ZURICH: Swiss jurists disagree about hospital action

Eurasia Review
July 29, 2012

Swiss Legal Experts Divided Over Circumcision

By Sophie Douez
Moves by two Swiss hospitals to suspend the practice of circumcising boys in the wake of an adverse court ruling about the procedure in Germany have sparked heated debate amongst legal experts in Switzerland.

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Marcel Niggli, professor of criminal law at Fribourg University told swissinfo.ch the two hospitals had “overreacted”, and questioned why they were acting in response to a ruling in Germany which had no legal implications in Switzerland.

He said that although Swiss and German laws were similar in that they are based on the principle that medical procedures do not constitute inflicted injury when they are carried out to better a person’s health, “a court decision in Germany is not more important [to Switzerland] than one in China or Argentina”.

But professor Martin Killias, a criminologist at Zurich University, said the German ruling was simply a “point of ignition” for a debate which had been brewing for some time. He said the hospitals had “absolutely” taken the right decision in suspending the practice of circumcision.

"I think they are opening a debate and there are obviously several points to be considered,” Killias told swissinfo.ch. “Beyond criminal law, it simply asks the question whether hospitals want to do that? I could imagine that hospitals could say that according to our view this is against our ethical standards in medicine.”

Health benefits?
Although circumcision is traditionally practised as part of a religious ritual, several studies undertaken in recent years suggest that the practice could have health benefits too.

The World Health Organization says there is “compelling” evidence to suggest that male circumcision reduces the risk of heterosexually acquired HIV infection in men by 60 per cent and is promoting the scale-up of male adult circumcision programmes for HIV prevention in Africa .

“You can show from research done that circumcision betters the health of the person concerned, they have lower risk of contracting or transmitting specific diseases,” said Niggli. “It is not endangering life and this is also what makes the difference with female circumcision.”

He said that if you ruled that medical circumcision amounted to inflicting injury for purposes which did not improve a person’s health, then the same could be argued in the case of cosmetic surgery procedures.

“I find it rather strange that you can do whatever you want as long as it does not have a religious element,” Niggli said.

But Killias said that: “It is up to the patient to decide what he considers an improvement and aesthetical operations can also have direct [positive] psychological impacts, so I think in these circumstances, I don’t see why this [cosmetic surgery] could be problematic in terms of criminal law.”

Competing rights
Killias said although he was not a medical expert, the question of health justifications for circumcision was “controversial”. He said the key point in the debate is that the child is not able to decide for himself if he wants to undergo the procedure for either religious or aesthetic reasons.

“If circumcision was practised at the age of 16 when young people are considered mature in terms of religious self-determination, nobody would debate about it,” he said. “But if it is done with young children, I see that there is obviously a conflict between the rights of the child and the freedom of religion of the parents.”

Niggli argued that as parents, people have both the right and the obligation to act in the best interests in their child, in which case they can take the decision of circumcision on behalf of the child “because circumcision is a small thing, it’s not anything endangering life and you can show that statistically, this betters the health situation”.

As to questions of religious freedom, Killias said history had shown that beliefs within the different religions had evolved and changed over the generations, and so they should be encouraged to do on the question of circumcision as well.

“Democratic and open societies have a right to impose certain values and we do that also in other respects,” he said. “We are more and more outlawing the physical punishment of children and for me, it is hardly acceptable that it should be a criminal offence to slash a child but no problem at all to disfigure its sexual organs forever.”

Earlier story

WASHINGTON DC: Circumcision for AIDS is a boondoggle - and read the small print

Salon.com
July 27, 2012

Africa's male circumcision crusade: Boon or boondoggle?

Just imagine that a simple, harmless, one-time medical procedure could provide you, your loved ones, and all your neighbors with lifetime protection from a deadly epidemic. You’d sign up for it right away, wouldn’t you?

This is precisely what the World Health Organization, the Bill & Melinda Gates Foundation, and countless other NGOs and government programs are offering the continent of Africa: A comprehensive adult male circumcision campaign aimed at stemming the devastating HIV/AIDS epidemic. According to the WHO, “Medical male circumcision reduces the risk of female-to-male sexual transmission of HIV by approximately 60%.” Moreover,
Medical male circumcision offers excellent value for money in such settings. It saves costs by averting new HIV infections and reducing the number of people needing HIV treatment and care. A one-time intervention, medical male circumcision provides men life-long partial protection against HIV as well as other sexually transmitted infections. Thanks to the WHO’s lobbying and financing efforts, countries across Africa are submitting thousands of their male citizens to the operation. Uganda, which has a 6.5% adult infection rate, launched a giant voluntary circumcision program in 2010. In June, 2012, ten Zimbabwean parliament members announced that they would undergo circumcision to set an example to the population as a whole. More than a million Zimbabweans are living with HIV/AIDS.

This is indeed marvelous news. The way Bill Gates and the WHO describe it, circumcision sounds like the greatest invention since penicillin. And yet the story does raise a question: Is it true? Does circumcision really reduce the transmission of HIV/AIDS, making it serve as a sort of invisible condom?

In fact, the pro-circumcision consensus the WHO implies in its statements is largely imaginary. Medical experts the world over doubt the wisdom of the campaign, and some studies suggest it is actually counterproductive. In May of 2011, the Panos Eastern Africa NGO determined that misconceptions about the procedure – specifically the widespread notion that circumcision alone, without taking additional precautions, significantly protects people from HIV/AIDS – was actually encouraging the disease to spread in Uganda. In December of 2011, an article in the Australian Journal of Law and Medicine cited grave flaws in three studies supposedly proving the benefits of male circumcision in reducing the spread of HIV/AIDS in Africa: “The trials were compromised by inadequate equipoise; selection bias; inadequate blinding; problematic randomisation; trials stopped early with exaggerated treatment effects; and not investigating non-sexual transmission.”
Furthermore, the authors discovered that
In the Ugandan male-to-female trial, there appears to have been a 61% relative increase in HIV infection among female partners of HIV-positive circumcised men. Since male circumcision diverts resources from known preventive measures and increases risk-taking behaviours, any long-term benefit in reducing HIV transmission remains uncertain. There is also a concern that the procedure itself can spread the disease among participants and their sex partners if it is not performed under completely sterile conditions and combined with qualified followup care.

So is the Great African Male Circumcision Crusade a boon or a boondoggle? In order to cast some light on what appears to an extremely murky and emotional issue, I contacted Dr. Ronald Goldman of the Circumcision Resource Center in Boston to get some hard answers:
Dr. Goldman, a number of sub-Saharan African nations have begun a crash adult circumcision program aimed at drastically reducing the incidence of HIV/AIDS among their populations. Their leaders, encouraged by foreign governments and NGOs, have apparently convinced themselves that a circumcised penis is practically immune to the virus. What effect do you think the mass circumcision of African men will actually have on suppressing the illness?

Many professionals have questioned the reliability and validity of studies claiming that circumcision reduces HIV transmission. African national population surveys in eight countries found a higher rate of HIV infection among circumcised men compared to men who were not circumcised. There are at least 17 observational studies that have not found any benefit from male circumcision in reducing HIV transmission. Therefore, I do not expect a reduction in HIV transmission. It's even possible that the incidence of HIV transmission will increase because the mistaken belief of protection from circumcision will result in more risk-taking sexual behavior.

In the United States particularly, circumcision has long been regarded as a sort of “magic bullet” against disease and a host of other evils. Why do so many health professionals believe the procedure is so beneficial to society as a whole?

Actually, only a relatively few health professionals believe that circumcision has significant health benefits. Most doctors take a neutral approach to circumcision, following the recommendations of the American Academy of Pediatrics. The AAP is considered to be the highest authority on the subject, but their recommendations also have problems. For example, their current policy is not balanced and uses about ten times more space on the "potential benefits" than on the harm. In addition, there are many questions of harm that have not been studied. Because circumcision is common in the United States, there is a strong psychological motivation to believe it is harmless or beneficial.

Since circumcision is a religious duty among Jews and Muslims, do you see any religious ramifications to this policy? For example, could non-Muslims see it as a covert conversion campaign, or could the practitioners believe they are performing “God’s will”?

I don't think so. What is covert about the campaign is that circumcision is being promoted by circumcision advocates that have personal, religious, political, and financial conflicts of interest. They intended to find a benefit for circumcision, and they found it. As I have written elsewhere, there is a strong pro-circumcision bias among those who are circumcised, have circumcised sons, belong to circumcised groups, or have performed circumcisions.

What potential drawbacks or side effects do you anticipate from this wholesale circumcision campaign?

