Very often, when debating circumcision, I encounter three layers of lies.
Fully debunking an argument might require addressing all three layers. However, if you can only address one, choose the deepest.
Let’s break this down using the common pro-circumcision argument:
“Circumcision prevents HIV.”
On one level, you could debate the data.
When I interviewed one of the authors of the HIV-circumcision studies for my film American Circumcision, he stated that the circumcised group used condoms at a higher rate than the intact group.
If one group used condoms at a higher rate, it would indicate that the results of the study are actually the result of condoms preventing HIV transmission, rather the circumcision. A methodological flaw of this size would invalidate the conclusion “Circumcision prevents HIV.”
However, there are numerous flaws in this study. Doctors Opposing Circumcision breaks down the flaws of the HIV-circumcision studies here:
- Researcher expectation bias − Many of the investigators had written papers advocating for male circumcision to prevent HIV infection prior to undertaking these RCTs. Siegfried et al. note, on the topic of research on circumcision to prevent HIV, that “researchers’ personal biases and the dominant circumcision practices of their respective countries may influence their interpretation of findings.”
- Participant expectation bias − The majority of participants were convinced that circumcision would reduce their risk of HIV infection.
- Lead time bias − Men randomized to the intervention arm of the trials (the group that was circumcised) were considered to be at risk for becoming infected from the time of the surgery, even though they were told to avoid sexual activity during the period of wound healing. Men in the control arm (the ones who were not circumcised) were able to be sexually active from the beginning of the study.
- Selection bias − Only men who were interested in a free circumcision were eligible to participate, and therefore may not have been representative of the general population.
- Attrition bias − For every man who became infected with HIV during the trials, 3.5−7.4 men were lost to follow-up. This is a serious methodological problem that could alter the statistical significance of the findings.
- Early termination bias − Studies that are terminated early are more likely to overestimate any treatment effect.[96,97]
- Duration bias − Because men who were not initially circumcised were circumcised at the end of the study, long-term comparison of the effects cannot be accurately extrapolated, as some modelers have proposed.
- Source of infection unknown − If the studies were designed to determine whether circumcision reduced the risk of heterosexually-transmitted HIV, the investigators should have confirmed that the infections were indeed transmitted through heterosexual sexual contact. They did not. Using the data reported, it is estimated that about half of the infections of the men in these studies were not sexually transmitted.
The cumulative treatment effect in these trials – which claimed a 38-66% relative risk reduction – was an absolute risk reduction of 1.3%. This is a very small effect, which could easily have resulted from the various forms of bias, rather than being a true treatment effect. The findings are not robust, given that all of the trials had nearly identical methodologies and nearly identical results.
Did you get that last part? Even if you accept the data of the studies at face value, the best you could argue is that “circumcision reduces HIV transmission by 1.3%.” Hardly “prevents.”
On a deeper level, you could debate the false assumptions.
Let’s pretend the statement “circumcision prevents HIV” is true. Does that mean that infant circumcision is good?
The assumption here is that if circumcision prevents HIV transmission in adults, that we should give that benefit by circumcising infants. However, infants are not at risk for HIV, because they are not sexually active.
The argument that infant circumcision is good, because “circumcision prevents HIV” assumes that implementing surgery on infants is the best way to protect adults from sexually transmitted diseases.
It also assumes…
- It assumes the child will engage in high risk sexual behaviors that could lead to HIV. How could you know what someone’s sexual choices will be when they are an infant?
- It assumes that HIV transmission conditions in Africa are the same as those in the United States, when in fact the conditions are completely different.
- It assumes HIV transmission conditions will be the same when that child is sexually active at eighteen as they are now – er, the same as they are in Africa now. Will HIV transmission conditions remain the same for two decades?
- It assumes that HIV treatment methods will not improve for eighteen years. Do you think in two decades of research there will be a better HIV prevention method than cutting part of your penis off?
There are a LOT of assumptions when this argument is used to justify infant circumcision, and unpacking them takes up a lot more space than the meme “circumcision prevents HIV.”
However, this doesn’t even address the biggest issue…
On a deeper level, you could debate values.
Many circumcision proponents are afraid to debate values, because this is where the truth is. They will say that bringing up values is “emotional” or “just feelings.” However, even the idea that “feelings” are less important than “data” is a values judgement. Values are unavoidable.
What values does “circumcision prevents HIV” imply?
Well, it implies preventing HIV is an important value. Duh. And I agree – preventing HIV is a good idea.
However, you could prevent 100% of HIV transmission by making a law that you can only have one sexual partner over the course of your lifetime, and rigidly enforcing it. If everyone only had sex with one person, then we would have no more sexually transmitted diseases, including HIV.
Most people would not accept this proposition because it conflicts with other values, like human freedom and autonomy. Entire dystopian fiction has been written around the premise of restricting sexuality, such as The Handmaids Tale. Even the most famous of the genre, 1984, features a “Junior Anti-Sex League.”
“But,” a proponent of this idea might sputter, “the data shows that if you don’t have sex, your HIV transmission rate is zero. You’re anti-science!”
It’s true – if you don’t have sex, you won’t get STDs. However, people protesting a law limiting how many sexual partners you could have wouldn’t be upset about the data. They would be upset at the values being imposed. We value the freedom to love who we want to love more than the potential risk of STDs. Personal autonomy is the greater value.
However, if I proposed chopping off part of the body part you use when you love someone, so you could never experience that with even one person – would it be less dystopian?
The argument that Intactivists make when they question circumcision is not just about data or assumptions – although they can debate on that level – but that the value of human rights and personal autonomy is greater than any supposed “benefit” conferred by cutting off part of someone’s body.
When circumcision proponents continue to argue “data” when Intactivist bring up this conflict in values, they are implying that the value of personal autonomy, freedom, the right to your own body and sexuality, etc. are less important that the judgement of authorities – parents, doctors, culture, religion, etc.
A worldview that values will of authorities important than individual freedom is known as totalitarianism. If you look at any argument that ends with someone imposing what they think is best on you against your will, this is the underlying value.
What other values do you see?
What Do You Value?
A simple statement like “circumcision prevents HIV” can actually be used to access our deepest values. Who has the right to your body? What do we value most? What power structure do we want to teach our children?
Part of the challenge of this issue is that we are debating three layers of lies – data, assumptions, and values. I could write a whole book unpacking the implied values of each argument alone.
However, many circumcision proponents do not even realize they are having a discussion about values. Their values are totally unconscious. When you bring values up, they will say “what do you mean? This is anti-science.” Yet even they are actually making their decisions based on values, not data.
The challenge of persuasion is condensing your values down to memes – short clear bumper sticker level statements that stick to the heart. “Circumcision prevents HIV” is a meme that contains many unacknowledged values and assumptions. “Human rights” is also a meme.
What is your meme? What values does it contain?
If you’d like to see the deepest examination of the values of circumcision ever made, watch my film American Circumcision.