop out of school or work.
Misleads circumcised men and their partners to believe they are safe from HIV and other STIs
- Creates a false security that may or may not be scientifically justified.
- Results in rumours of HIV immunity from circumcision; no campaign to address or control these rumours.
- Results in men and women deprioritising condoms.
- Reverses prior gains in sex education.
- Increases STI transmission.
Increases HIV/AIDS infections and deaths
- Increases sexual violence against women.
- Increases tensions between circumcising and non-circumcising tribes.
- Increases the rate of forced circumcisions in traditionally circumcising areas.
- Encourages the unsafe “bush circumcision” underground market.
- Viral-shedding for two months after surgery, putting women at high risk for HIV infection.
- Open wounds put men at high risk for bloodborne infections including HIV and tetanus.
Low long-term satisfaction rate
- Impaired sexual functioning in most men who responded in our sample.
- Results in callousing, nerve loss, loss of lubrication and skin mobility, and occasional disfigurements.
- In adults, skin removal can result in painfully tight or bent erections.
- Leaves a prominent scar.
- No local urological expertise; no resources for victims of botched circumcisions.
- No legal accountability for malpractice.
- Subjects have no means of providing feedback to policymakers and implementors.
- No measure for its effectiveness in reducing HIV.
No evidence that it has been successful
- The epidemic has measurably worsened from the time of VMMC roll-out (UNAIDS report).
Resentment and outrage among Africans
- Racial baggage from prior circumcision propositions for Africans; and similarities to the Tuskegee syphilis study.
- Subjects don’t have a say in the policy: African resistance is met with increased propaganda and “demand creation” messages.
*Money and food stamp incentives are intended to encourage “present-biased decision making” – impulse decisions or circumcisions on a whim – instead of informed consent.
The … human subject … should be situated as to be able to exercise free power of choice, without the intervention of any element of force, fraud, deceit, duress, overreaching, or other ulterior form of constraint or coercion; and should have sufficient knowledge and comprehension … as to enable him to make an understanding and enlightened decision.
—The Nuremberg Code