Unbiased Analysis of Today's Healthcare Issues

Mass Circumcision and Moral Hazard

Written By: Jason Shafrin - Jan• 18•11

In Swaziland, a nationwide campaign is under way to circumcise 160,000 males by the end of this year.  Not 160,000 male babies, 160,000 adult males.  In a country with less than 1.5 million people, this is a huge undertaking.

Why would the government of Swaziland promote adult circumcision so strongly?  Here’s the answer:

“…a randomized controlled trial in South Africa (later confirmed by studies in Uganda and Kenya) found that circumcised men are as much as 60 percent less likely to contract HIV through heterosexual sex. Scientists do not yet know exactly why, but the study was so convincing that it was stopped after 18 months, because preventing the uncircumcised control group from getting the procedure would have been unethical.”

“Currently, 20 percent of Swaziland’s population are HIV positive…Nearly half of women ages 25 to 29 and men 35 to 39 are infected.”  Thus, circumcision is seen as a way to reduce the spread of HIV.

However, could circumcision actually increase the prevalence of HIV in the country? This may be the case if moral hazard strikes.

Moral hazard would occur if young Swazi males now overestimate their protection against HIV and these men become more promiscuous.  In fact, after circumcision “Some of the men have the misconception that they’ll be 100 percent safe.”  Fortunately, NGOs are providing counseling before and after the procedure to educate the Swazi men on the post-circumcision risk and the need to use condoms.  For the sake of their future, let’s home the young men listen.

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  1. Hugh7 says:

    The name for men thinking they’re immune because they’re circumcised and so putting themselves at greater risk is “risk compensation”. (“Moral hazard” is a religious expression about exposure to temptation. To clarify: condoms protect against risk compensation, but not against moral hazard, if you believe in that kind of thing.)

    More to the point, in Swaziland 21.8% of circumcised men have HIV, compared to “only” 19.5% of intact men, according to the National Health and Demographic Surveys. That really needs to be explained, or the hazard of circumcision may be not just moral but all too medical.

  2. Fred says:

    A recent study that I co-authored found little evidence of moral hazard for at-risk males in South Africa. I agree that an educational component about the need to continue with protective behaviors would be crucial for any large-scale program. Check out http://heapol.oxfordjournals.org/content/early/2010/10/19/heapol.czq064.abstract

  3. James Loewen says:

    Sorry Fred, your recent study fails on several counts.

    It appears that harm from circumcision is not factored into your study. Nor are the ethical concerns of operating on healthy infants and children to remove normal, beneficial, erotic body parts.

    Those of you who are promoting this unethical campaign will have to answer to a larger crowd of public opinion. The general public is waking up to the history of medical fraud of circumcising for “health” reasons.

    The motivation to circumcise is strong amongst those to whom circumcision has been forced upon. It is racist and sexist to target the genitals of African men, it is unethical (and perverted) to target the genitals of children.

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