Many of the psychological, sexual, and social effects that I discuss in my book, Circumcision: The Hidden Trauma, could become more common as circumcision becomes more common. We expect that though men may choose circumcision now for themselves (based on misinformation about protection from HIV), the campaign is moving toward forcing circumcision on infants who will then have no choice. This is the source of the trauma. Imagine being forcefully held down and having the most sensitive parts of your genitals cut off. Trauma is remembered by the body and has long-term effects. Feelings, attitudes, and behaviors are affected. For example, some men are angry that they are circumcised. Other men are angry and don't know why. That repressed anger has many effects on their lives and the lives of others.

Condoms have proven to be vastly cheaper and far more effective than circumcision when it comes to reducing the spread of HIV/AIDS, and they also reliably prevent other sexually transmitted diseases as well as unwanted pregnancies. Why aren’t the UN and the Western nations showering Africa with condoms instead of removing men’s foreskins in what looks like an unprecedented social engineering experiment?

There is a lot of psychological motivation behind the advocacy of circumcision. Circumcision is traumatic. Psychologists know that there is a compulsion to repeat trauma on others. Some American circumcised men have placed themselves in administrative and research positions where they can act out this compulsion and influence many others to be circumcised. They are simply using the cultural beliefs and values (e.g, medical studies and authorities that claim that circumcision has benefits, etc.) to accomplish their goal.

As most people probably know by now, so-called female circumcision (a.k.a. female genital mutilation or FGM) is a much more radical procedure than the male version, frequently including the excision of the labia and even the clitoris. Do you see a possibility that government and NGO support for male circumcision could potentially water down campaigns targeting FGM?

I do not think so. I point out that the cutting of male and female genitals are qualitatively the same thing. The harm and violation start with the first cut.

If male circumcision is as harmful as you claim, does this mean that all male Jews and Muslims, not to mention tens of millions of Americans, are essentially “damaged goods” when compared to their non-circumcised contemporaries?

What circumcised cultures do not want to know is that a natural body part, in this case a penis, functions better than a surgically reduced one. We do not need studies to know this. It's just common sense. For example, if we cut off the thumb, the functions of the hand would be adversely affected. It's the same for the penis. Most American circumcised men (and doctors) do not know what they are missing. Based on recent reports, circumcision removes up to one-half of the erogenous tissue on the penile shaft, equivalent to approximately twelve square inches on an adult. Medical studies have shown that the foreskin protects the head of the penis, enhances sexual pleasure, and facilitates intercourse. Cutting off the foreskin removes several kinds of specialized nerves and results in thickening and progressive desensitization of the outer layer of the tip of the penis, particularly in older men.

The current African circumcision drive is being generously financed by the UN and WHO, foreign and national governments, and a variety of NGOs. It is big business for those involved and money, as they say, is the root of all evil. Would it be cynical to speak of a “circumcision-industrial complex” at work in Africa?

Certainly money is an important factor. An African official said, "Profiteering has trumped prevention." A WHO researcher said that billions of dollars have been wasted. The focus on circumcision reduces support for more effective measures.

Has anyone, aside from yourself and a handful of other circumcision skeptics, openly challenged the policy and called for resistance?

There are very reputable researchers who have been published in foreign medical journals because the peer reviewers for circumcision articles submitted to American medical journals are circumcision advocates. They will not approve of an article that is critical of circumcision. The review process is as deeply flawed as the studies that advocate circumcision.

There are other serious problems that prevent a fair and open debate. Circumcision advocates have access to much money, and American media, reflecting the pro-circumcision bias of the culture, routinely ignore stories critical of circumcision and focus on reports of circumcision "benefits." Journalist regularly violate their professional principles and obligations to report different views on this controversy.

Finally, circumcision advocates are afraid to debate circumcision critics. This shows up at professional conferences where critics are not provided equal opportunity to participate. The upcoming international AIDS conference will include a one-sided commercial for circumcision. The lack of debate is also apparent in the media. For example, two circumcision advocates refused to debate me on two radio talk shows.

If the circumcision program is indeed misguided, what alternative advice would you give to African governments seeking a viable solution to the HIV/AIDS crisis?

Most HIV infection in Africa are transmitted by contaminated injections and surgical procedures. The advice is simple: sterilize any instrument that will be used on a person's body. Condoms are better than 99% effective, less invasive, and the cost of one circumcision in Africa can pay for 3000 condoms. Unlike circumcision, condoms also have the advantage of also protecting women, and there are no surgical risks and complications. Even the pro-circumcision studies recommend using condoms in addition to circumcisions. With a condom, circumcision adds no significant additional protection value even if the advocates' protective claims for circumcision without condoms are true.

Ronald Goldman, Ph.D. is a psychological researcher, educator, and Executive Director of the Circumcision Resource Center in Boston, a nonprofit educational organization. Dr. Goldman is internationally known for his work on circumcision and is the author of Circumcision: The Hidden Trauma and Questioning Circumcision: A Jewish Perspective. He gives lectures on the psychosocial aspects of circumcision, counsels parents and circumcised men, and has participated in over two hundred interviews with broadcast and print media.

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The bottom line - read the small print!

At the AIDS 2012 conference they were handing out samples of posters (which also illustrated the above interview) being used in Africa, designed to stigmatise intact men:


The small print -

"Even with circumcision, having sex without condoms puts you at great risk of HIV/AIDS"

Note the soothing "Even with...." Here's where "even" should go: "Circumcisng men may put women - already at greater risk of HIV/AIDS - at even greater risk.

Earlier story

BERLIN: Turkish Bundestag member opposes law-change

TagesZeitung (TAZ, liberal-progressive, Berlin)
July 26, 2012

Religions should accept a subordinate role

Green Party member of Parliament Memet Kilic of Heidelberg grew up in Turkey. He voted against the Bundestag resolution. He finds that those affected should decide for themselves at the age of 14 what should happen to their foreskin.

TAZ (Interviewer Daniel Bax): Mr. Kilic, recently the Bundestag weighed in on a law to regulate religious circumcisions. Why did you vote against it?

Kilic: I was against it because it stifled a necessary debate. This must occur before such a decision is made.

TAZ: Many Muslims and Jews consider the circumcision of boys as a religious obligation. Can the German state assume a right to pass judgment on that?

Kilic: Until a few weeks ago I would have said no to that. But the Cologne ruling has given me food for thought because what is preached in holy books must now be freshly interpreted in light of reason and medical progress. Indeed, one country alone cannot succeed in changing religious rituals and customs of its citizens. But it can question them and can enter into a dialogue with the religious communities.

TAZ: Didn’t the Cologne ruling make a quick political action necessary because it caused uncertainty for so many parents and physicians?

Kilic:  Absolutely. But when there are strong reasons, in Islam as well as in Judaism, circumcision can be postponed for a while. The Cologne ruling is one such strong reason – and the religious communities must respect constitutional democracy.

TAZ: A prohibition on religious circumcision could tempt many Jewish and Muslim parents to have their sons circumcised abroad. Isn’t that risking the creation of circumcision tourism into different countries?

Kilic: That already exists. For cost reasons, or because they want to celebrate the circumcision within family circles, many parents already allow this surgery to be performed in their home country. Yet, a constitutional state is therefore not tasked with making it easier in this country, but has to balance different legally protected rights.

TAZ: Whether circumcision comes with physical disadvantages is controversial. Why should the German state interfere in those questions?

Kilic: The medical benefits are not proven but if it’s medically necessary then such circumcisions should continue to be permitted. Yet I consider it questionable to rely on health arguments to justify religious commandments. Certain religious communities mark their members with circumcision. I’m all for those affected making this decision themselves when they are 14, at the age of religious consent under German law.

TAZ: Unlike Muslims, for religious Jews it isn’t possible to wait that long when the procedure traditionally happens at 8 days. Is your suggestion realistic?

Kilic:  For devout Jews this is difficult, I agree. But some Jewish communities in Great Britain have reduced circumcision to a symbolic act and postponed the operation to a later time. This seems exemplary to me.

TAZ: Should Germany of all countries, with its history, be the first to restrict a Jewish tradition?
Kilic: I’m aware that anti-Semitic or anti-Muslim sentiment may rise to the surface in such a debate.  It’s our duty to be sensitive with such issues, not only because of the Holocaust, but Germany also has signed a treaty on children’s rights. Furthermore, the Cologne ruling  is simply logical for a secular society and is much better than what it’s been made out to be because it balances many aspects. Therefore the large religious communities should not jump the gun by swinging a big stick with the slogan “You don’t want us!”

TAZ: About 30% of men worldwide are said to be circumcised. And so far there has hardly been any controversy about it. Isn’t this just an artificially created problem that doesn’t exist?

