Ethics of using male circumcision for HIV prevention: exploring the middle ground

Abstract

Three recent randomized, controlled trials in Africa indicate that male circumcision significantly reduces the risk of men acquiring HIV from HIV-positive women via sexual intercourse. These promising new findings have added fuel to already volatile debates about the ethics of male circumcision. In this paper, we seek to briefly identify and evaluate some key ethical positions in this increasingly complex debate. We first distinguish between the debate on the science linking male circumcision and HIV transmission, and the debate on the implementation of the science. We then identify a few intermediate ethical positions within each of these two debates. The aim of our analysis is to suggest the range of positions within the ethical debate on male circumcision and HIV prevention, particularly moderate positions sometimes overlooked or misrepresented by the media and advocacy groups. We suspect that, despite the promise of the recent studies, the future role of male circumcision in the fight against HIV/AIDS will be a modest one, owing in large part to difficulties in increasing the uptake of the intervention in the face of considerable religious, cultural, ethical and socioeconomic obstacles in countries most affected by the epidemic.