Circumcision of babies for proposed HIV prevention unethical and illegal
Dear Dr Tshabalala and Mr Maxon,
It has recently come to our attention that the KZN-Natal Health Department is planning to encourage the universal circumcision of infant boys in an attempt to curb HIV infection rates.
We hope that you have had time to review such ideas over the Christmas break and have decided not to continue with such a drastic plan, which would violate several aspects of current law, most notably the Children’s Act number 38 of 2005, as well as the National Health Act.
According to the Children’s Act, children can only be circumcised for ‘medical reasons’ related to current pathology of the foreskin, not for prophylactic reasons. In other words, circumcision of a foreskin is now illegal unless the child has a current medical pathology that can only be remedied by the amputation of the foreskin. It is Important to realize that it is extremely rare for a newborn male infant to have a pathological condition of this nature. If a child happens to have a mild condition such as phimosis or a urinary tract infection, less drastic remedies must always be used in a genuine effort to resolve the problem without resorting to circumcision. In other words, infant male circumcision is only legal if it can be proved that such a serious measure is genuinely in the best interests of the child, a standard that can only be met in extraordinary circumstances, and only after several more conservative treatments have been attempted and failed.
These legal stipulations exist for what should be obvious reasons. Circumcision is a serious surgery that is inevitably traumatic for the infant, and is irreversible. Circumcision that is deemed “successful” always results in a significant loss of sexual sensation and capability. A healthy foreskin is important for normal sexual functioning when the child becomes an adult. If the guidelines imbedded in current law are not followed, once the child becomes an adult he will have a strong basis for accusing the KZN-Natal Health Department of having violated his basic human right to a complete body.
The standard for a legitimate prophylactic reason to circumcise a baby boy would be much higher than can be met by any existing medical danger, including the possibility of eventually contracting HIV. No credible scientific basis to justify the removal of healthy tissues in male children for HIV prevention has been found, and circumcision performed on that basis violates a child’s right to bodily integrity and medical ethics. Since the infant is being circumcised to ‘possibly’ prevent HIV, there is no immediate medical need, making circumcision illegal, unnecessary, and unethical.
Medical circumcisions require a valid ICD-10 code to indicate the medical reason for the circumcision and thus define whatever pathology the doctor believes justifies the circumcision. The written consent of both parents is also required. This documentation will become a permanent record of the basis upon which the circumcision was performed, available for scrutiny at any later time in which the legitimacy of the reasons for the circumcision are questioned by the child, his parents, or others.
Doctors cannot act as agents of a social custom in the Health Department, and thus cannot perform a circumcision on a child unless it is medically indicated; that is, unless an actual current medical disease exists and is deemed to be so serious that circumcision is necessary. Circumcision for religious reasons are not for the Health Department doctors to carry out, since they carry no immediate health benefit and are a social custom. These should be performed by a Jewish or Muslim doctor privately, and according to the regulations of the Children’s Act, including the completion of the appropriate consent forms (see attached).
The KZ-Natal Health Department will be opening the door for legal challenges should they go ahead.
The medical records of any children that are circumcised in your departments are required to be kept until the age of majority of the child. We will be supporting these children to take appropriate legal action against the KZN-Natal Health Department and individuals promoting the proposed agenda of routine neonatal male circumcision despite these warnings. Parents of children will also be encouraged to take legal action whenever they become aware of legal stipulations in current law that were willfully overlooked.
No scientific basis for circumcision of babies for HIV prevention exists.
While we are aware of the well-known randomized control trials (RCT’s) used to justify the circumcision of consentingadults in order to provide some protection against HIV, we would like to remind you that there are currently no RCT studies in existence showing that circumcision of infants reduces their chances of acquiring HIV later in life. Any suggestion that such evidence exists is inferred and not based on medical fact. Willfully proceeding with plans for routine circumcision of infant boys with no valid medical reason, therefore provides legal and medical justification to sue. Since the KZN Department plans to proceed at least 12-14 years before the child becomes sexually active, by which time a vaccine may be present, and since ways exist to educate young people about how to protect themselves against HIV, it is unreasonable and inhumane to assume that a radical genital modification doomed to fail in its intended purpose and doomed to bring great unhappiness on a massive scale is necessary to achieve these aims.
Circumcised men still acquire HIV at an alarming rate, and circumcision is no permanent safe-guard against HIV infection.
Only a condom is proven to reduce HIV acquisition over repeated exposures. Any circumcised man having regular unprotected sex over time will ultimately carry the same risk of HIV exposure and increase the risk of his partner, especially if he falls prey to the belief that he is protected from HIV. Already, throughout Africa, men are beginning to believe that they do not need to wear a condom because they are circumcised.
We would be happy to engage your department in face-to-face discussions and to provide you with any information you may require to assist you in adjusting your present position.
This letter will be uploaded to our website in the interest of public knowledge. Please also find supporting articles attached.