Kilic: No I don’t see it like that. It doesn’t help the argument to point to statistics. The Cologne court has ruled in a concrete case, and medical and children’s organizations have clearly spoken to this question. However, many of those involved act out of social pressures and traditions without properly reflecting upon them. Also the motivations of the circumcision industry which originated in the USA is by all means questionable.

(Translated by Bernd Vey and Tim Hammond)

Earlier story

EASTERN CAPE: 42 Circumcision deaths in three weeks

the Sowetan
July 27, 2012

42 boys perish - but silence

By Mbuyiselo Botha and Nomonde Nyembe
THE figures of young boys dying at initiation schools are shocking. The death toll, as at July 11, was 42, in just three weeks.

According to reports, this is nearly double last years' figure of 26.

South Africa is now 18 years into democracy but the shame of young boys dying in Eastern Cape initiation schools continues unabated.

Why do we, as a caring, compassionate, democratic society, look the other way? Why do we allow certain cultural practices to rob young people of their future?

We are reminded of the work of gender activist and author Dr Gary Barker, whose comments in his book Dying to be Men describes the debilitating association of notions of manhood, issues of violence and HIV - that some young people will die for in their quest to become so-called "proper" or "real" men.

What it means to be a "proper" man and the fact that it has been reduced to the practice of circumcision is detrimental not only to the young men who go through the process but to society as a whole.

A society where manhood is ascribed only to individuals who have gone to initiation school is one that does not value men as whole beings with other aspects to their humanity. However, this does not affirm the notion that you can still be a man without being subjected to inhumane treatment.

Too often, not enough attention is paid when people's rights are trampled on with impunity. What message does the silence send to these young men who are expected to go through this route without any guarantee that they will come back alive?

It is our view that any other traditional law is subjected to our supreme law, the Constitution.

There are those who would argue that constitutional protection of culture gives them carte blanche to engage in practices that are not only harmful but may, in fact, lead to death. This is not so. Cultural and religious practices are protected to the extent that they are consistent with other rights in the Constitution (sections 15(3)(b) and 31(2)).

We are concerned that there is not a universal outcry from all of us to these statistics.

We wonder if this silence is a result of us fearing to be labelled as "Eurocentric" or "sell-outs" out there to please the white master.

The Children's Act prohibits the circumcision of young men and joins a number of other provincial [A]cts that regulate male circumcision in Free State, Limpopo and Eastern Cape.

Parents themselves are under an obligation to consent to the circumcision before it occurs.

There is a need for active citizenry in if we are to stop practices that not only harm but endanger people's lives.

We must hold our government to account and using the law to do so is our constitutional mandate. Doing otherwise would be betraying those who died for us to have those freedoms.

Earlier story

AUSTRIA: Religions unite against circumcision age-restriction

Associated Press
July 27, 2012

Austrian religious reps fear circumcision backlash

VIENNA – Senior Christian, Jewish and Muslim representatives are demanding that Austria formally declare its backing for circumcisions of male infants on religious grounds.

Their call Friday comes after two provincial governors spoke out against such procedures based on a German court ruling that it could amount to criminal bodily harm.

Last month's verdict by a German regional court did not ban male circumcision of Muslim or Jewish infants. But it led the German Medical Association to recommend that no unnecessary circumcisions be performed until the legal situation is clarified. That is prompting calls for restrictions in Austria, which does not forbid the practice.

Vorarlberg Governor Marcus Wallner has told hospitals to suspend circumcisions except for health reasons while Carinthia Governor Gerhard Doerfler has called for a nation-wide prohibition by law.

NEW YORK: Metzitzah - Bloomberg won't back down to mohelim

City and State
July 25, 2012

Heard about town

* Bloomberg yesterday rebuffed rabbis’ threats of legal action if the city goes through with a proposal to restrict a controversial Orthodox Jewish circumcision procedure. “We have an obligation to keep people alive and safe and the courts have held that up repeatedly,” Bloomberg said yesterday at a press conference. “There are certain practices that doctors say are not safe and we will not permit those practices to the extent that we can stop them. You don’t have a right to put any child’s life in danger, and this clearly does.” His comments came in response to Orthodox rabbis who defended the controversial practice of “metzitzah b’peh” at a New York City Health Department public hearing this week. ...

Earlier story

BERLIN: Circumcision age-restriction "could spread"

Washington Post
July 26, 2012

Orthodox rabbis fear circumcision restrictions could spread across Europe after German case

BERLIN — A group of Orthodox rabbis warned Wednesday that the ancient Jewish practice of infant male circumcision could face further restrictions in Europe after some hospitals in Austria and Switzerland suspended the procedure by citing a German court ruling that it could amount to criminal bodily harm.

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“Of course we in Switzerland aren’t directly affected by the Cologne ruling, but it sparked a debate about how to deal with the medical and ethical issues involved,” said Marco Stuecheli, a spokesman for Zurich’s Children’s Hospital.

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“Our fears that the court ruling in Cologne could have a knock-on effect across Europe are now being realized,” said Pinchas Goldschmidt, the president of the Conference of European Rabbis.

He said Jewish leaders across the continent would seek out lawmakers and government officials to impress on them how central the practice is to their faith, and to forestall further restrictions elsewhere.

While Muslims, too, commonly circumcise their sons at a young age, in Judaism the procedure must take place eight days after birth. According to religious law, an uncircumcised male isn’t considered fully part of the Jewish community, Goldschmidt said.

“In order to change that we would have to convene a supreme Jewish religious court, which has not convened for the last 2,000 years,” he told The Associated Press.

The German government is expected to propose a bill this fall which would ensure that circumcision remains legal in the country.

The Children’s Hospital in Zurich said it hopes to reach a decision next month about whether to resume circumcisions. So far, the suspension has delayed only two planned operations, because many Jewish parents prefer to have their sons circumcised privately, Stuecheli said.

...

Earlier story

NEW YORK: Metzitzah - mohelim object to informed consent forms

City & State
July 23, 2012

Rabbis Defend Controversial Circumcision Practice to City Health Officials

By Wilder Fleming
At a hearing yesterday in Queens, New York City rabbis defended a controversial circumcision practice that has been blamed for infecting infants with herpes, in some cases causing their death.

The practice, called “metzitzah b’peh,” requires the circumciser, or mohel, to suck the infant’s wounds after circumcision, and has led to at least two cases of infant death in New York since 2000.  The city wants to amend the health law to require mohels to obtain written consent from parents indicating they are fully aware of the risks involved in the ritual circumcision, or bris.

“I myself have performed 25,000 circumcisions, and, thank God, we have not had one single incident … our guidelines are, I think, much stricter than the medical profession,” said Rabbi A. Romi Cohn, a mohel and a Holocaust survivor who represented the American Board of Ritual Circumcision at the hearing.

But Cohn admitted that some people who are not certified according to Jewish law masquerade as mohels in order to make money, sometimes as much as $500 to $1,000 per bris.

“This is completely forbidden, but unfortunately they are doing it,” Cohn said. “These people don’t know what sterility means. They don’t know about infection. We try to tell parents that if they choose a circumciser, he should be board-certified.”

Mohels argued the city’s proposed changes would infringe on their religious freedom, but city health officials are pushing back.

“The concept of informed consent puts more of the decision-making power and more of the information in the hands of the parents,” said Susan Blank, the assistant commissioner of the STD Control Program at the city’s Department of Health and Mental Hygiene.

Blank said she was confused by rabbis’ opposition, which she argued allowed them their religious freedom while simultaneously allowing parents greater control over their child’s welfare.

“The Department has received multiple complaints from parents whose children may not have been infected who were also not aware that direct oral suction was going to be performed as part of their sons’ circumcisions,” according to a notice from the New York City Board of Health.

The city’s interference in the ritual could lead to legal action, the mohels said.

“Being a mohel is a religious status…I cannot follow an outside authority,” said Rabbi Levi Heber, the director of the International Bris Association. [Translation: "I believe I am above the law."]
Heber said that if the city enacted the proposed amendment the mohels would take legal action to stop it.

“If we feel that our religious freedom is being restricted, we have the right to challenge it in court … we are ready, if needed, to challenge this,” he said.

The Board of Health plans to reach a decision on the proposal in September.
[The Gothamist headline: Rabbis: Pry These Foreskins From Our Cold, Dead Lips]
 
Earlier story

VIENNA: Hospitals to stop circumcising

the Huffington Post
July 24, 2012

Some Austrian Hospitals End Religious Circumcision

VIENNA -- The governor of Vorarlberg has told hospitals run by Austria's westernmost province to suspend circumcisions motivated by religious custom, citing a German regional court ruling that the practice amounted to causing criminal bodily harm.

Markus Wallner says he sees the German decision last month, arising from the case of a child whose circumcision led to medical complications, as "precedence-setting judgment."

