Scientific uncertainty

What is evident is that the male circumcision research has been conducted on a macro level of large populations of men, often involving whole societies. Differ­ent infection rates in different countries are explained by the rate of male circum­cision in different areas (Halperin and Bailey 1999). In an often cited study by

Preventing HIV? Medical Discourses and Invisible Women

Moses and colleagues (1990) infection rates in populations are explained in terms of male circumcision, while other factors such as access to health care, HIV drugs, gender inequalities, money spent on prevention programmes and availability of condoms, that could be seen to influence the different infection rates in different countries, are unaccounted for. The social, cultural, economic, religious, and oth­er differences within different countries are disregarded—and only the foreskin of the black penis prevails as a way to explain difference.

During the 1990s the research on male circumcision takes regional and cultur­al differences in African societies more seriously, and detailed studies within local communities are conducted (Urassa et al. 1997; Quinn et al. 2000; Gray et al. 2000; Oliver et al. 2000). The Rakai study in urban Uganda (Quinn et al. 2000; Gray et al. 2000) is the only one where a clear pattern is found: but this only in as small a “population” as 50 men. The Rakai researchers themselves do not, how­ever, promote male circumcision in their conclusions (Quinn et al. 2000:928), but maintain that the issue is too complicated—for example by social factors—for any recommendations. Yet, this study is continuously used as a basis for male cir­cumcision promotion (Szabo and Short 2000a:1592; Ford 2000:9).

The only certain result our examination of the pro-circumcision texts found is the uncertainty regarding scientific proof of whether male circumcision is related to HIV infection rates among men. In studies where a weak connection is found it is still unclear at which age the procedure should be conducted and how much of the foreskin must be removed. Most studies conclude with a statement that more research is needed. “Randomized trials are needed to determine the utility of circumcision as an HIV preventive measure“ (Gray et al. 2000:2380).

No texts promise anything close to total protection for men. The studies are conducted on the level of populations, and social aspects, such as differences in behavior between different social groups—not to mention monitoring for indi­vidual behavior such as actual sexual practices—cannot be sufficiently accounted for. Based on populations it should be clear that these studies do not offer evi­dence on the level of the individual, even if they had found a connection between male circumcision and male infection—which they did not. Yet, the highly re­garded medical journals publish texts where male circumcision is strongly pro­moted. The article titles describe the political agenda: “How does male circumci­sion protect against HIV infection?” (Szabo and Short 2000a:1592)—the ques­tion is how, not whether. In their article, Harper and Bailey phrase the problem as a lack of circumcision as if circumcision would be a natural and unproblematic procedure.

Even when skepticism or reluctance is expressed, the common conclusion is that more research should be conducted. Our question is: why? In addition to the highly problematic ethical issues involved in any medical trials and research in de­veloping countries (see Benatar 2002; Pang 2002) HIV prevention trials highlight some specific problems. When studying the effectiveness of one prevention strat­egy, others may be neglected. Even the promoters conclude that people would

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Katarina Jungar and Elina Oinas

still need other prevention measures, like condoms—but the role of condoms be­comes unclear if male circumcision is promoted.[74]

One answer to the question of why there is such urgency in promoting such procedures, is that the ‘dark continent discourse’ is at work here: it can only be on a continent that is seen as already lost, that such a preventive measure can make any sense at all. It does not make any sense if the realities of HIV infection in Af­rica are in focus, but they are not. As we will discuss further on, male circumcision promotion draws from the image of ‘Africa as different’, creates a boundary be­tween Africa and the West, and thus protects Western white heterosexuality.