He told provincial hospitals Tuesday not to perform the procedure except for health reasons until the legal situation is clarified in Austria.

The decision does not affect religiously motivated circumcisions performed outside hospitals run by the Vorarlberg government.

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the Telegraph
July 24, 2012

Circumcision row hits Austria as doctors advise against it even on religious grounds

A row over circumcision has spread to Austria from Germany after a state governor advised doctors against performing the procedure, even when it is on religious grounds.

...

Wallner's move meanwhile was slammed as an "attack on religious freedom" by Fuat Sanac, head of the Islamic Community of Austria (IGGiOe), according to comments due to be published in Wednesday's Der Standard daily.

The move "is not worthy of Austria", Sanac said, calling circumcision "a tradition going back thousands of years". Oskar Deutsch, the head of Vienna's Jewish Community, said that the practice was "protected by the constitution".

A spokesman for the centre-left Social Democrats - in a coalition at national level with Wallner's Austrian People's Party - accused the state premier of "giving in to populism".

In Graz, the capital of the southeastern state of Styria, the children's hospital has decided not to carry out any more circumcisions that have not already been scheduled.

WASHINGTON DC: Intactivists noticed at AIDS conference

Washington Post (Live Blog)
July 22, 2012

Battle over circumcision

By Pamela Constable
An impassioned battle over male circumcision emerged at the conference Monday, where advocates said the procedure would help reduce the spread of HIV/AIDS in impoverished countries, but opponents asserted it would undermine the use of condoms while doing nothing to stop virus transmission.

Male circumcision has become increasingly accepted in Africa and Asia as awareness of AIDS has spread. A display by the AIDS Council of Zimbabwe featured photographs of boys in tribal costumes at a mass circumcision ceremony. Constant Karma, a doctor from Papua, Indonesia, led a delegation that promotes circumcision among religious communities there. He handed out brochures quoting Biblical verses and illustrated with traditional drawings of priests circumcising men. Karma said the former Dutch colonial rulers in Indonesia banned traditional circumcision for generations, but the AIDS epidemic has spurred activists to re-introduce a modern version.

“We are going to every church and mosque with our message. We have to do everything we can to stop the spread of AIDS,” Karma said through a translator. “We know how important this is, but even now there are groups preaching against it.”

Outside the convention center, protesters had erected banners that said “Circumcision is Torture” and “Intact Genitals are a Human Right.” Natalie Erdossy, 29, an activist from Reston, said circumcision is not the answer to AIDS, and that it can lull men into thinking wrongly that they are protected against the virus.

“People are touting studies from Africa saying circumcision reduces HIV infection,” she said. “That is totally flawed. Only condoms protect people from it. If a man in Africa hears that circumcision can protect him, he’ll think, ‘Hot dog, now I don’t have to use a condom.’”

Brochures handed out by Erdossy and a group called NOCIRC said male circumcision might actually increase the rate of HIV/AIDS transmission and place female partners at greater risk, because circumcised men may believe it provides an “invisible condom.” They also said there is frequent risk of infection from surgical complications.

DAVIS, CALIFORNIA: Foreskin immunlogically complete - hope for specific vaccine

MedicalXpress
July 23, 2012

Penile foreskin is immunologically complete: raises new vaccine possibilities for HIV vaccine

Rhesus macaque monkeys infected with simian immunodeficiency virus (SIV) harbor immunoglobulin G (IgG) and SIV-specific antibodies and T cells in the foreskin of the penis, according to a study in the July 2012 Journal of Virology. This is the first time antibody secreting cells, antiviral antibodies or antiviral T cells have been reported in the foreskin of any primate.

Although "it has been known for some time that there was a population of immune cells in the surfaces of the human penis, and in all skin, for that matter, the potential functions of these cells, especially with regard to anti-HIV activity, had never been determined," says principal investigator Christopher J. Miller of the University of California, Davis. The new finding, he says, could lead to vaccine strategies designed to elicit HIV-specific immunity in the foreskin. [...and thereby rendering circumcision {even more} unnecessary.]
 
Cells which are targets of HIV are present in multiple epithelial tissues of the penis, and the foreskin—the skin of the penis that is lost during circumcision—is thought to be an especially important route of HIV transmission. "…the presence of an intact foreskin is associated with an approximately 50 percent increased risk of HIV acquisition," the researchers write, citing [the usual] seven studies. Although HIV-specific antibodies and T cells are present in semen of HIV-infected humans, very little research has investigated mucosal immune responses of the surface of the penis, says Miller.

Male rhesus macaques are good models for the human reproductive system immunity. "…based on histology, there is no difference in the numbers or locations of CD4+ cells in the inner and outer foreskin of adult [rhesus macaques] or men," according to the report. "In addition to CD4+ T cells, the foreskin and glans of the human penis have a complete population of immune cells, but antigen-specific immune responses in these tissues have not been described [until now]," says Miller.

Miller's lab was also the first to report antiviral T cells in the female genital tract, research which led to efforts to develop vaccines that could elicit anti-HIV immunity in the female reproductive tract.

More information: K. Rothaeusler, Z.-M. Ma, H. Qureshi, T.D. Carroll, T. Rourke, M.B. McChesney, and C.J. Miller, 2012. Antiviral antibodies and T cells are present in the foreskin of simian immunodeficiency virus-infected rhesus macaques. Journal of Virology 86:7098-7106.

GERMANY: Organisations support Cologne decision

Gatestone Institute
July 22, 2012

Germany Debates Male Circumcision

By Peter Martin
In violation of their Hippocratic Oath to do no harm, doctors are interpreting a medical practice in purely religious terms - choosing religion over science.
[The opposite of this statement makes more sense: Following their Hippocratic oath to do no harm, doctors are interpeting a religious practice in purely medical terms - choosing science over religion.]

...

The verdict was applauded by many organizations. Deutsche Kinderhilfe, a non-profit organization to aid children, said that the wellbeing of children had been served by the court. The German Institute for Pediatric Surgery stated that the verdict conformed to medical ethics. The Professional Union of Pediatricians warned "for the trivialisation of this form of physical damage by the circumcision defenders" and said that the right of children to physical integrity should be society's primary concern.

The International League of Non-Religious and Atheists also welcomed the verdict, stating that religiously motivated circumcision is a form of physical damage and mutilation. Terre des Femmes, an international women's rights organization, also applauded the Cologne verdict. It said the physical integrity of children should not be restricted for religious reasons.

In the German media, psychotherapists stated that circumcision on six- or seven-year old boys can have a traumatic effect. Jewish organizations pointed out that Jews have been circumcising boys on the eighth day after birth for thousands of years, without any Jewish men later complaining about harmful side-effects. They also emphasized that male circumcision cannot be equated to female genital mutilation.

...

Earlier story

ZIMBABWE: Health advisor rejects circumcision

AllAfrica.com
July 22, 2012

Zimbabwe: Stamps Scoffs At Circumcision

By Rutendo Mawere
PRESIDENT Robert Mugabe's health advisor, Timothy Stamps, has rubbished claims that male circumcision reduces HIV and Aids prevalence rate at a time the country had embarked on a foreskin cutting crusade, ostensibly to lessen chances of contracting the deadly disease.

The former minister of health said circumcision did not make any difference to the adult prevalence rate, noting researches had shown that countries with a higher number of circumcised men, like the US, also had a high HIV prevalence rate.
[That is not his strongest suit, but the rate in Zimbabwe itself.]

Click to enlarge

He said instead of channelling funds towards circumcision, the money must be used to save pregnant mothers who die in huge numbers in this country.

"When we are losing 960 mothers for every 100 000 pregnancies, should circumcision be a priority?" said Stamps.

He said circumcision had led to men being more reckless in sleeping around.

"Young men are happier to take risks and chances without the use of condoms or any other preventive measures because they are told circumcision will protect them," he said.

...

Earlier story

HEIDELBERG: Germany-born US babies still at risk

Stars and Stripes
July 23, 2012

German court's circumcision ban does not affect US military clinics

By Nancy Montgomery
HEIDELBERG, Germany — U.S. military doctors will continue performing circumcisions on male infants when parents request it, officials say, despite a controversial German court decision that banned the procedure as inhumane.

The June decision by a court in Cologne applies only in that jurisdiction, not in any of the German states in which U.S. military clinics are located, said Ed Rohan, a spokesman for Europe Regional Medical Command.

“If another jurisdiction in which we have military treatment facilities were to pick up the same legal reasoning, there is a possibility that it would apply to health care providers” there, he said.

“At this point they will continue to perform circumcisions, but our legal experts will continue to follow this issue and provide advice based on any other court or legislative actions,” Rohan said.

U.S. facilities may be among the few places now in Germany to do the procedure that removes some or all of the foreskin from the penis. After the June court ruling, the head of Germany’s medical association said he was advising colleagues throughout the country against performing circumcisions to avoid any risk of criminal prosecution.

Even before the ruling, however, many German pediatricians would not perform them.
“For example, in Heidelberg, all circumcisions (on Americans) are performed in the Army Health Clinic. But in Stuttgart, about half were performed by host nation providers in the local community,” Rohan said.

Rohan agreed that the ruling had muddied the legal waters surrounding the procedure, which has never been embraced in Europe, but since the 1900s had been done on the majority of U.S. male babies.

Teams of U.S. and German lawyers had been discussing the implications of the court ruling, Rohan said, and had “reached varying conclusions as to its impact” on U.S. military facilities, he said. “The general consensus, however, is that we will not see a wave of prosecutions based upon this singular and narrowly applied interpretation of law.”

...

It’s not the first time circumcision has been subject to restrictions in Europe.

In 2001, Sweden passed a law allowing only people certified by the National Board of Health to circumcise infants. Swedish Jews and Muslims objected to the law and the World Jewish Congress called it “the first legal restriction on Jewish religious practice in Europe since the Nazi era.”

In 2006, a Finnish court ruled the circumcision of a 4-year-old boy to be an illegal assault, but in October 2008 the Finnish Supreme Court ruled that the circumcision, “carried out for religious and social reasons and in a medical manner,” was not criminal.

The swiftness of the German parliament’s response seeking a law allowing circumcision is attributed to the sensitivity surrounding Germany’s Nazi past.

Circumcision rates vary throughout the world. The U.S. has had one of the highest rates: The conventional view was that a foreskin-free penis was healthier and cleaner. But the procedure became increasingly controversial, with some arguing that it was a sort of mutilation that conferred few benefits and caused harm, such as pain to the baby and later decreased penile sensitivity.

...

Rohan said circumcision rates in the U.S. were falling, from some 63 percent in 1999 to 54.5 percent in 2009. The German circumcision rate is about 20 percent, he said. [That sounds improbably high.]
In 2011, 518 boys were born at Landstuhl Regional Medical Center, officials there said, and 145 of them were circumcised [only 28% - much lower than in the US] shortly after birth, which is when doctors say it is least traumatic [- contrary to the evidence].
 
...

Earlier story

UGANDA: "Circumcision not enough" - Museveni

the Observer (Uganda)
July 22, 2012

Circumcision not enough to curb HIV - Museveni

By Wilber Muhwezi
President Yoweri Museveni has said it is not enough to promote circumcision as an effective strategy in fighting HIV/AIDS, without continued emphasis on behaviour change.

Campaigns aimed at reducing infection levels, he says, ought to concentrate on advocating good behaviour: abstinence for unmarried people and faithfulness among those in wedlock. [and condoms]
“I have witnessed Muslims and other people from tribes that cherish circumcision like the Bagisu, die of Aids. Therefore, who told [health workers and leaders] that circumcision [prevents] HIV [infection]? ” he said.

...

“[Leaders and health workers] are busy spreading confusion of circumcision, instead of concentrating on behaviour change,” he said.

...

BERLIN: Resolution "hasty"; law change not easy

Alternet/AFP
July 22, 2012

German circumcision row heading for new legal battle

Germany's constitutional court may have the last word on religious circumcision, the justice minister said in remarks to appear Monday, after lawmakers called for a legal framework to protect the practice.

Their resolution on Thursday came after a court in the western city of Cologne sparked nationwide debate by ruling last month to criminalise the practice - observed by both Muslims and Jews on religious grounds - deeming it tantamount to grievous bodily harm.

"It's more complicated than adding a simple little phrase somewhere," Justice Minister Sabine Leutheusser-Schnarrenberger told the weekly Der Spiegel.

"I wouldn't be surprised after this emotional debate if the law landed before the German constitutional court," said the minister, who belongs to the liberal Free Democratic Party, part of the government coalition.

MPs of the lower house Bundestag adopted a cross-party motion Thursday calling for legislation by this autumn that would guarantee the right to religious circumcision as long as it does not entail "unnecessary suffering."

Two opposition lawmakers who spoke to the Sunday weekly Frankfurter Allgemeine Sonntagszeitung voiced scepticism that legislation could be hammered out so quickly.

Social Democrat Marlene Rupprecht, a children's advocate, said more than half of the party's parliamentary group thought the resolution was hasty.

Her counterpart for the Greens, Katja Doerner, said many in her party agreed.
...
In an interview with the weekly Focus to appear on Monday, the president of the Central Council of Jews in Germany, Dieter Graumann, said the debate had "nothing to do" with anti-Semitism.

But he said he was surprised at the apparent ignorance of many Germans about religious rites, while hailing the Bundestag resolution.

DORTMUND: Anti-FGC group: "If boys cut, why not girls?"

Where male cutting is not common, anti-female-cutting organisations Get It:

With (he)art against FGM (Pressemeldung) 20, Juli 2012 Nein zur Straffreiheit bei Beschneidung im Kindesalter! Mit ‚großer Sorge" beobachtet die private Kampagne With (he)art against FGM, in der sich Künstler, Musiker und Autoren zusammengeschlossen haben, die aktuelle Diskussion um die Straffreiheit von Beschneidungen. Isabel Henriques, Initiatorin des Projekts, sagt: „Wenn Jungen mit gesetzlicher Erlaubnis rituell beschnitten werden dürfen – warum dann nicht auch Mädchen?" Das, so Henriques, würde alle Bemühungen um ein Ende weiblicher Beschneidung zunichte machen. Die Kampagne stellt klar, dass sie nicht gegen Religionen und Riten vorgehen will. „Wir respektieren und achten Juden und Muslime, die durch den Gesetzentwurf in die Diskussion geraten sind." Das geplante Gesetz betrifft in Deutschland nur die Beschneidung von Jungen. Die Kampagne verweist auf die USA. Dort gab es im Jahre 2010 einen riesigen Aufschrei, als die American Academy of Pediatrics (Kinderärzte) auf Verlangen religiöser Kreise eine rituelle Beschneidung (ritual nick) als mögliche Alternative zu einer vollständigen Ablehnung der weibliche Beschneidung vorgeschlagen hat. Damit wollten die Kinderärzte den Mädchen die Eingriffe in ihren Heimatländern ersparen, die dort oft unter katastrophalen hygienischen und medizinischen Bedingungen stattfinden – und nicht selten den Tod des Kindes zur Folge haben. Auf Druck der weltweiten Menschenrechtsorganisationen hat die Academy diese Empfehlung rasch zurückgezogen. Isabel Henriques dazu: „Wir kritisieren und verurteilen nicht die rituelle Beschneidung, sondern dass diese Beschneidungen an Kinder durchgeführt werden, die noch nicht in der Lage sind, selbst eine bewusste Entscheidung zu treffen oder sich dagegen wehren zu können. In unseren Augen sollte es nach wie vor die Aufgabe der Regierung sein, das Recht auf körperliche Unversehrtheit im Kindesalter zu bewahren, und nicht irgendeinem Druck nachzugeben, egal von welchem Kreis er kommt, oder welche Argumente herangezogen werden." Die Initiative erinnert daran, dass in Afrika auch Jungen beschnitten würden, unter denselben schlimmen Bedingungen wie Mädchen. Auch böten die Krankenhäuser in der dritten Welt den Kindern oftmals keinen Schutz. Doch selbst in hochmodernen Kliniken in den USA oder Europa seien die Kinder nicht vor medizinischen Schäden oder dem Tod gefeit.Wie der traurige Fall in Köln, der letztendlich diesen Streit ausgelöst hat, deutlich zeigt.

With (he)art against FGM Press Release July 20, 2012 No to impunity for circumcision in childhood! "With 'great concern' the private campaign with (he) art against FGM (in which artists, musicians and authors have joined together) has observed the current discussion about the impunity of circumcisions. Isabel Henriques, initiator of the project, says: "If boys may be ritually circumcised with legal permission - then why not girls also?" That, says Henriques, would negate all efforts to end female circumcision. The campaign makes it clear that it will not take action against religions and rites. "We respect and regard Jews and Muslims, who are advised by the draft law in the discussion." The proposed Act concerns only the circumcision of boys in Germany. The campaign refers to the United States. There was a huge outcry when the American Academy of Pediatrics, at the request of religious circles, proposed a ritual nick in 2010 as a possible alternative to a complete rejection of female circumcision. Thus, the pediatricians wanted to spare the girls the procedures often held in their own countries - under catastrophic hygienic and medical conditions there, and often resulting in death. Under pressure from global human rights organizations, the Academy rapidly withdrew this recommendation. Isabel Henriques added: "We do not criticize or condemn ritual circumcision, but carried these restrictions to children who are not able, even to make a conscious decision or [in any way] to defend themselves. In our view it should be the task of the Government to preserve the right to physical integrity of the child, and not to give in to any pressure, no matter what county it comes from nor what arguments will be used." The initiative pointed out that in Africa boys would also be cut under the same bad conditions as girls. Also the hospitals in the developing world often offer no protection to children. But even in modern clinics in Europe or the United States, the children were not immune against medical damages or death. Clearly shows how the sad case in Cologne, has ultimately triggered this dispute. Earlier story

IVORY COAST: Nine women imprisoned for female cutting

AP
July 21, 2012

9 Ivorian women sentenced over genital mutilation

ABIDJAN, Ivory Coast (AP) — An Ivory Coast official says nine women have been sentenced to two years in prison each for involvement in female genital mutilation, marking the first time such a case results in jail time in the West African nation.

Justice ministry official Jean-Luc Molo said Friday courts previously convicted defendants for genital mutilation but pressure from local communities hindered them from imposing prison sentences.

He said the women from the northern town of Katiola were found guilty of carrying out the genital mutilation on a "groups of young girls" over an extended period. He could not provide an exact number of victims or their age.

Female circumcision is banned in Ivory Coast since 1998 but the practice remains widespread. The United Nations say the practice violates fundamental human rights and endangers girls' health.

SOUTH AFRICA: Number of dead approaches 50

Mail & Guardian (South Africa)
July 20, 2012

Editorial: Too many young men are dying

The proliferation of illegal initiation schools is a threat not just to cultural practices or even young men's lives, but to public health in general.

Judging by the number of deaths – approaching 50 this year – and hospitalisations, it is clear that the cultural practice of initiation in the Eastern Cape is under severe threat from its commodification, which has resulted in the proliferation of illegal schools. At risk are not just lives, or cultural practices, but potentially important public health gains.

...

But the health department and institutions of traditional leadership need to work together to ensure that initiates are not endangered, and that circumcision is performed in a way that confers its health benefits on initiates.

And both sides need to be held responsible for stopping the needless deaths and mutilation of so many young men.

...

DENMARK: Majority of parliament would vote against circumcision

Europe News
July 20, 2012

Danish parliament: Majority against religious circumcision

"If the Danish parliament would vote on whether religious circumcision of male children should be prohibited, there is strong evidence that such a ban would be enacted. Spokesmen from the three largest parties in Denmark (Liberals, Social Democrats and Danish Peoples' Party) express that they and their parties are skeptical about the current practice where Jewish and Muslim boys may lawfully be circumcised, if there is a doctor present when surgery is performed.

...

'It will be difficult to find a doctor who will claim that it is a risk free procedure. ... Based on the fact that it can cause medical complications, I think it is a procedure that should only be made when the person is adult and can decide himself,' says Sophie Løhde (Liberals). ...

The Danish Council of Ethics and the Danish Children's Council has recommended a ban. Also the two parties Green Alliance and Liberal Alliance has declared themselves in favor of a ban."

BERLIN: Child-proteciton organisations want delay in law

Der Spiegel
July 20, 2012
Support for Religious Traditions

Politicians Welcome German Circumcision Motion

Germany's parliament approved a resolution on Thursday that called on Berlin to create legislation that would ensure that circumcision of boys remain legal in the country. The move is intended to quiet international outrage over a recent German court ruling that criminalizes the tradition.

...

The co-head of Germany's opposition Green Party also supported the measure. "A circumcision ban would disregard and ostracize long cultural and religious traditions that are part of Jewish and Muslim life," said Claudia Roth, who called for expedited legislation ensuring that circumcision remains legal.

Child Rights Groups Oppose Quick Law
But not all were pleased by the decision, including the Federation of German Criminal Police (BDK). "Our constitution cannot be limited by a simple law, as parliament is currently trying to do in panic," BDK chief André Schulz told the Neue Osnabrücker Zeitung newspaper. "The freedom of parents to practice religion will nevertheless be limited by a child's more important right to physical integrity."

Meanwhile, a group of child-protective organizations has also issued a petition calling for a two-year delay on any new law on circumcision so that the issue could be debated more intensely by experts. The groups include the BDK as well as Deutsche Kinderhilfe (German Children's Aid) and the German Association of Physicians in Child and Adolescent Medicine. In the petition, they warn that a working group should be created before taking any legal steps that could permit the "serious and irreparable intrusion on the physical integrity of a child." The petition claims that complications arise in 10 percent of circumcision cases.

In Germany, public opinion is mixed over circumcision. A survey conducted this week by pollster YouGov for the German news agency DPA found that 45 percent of Germans support a ban on circumcision of boys, whereas 42 percent were opposed to it and 13 percent undecided. Fifty-five percent said they did not believe a national ban on circumcision would damage Germany's image abroad, compared to 33 percent who thought it would.

Earlier story

ZURICH: Two Swiss hospitals stop circumcising

the Australian
July 21, 2012

Some Swiss hospitals follow German circumcision ruling

A GERMAN court ruling that branded circumcision as grievous bodily harm has created waves in Switzerland where a second hospital announced a possible halt to the procedure.

The announcement, by St Gall hospital in the country's northeast, follows a decision on Thursday by the Zurich children's hospital to temporarily suspend the operation, media reported.

"We are in the process of evaluating the legal and ethical stance in Switzerland," Marco Stuecheli, spokesman for the Zurich hospital, told AFP.

"There can be complicated cases where the mother of a child wants a circumcision but the father is opposed to it."

The development is unlikely to affect the practice in Switzerland, where it can be carried out in any hospital for a fee, the spokesman added.

"Most Jewish patients go to specialist doctors known within their community," the spokesman said, adding that the hospital carried out "only one or two circumcisions for religious reasons per month".

A senior executive at the St Gall teaching hospital said a decision would be taken after the summer holidays, Beobachter magazine reported.

In French-speaking Switzerland, a spokesman for Lausanne's university hospital expressed surprise at the level of debate surrounding the issue.

The hospital carried out the operation because it was important that it took place "in the best medical conditions possible", said a spokesman.

The Swiss reaction follows a June ruling by a court in the German city of Cologne ...

...

Earlier story

ZIMBABWE: Infants to be circumcised - despite adult failure

New Zimbabwe
July 19, 2012

Newly-born babies to be circumcised

By Phyllis Mbanje

ZIMBABWE is planning to expand its circumcision campaign to include newly-born babies as part of the country’s fight against the spread of HIV and AIDS, a senior health ministry official has confirmed.

The ministry’s AIDS and TB unit co-ordinator, Getrude Ncube, said a pilot project targeting babies between one and 28 days old would be launched before year end with the full programme likely to be rolled out in 2014.

"The project will start in Harare and Bulawayo," Ncube said adding that, gradually, all maternity sites across the country would be circumcising newly born babies by 2014.
[No mention of parental consent.]

"Although circumcising neonates will not have an immediate an impact, results will show in 20 years’ time. Our sole aim is to try and reduce new HIV infections."

...

Circumcised men are said to be 60 per cent less likely to get infected with HIV but the latest Zimbabwe Demographic Survey indicated that the prevalence rate among circumcised men was higher than that of those who were uncircumcised.
[And so did the 2005 one, before the circumcision campagin began.]

...

“Women are now looking for men who are circumcised and they do not want to use condoms. We do not want to create false hope.”

...

UGANDA: HIV campaign confused with circum-rape: no effect on HIV rate

VOA News
July 19, 2012

Ugandan Circumcision Campaign Goes Awry

July 19, 2012 MBALE, Uganda – Uganda’s national campaign to help reduce HIV/AIDS transmission through male circumcision has taken an unexpected turn in eastern Uganda, where Bamasaba tribesmen forcibly circumcised more than 20 men in recent weeks.

Traditional male circumcision is an important cultural tradition for the eastern Ugandan ethnic group, for which the procedure represents entry into manhood. Every other year, the tribe holds a ritual circumcision ceremony called Imbalu. Although the decision to be circumcised is supposed to be voluntary, men have consistently been pressured to participate. Now that pressure has spread beyond the tribe.

Seeking work, Charles Mukwana arrived in Mbale, a town in the heart of Bamasaba lands, from a neighboring region. It was after he started driving a motorcycle taxi that he overheard other drivers at the staging area talking about forcibly circumcising the transplant.

“I feared, because they were bothering me," he says. "I heard them talking about me when they wanted to force me. They were asking me why I’m staying here and I’m not circumcised in their land."

Mukwana avoided forced circumcision by voluntarily undergoing an operation at a local health facility, but others weren't so lucky. [Lucky? That's lucky?] For several days at the end of May and beginning of June, local officials say more than 20 men were forcibly circumcised, a half-dozen of whom were hospitalized. Many of those targeted were outsiders like Mukwana, who had come to Mbale in search of work.

Officials say dozens of people have since fled Mbale, and several businesses owned by non-Bamasaba remain shuttered more than a month later.

John Martin Okware, another motorcycle taxi driver, was part of a group that encouraged four men to undergo circumcisions. There was no specific intention to drive outsiders away, he says, but only to reduce their risk of getting infected or transmitting HIV.

"We were taking them to circumcise, because they get HIV very fast," he says. "A person who is not circumcised, he gets HIV very fast. The person who [is] already circumcised, he cannot get that disease immediately at that time."

Attacks Coincide With Campaign
In Uganda, where more than 75 percent of the population is uncircumcised, the Ministry of Health has been encouraging men to undergo the procedure. Research has shown circumcision can reduce the risk of HIV transmission by up to 60 percent, and the attacks come amid an ongoing national campaign for safe male circumcision.

Since the campaign launched, the Bamasaba have been praised for already practicing circumcision, although the region’s HIV infection rate is only slightly less than the national average of 7.3 percent. By forcing men to get circumcised, Okware says, he is doing his part to reduce HIV transmission and uphold tribal tradition.

But Charles Siango would disagree. As Bamasaba minister of culture, heritage and sports, he says forced circumcisions do not represent the tribal culture. Circumcision, he says, has always been a decision men make voluntarily in consultation with their family and that uncircumcised outsiders are welcome.

“We quickly went to radio and told people concerned -- circumcisers, those surgeons, the rest of them -- to stop, because that’s not the way our cultural things should be taken," he says.

But recent attacks still raise questions about the ritual practice of Imbalu, during which, Siango says, trained professionals perform the circumcisions, albeit in an area outside of town and away from medical facilities.

Local officials says they are working with the Bamasaba to make next month’s Imbalu as medically sound as possible, and district health educator Deborah Alupo recommends seeking circumcision at a health facility, even if the advice contradicts cultural norms.

“You have to undergo that process," she says. "But if you go to hospital and it is done there, they say you’re a coward ... [that] the way the hospital cuts is not [in keeping with the] cultural way.”

She hopes expansion of safe male-circumcision facilities, a part of the government’s health campaign, might help to change attitudes.

Earlier story

BERLIN: Resolution passed - no legal effect

Reuters, Jerusalem Post
July 19, 2012

German parliament defends circumcision after ban

Resolution to protect religious circumcision passes first hurdle in German parliament, decision would overrule Cologne court.

Germany's lower house of parliament passed a resolution on Thursday to protect the religious circumcision of infant boys after a district court ban on the practice outraged Muslims and Jews and sparked an emotional debate in the country.

The main political parties have criticized the ruling by a Cologne court and Chancellor Angela Merkel's government has promised a new law to make clear doctors or families will not be punished for carrying out the procedure.

The speed with which lawmakers agreed on the terms of the motion underscored sensitivity to charges of intolerance in a country haunted by its Nazi past.

The resolution, jointly filed by Merkel's conservatives, their liberal coalition ally (FDP) and the opposition Social Democrats (SPD), demanded that "the government present a draft law in the autumn ... that guarantees that the circumcision of boys, carried out with medical expertise and without unnecessary pain, is permitted".

The new law would overrule the Cologne court decision.

Lawmakers noted in the resolution that the court ruling had deeply unsettled Muslims and Jews in Germany, as they feared the practice would now be outlawed, while doctors were alarmed at the threat of prosecution if they performed operations.

...

An overwhelming majority of lawmakers voted in favor of the resolution, although the small opposition Left party opposed it, suggesting that infant boys could have a "symbolic circumcision" then undergo the actual operation when older.

...

The bill was rushed through in the same sitting as a vote on aid to Spain for which lawmakers were recalled from their holidays. [And are those events unconnected? Merkel's panic seems disproportionate to the number of people actually affected by an age-restriction.]
 

---

Haaretz
July 19, 2012

Germany's parliament endorses resolution supporting circumcision right

Though it has no legal status, resolution aimed at calming outcry against court's verdict banning circumcision of a minor; government to draft legislation later this year. 

Germany's parliament passed a resolution Thursday endorsing the right of Muslim and Jewish parents to have sons circumcised.

The resolution, passed by a large majority on a show of hands, has no binding legal effect.

...

The government is expected to draft legislation later this year to protect doctors performing male circumcisions from prosecution.

Although Chancellor Angela Merkel has warned that prohibiting the religious practice would make Germany a laughing stock, surveys show large numbers of Germans are hostile to circumcision and want it outlawed.

Christine Lambrecht, a Social Democratic legislator, said many Germans had written to her charging that a legal exemption for Jews and Muslims would also permit a practice in some African and Middle Eastern nations known as female circumcision.

"Genital mutilation has nothing to do with the circumcision of boys," she said. "That is a crime and it will stay that way."

The Left Party opposed infant circumcision on the grounds that a baby cannot consent. One of its legislators, Jens Petermann, told the parliament: "A decision by the parents cannot prevail over the consent of the child himself."

A survey by the YouGov polling company for dpa found 45 percent of Germans want circumcision to be outlawed, 42 percent want it kept legal and 13 percent had no opinion.

Some 55 percent said they did not believe a legal ban on circumcision would lead hostility to Germany abroad. The circumcision of boys for non-religious reasons is rare in Germany.

The parliamentary resolution was jointly drafted by legislators from Merkel's coalition and opposition Social Democrats and Greens.

"The Bundestag urges the government to propose a bill in autumn 2012 which, taking account of the constitutional values of child welfare, physical freedom from injury, religious freedom and parents' upbringing rights, ensures that the medically competent circumcision of boys without unnecessary pain remains basically permissible," it said.

Earlier story

BERLIN: Human rights to be thrown out this year

Business Week
July 18, 2012

Germany to Pass Law on Circumcision to Counter Judges' Ruling

By Patrick Donahue
German legislators will pass a law this year permitting the circumcision of boys in response to global protests by religious groups reacting to a district court ruling that the practice amounts to bodily harm.

Social Democrat Burkhard Lischka, who sits on parliament’s legal-affairs committee, said his opposition party and the environmental Greens reached agreement with the governing coalition to seek draft legislation, probably by October. He said a “broad majority” will approve a resolution in the lower house, or Bundestag, tomorrow.
[Maybe the Japanese should just tell the Greens that killing whales is part of their religion....]
 
“You have two world religions that view the circumcision of boys as a constitutive path to join a community of faith,” Lischka said today in a phone interview in Berlin.
[If it's to join a community of faith it can wait until the person is old enough to have a faith.]
 
Jewish, Muslim and Christian organizations this month decried a May 7 Cologne court decision that circumcising boys constitutes battery even if parents consent to it, creating legal uncertainty and the prospect that doctors could be committing a crime by performing the procedure. Chancellor Angela Merkel warned party colleagues this week that Germany risks being branded a “nation of buffoons” if it becomes the only country to prohibit the practice, Bild newspaper reported.

Lischka said the legal situation was “somewhat complicated” by balancing the constitutional right of bodily integrity with freedom of religion. The resolution language will permit circumcision of boys by a trained professional in situations that avoid inflicting “unnecessary pain.”

Justice Ministry spokeswoman Mareke Aden said today that a draft law is planned by the fall and that the issue “can’t be pushed off” amid global scrutiny.

Vacations Interrupted
Bundestag lawmakers are interrupting their vacations to attend an emergency session tomorrow to approve as much as 100 billion euros ($123 billion) in bailout aid for Spain. The legislative process on circumcision will probably begin in late September after parliament reconvenes on Sept. 10.
European rabbis held a three-day emergency meeting last week ...

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Earlier story

NORWAY: "We can't go first" - Minister

the Foreigner
July 3, 2012

Norway minister discounts anti-circumcision move

By Michael Sandelson
Norwegian Ministry officials sent a legal proposal to allow ritual neo-natal circumcisions at hospitals out for hearing in May 2011 aimed at preventing the practise going underground. The issue of permitting this is to be discussed in Parliament after the summer recess.

Child Ombudsman Reidar Hjermann has also argued for the imposing of a minimum age requirement of 15.

Whilst tri-partite coalition member the Centre Party (Sp) has officially vetoed the multi thousand-year tradition, the minister told VG, “We’d be the only country in the world to forbid ritual circumcision if we moved for this. I cannot, therefore, think that this will apply.”
[Where have we heard that before? How many countries "can't go first" before one can?]

A Cologne District Court Judge recently ruled

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Meanwhile, Norwegian Health Ministry advisor Tord Dale explained that the government proposes that a Mohel performs the procedure in hospital supervised by medical staff, with strict hygiene, and pain relief requirements, before the child travels home following birth.

Muslim male circumcisions have no fixed age and are carried out according to familial, regional, and national traditions. Jews circumcise male children on the eight day to recall their covenant with God.

“The most important is that it is carried out in a safe way. A Mohel performs far more of these than most Norwegian doctors do,” said Tord Dale.
[But there is no evidence that ritual circumcision is any safer than other kinds.]

MUNICH: "Wait until he's older" - paediatricians

Deutche Welle
July 17, 2012

'Wait until later,' say pediatricians

By Dagmar Breitenbach and Joanna Impey
Children have to be old enough to give their consent to a religious circumcision, says leading pediatrician Maximilian Stehr. But the law does not need to be changed.

Maximilian Stehr is a pediatric surgeon at the University Hospital in Munich and chair of the working group on pediatric urology at the Germany Association for Pediatric Surgery.

DW: What has been the effect as far as pediatricians are concerned of the ruling by the court in Cologne regarding the religious circumcision of boys who are not yet able to give informed consent?
Maximilian Stehr: To start with, one should note that this ruling has not changed the law, it has merely interpreted existing law and applied it. There has of course been an effect on colleagues working in the field of pediatric surgery and urology in that the ruling has led to a public discussion, and, should similar charges be brought against a doctor in future, it will not be possible to argue [as in this case] that the doctor could not be expected to know that his actions were illegal. I know of many doctors who are currently not carrying out any circumcisions of boys who are not able to give informed consent.

What is your advice to doctors who ask whether they should carry out this operation?
I've always given the same advice, even before this ruling. I've always held the view that this medical intervention cannot be regarded as conforming to current law or current medical ethics. And so I continue to advise doctors not to carry out this operation; instead, if religiously-motivated circumcision is to be carried out, it should only be carried out at an age when the child or the young person is able to permit it himself or at least consent to it.

Would you see the issue of the inability of the child to give its consent as a bigger issue than that of the child's physical integrity?
I don't think you can separate the two. Physical integrity is certainly the highest value. That goes without question. There are certainly medical conditions and situations in which people want to decide for themselves that they would like to change something about their body. That is standard procedure in cosmetic surgery - it's the same in pediatric surgery, for example, when we correct protruding ears. For that, the child has to be able to judge for itself the seriousness of the operation, as well as its risks and side-effects, and that is only possible when the child is 14 or 16 years old.

How far is this an issue of medical ethics?
Medical ethics is very closely related to the Hippocratic Oath. All our actions as doctors must work towards healing and towards the benefit of the patient to the best of our knowledge and conscience. A further principle is never to cause any harm. Both these principles are imperiled when one carries out the circumcision of a boy who is unable to give consent.

That means it's an unnecessary operation?
It is an unnecessary operation. All the benefits which are said to come from circumcision, some of which are certainly valid - for example, concerning sexual infections or penile cancer or the development of tumors - are all reasons which argue for circumcision as a possible preventative measure - but not at this age.

The German government wants to find a speedy solution to the problem, and it has hinted that it plans to introduce a law which will continue to permit religious circumcision. Would you consider that any solution must include restrictions as to age?
I don't see any reason to pass a new law - one just has to apply existing law and existing medical ethics. There's no need for anything else. Then you come to the situation we have at the moment, that, if one wants to carry out such an operation which has no medical justification, it requires the consent of the patient. I would find extremely dangerous if there were to be a special law to permit such an operation to be carried out on, for example, Jewish children. That would go entirely against the principle of equal treatment. One could then certainly argue that this in itself would be discrimination.

Currently, though, it's the case that the parents can decide, since they have legal custody.
The legal custody of the parents only allows decisions which are clearly for the benefit of the child. That's why I consider this medical intervention to be illegal. It can only be dealt with if the religious communities can agree that the operation can be delayed until the child is old enough to decide for itself or to give its consent. There has to be a compromise, but I don't see any compromise possible which involves special laws for specific religious communities or other groups. That would go against the principle of equal treatment and would backfire in the end.

Earlier story

BERLIN: Cross party support to legalise cuting (male) baby genitals

Europe Online magazine
July 17, 2012

Cross-party support forms in Germany to back circumcision

By Jean-Baptiste Piggin, Axel Hofmann
Berlin (dpa) - Chancellor Angela Merkel‘s supporters and the main opposition parties are in behind-the-scenes talks to endorse the Muslim and Jewish practice of circumcising boys, insiders said Tuesday.

They are jointly drafting a resolution to be passed on Thursday by the Bundestag, or lower house of parliament, asking the government to overrule a court which ruled last month that circumcision is a form of assault.

There has been an international outcry over the trial of a Muslim doctor, who was let off but told that his circumcision of a young boy had been a crime because the child was too young to give consent.

Merkel‘s government has already said it will introduce legislation that explicitly allows circumcision, but this may take months. The urgent parliamentary resolution is seen as necessary to calm Jewish and Muslim anger on the issue.

Legislators said Merkel‘s Christian Democrats, the Christian Social Union and the Free Democrats (FDP), as well as opposition Social Democrats and Greens, were helping draft the broad resolution.

"Parliament has to do its bit to ensure that the religious beliefs of Muslims and Jews are respected," said Joerg van Essen, the FDP parliamentary whip. "The row shows we have to settle the law as quickly as possible."

Sources said all the parties agreed it was permissible to circumcise boys if the operation was done to a high standard. The resolution would at the same time condemn female circumcision. [Thus it will break the Basic Law 3.2 "Men and women shall have equal rights."] Other details had still to be negotiated.

While some commentators have supported the court ruling, Chancellor Angela Merkel has warned that Germany would be a laughing-stock if it became the sole country in the world to ban the practice. [So other countries should ban - or rather, age-restrict - the practice, Dumkopff!]
 

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Reuters
July 17, 2012
... But the court ruling has drawn support from some, including Britain's Secular Medical Forum which has written to Merkel urging her to resist pressure to make non-consensual circumcision lawful.
"EMOTIONAL BLACKMAIL"

"We are shocked that religious groups deny the harm (caused by circumcision) and at the distorted and disingenuous claims made by those opposing the court's decision, wrongly suggesting that it is an indication of anti-Semitism," the chairman of the Secular Medical Forum, Dr. Antony Lempert, said in the letter.

"We urge you not to let such emotional blackmail persuade you to change the law or criticise the court's decision. As it stands, the court's decision ensures that today's children will be free to grow up to make their own decisions," it said.

Echoing such comments, Ronald Goldman, head of the U.S.-based Jewish Circumcision Resource Centre which opposes the practice, cited studies he said show that circumcision causes considerable pain and trauma.

"The majority of the world does not circumcise because of an instinctive awareness of the harm, analogous to cutting off any other healthy body part," it said in a statement entitled "The German Circumcision Ruling: What about the harm to the child?"

The German court ruling applies only to the city of Cologne and its environs - home to a large Muslim minority - but Jewish and Muslim groups fear it could set a precedent and the ban could spread to other parts of Germany.

German doctors have also urged politicians to act to clarify the legal situation, fearing the ruling may force circumcisions underground and increase health risks for young boys.
[This has never been offered as a reason to allow any female genital cutting - except briefly and abortively by a committee of the AAP in 2010 - though the health risks to them from backstreet FGC are much greater.]

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Earlier story

MARYLAND: FDA approves HIV drug

BBC
July 16, 2012

HIV-prevention drug Truvada approved by US

US health regulators have for the first time approved a drug to prevent HIV infection.

Truvada can be used by those at high risk of infection and anyone who may engage in sexual activity with HIV-infected partners, said the Food and Drug Administration (FDA).

Studies showed the drug reduced the risk of contracting HIV by up to 73%.
[But unlike circumcision, it will work for women and men who have sex with men.]

Some health workers and groups active in the HIV community opposed a green light for the once-daily pill.
There have been concerns the circulation of such a drug could engender a false sense of security and mean people will take more risks. There have also been fears that a drug-resistant strain of HIV could develop.

In a statement, the FDA stressed that the drug should be used as part of a "comprehensive HIV prevention plan", including condom use and regular HIV testing.

In May, an advisory group of health experts recommended approval for the pill.

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Studies from 2010 showed that Truvada reduced the risk of HIV in healthy gay men - and among HIV-negative heterosexual partners of HIV-positive people - by between 44% and 73%.

Michael Barton of UNAIDS, the Joint United Nations Programme on HIV/AIDS, said there was good trial evidence that the drug could significantly cut the risk of the infection being passed on, but only if the tablets are taken consistently.

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But he said the new drug might be useful in situations where, for example, a woman has a partner with HIV who is unwilling to take antiretrovirals or use condoms.

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