Friday, August 22, 2014

NEW YORK: Metzitzah: Court considers if consent form requirement needs strict scrutiny

August 15, 2014

U.S. court revives challenge to New York City circumcision law

by Jonathan Stempel
NEW YORK (Reuters) - A federal appeals court on Friday revived an effort to block a New York City regulation that requires people who perform a Jewish circumcision ritual on infants that involves oral suction to first obtain parental consent.

A unanimous panel of the 2nd U.S. Circuit Court of Appeals said a trial judge had been too deferential to the city, which had linked the ritual to a deadly form of herpes, in rejecting a request by rabbinical groups for a preliminary injunction.

The three-judge panel directed U.S. District Judge Naomi Reice Buchwald in Manhattan to instead use "strict scrutiny" to see if the regulation infringed the plaintiffs' free exercise of religion, violating the First Amendment.

At issue was the ritual metzitzah b'peh (MBP), in which a mohel who performs a circumcision uses oral suction to draw blood away from a wound on an infant's penis. The procedure is sometimes performed in ultra-Orthodox communities.

In September 2012, the New York City Board of Health voted to require mohels to obtain advance consent in which parents acknowledged the risk of herpes infection linked to the ritual.

The Central Rabbinical Congress of the United States and Canada, the International Bris Association and some rabbis sought to halt enforcement, but Buchwald denied the request, saying the regulation addressed "legitimate societal concerns."

Circuit Judge Debra Ann Livingston, however, wrote for the 2nd Circuit that the regulation was not neutral toward religion because it "purposefully singles out religious conduct performed by a subset of Orthodox Jews," and applies exclusively to them.

As a result she said Buchwald should have not reviewed simply whether there was a rational basis for the regulation.

"The Department (of Health) may have legitimate reasons for addressing HSV infection risk among infants primarily, if not exclusively, by regulating MBP," Livingston wrote. "On the present record, however, the plaintiffs have made a sufficient case for strict scrutiny by establishing that the risk of transmission by reason of metzitzah b'peh has been singled out."

The 2nd Circuit did not rule on the regulation's constitutionality.

The city's law department had no comment on the decision.

In a joint statement, the plaintiffs called the decision a "great victory," and said they remain ready to work with city officials "to protect our children's health while fully respecting and accommodating our religious practice."

The case is Central Rabbinical Congress of the United States and Canada et al v. New York City Department of Health & Mental Hygiene et al, 2nd U.S. Circuit Court of Appeals, No. 13-107.

Earlier story

MALAWI: Artist slams mass circumcision

Malawi Voice
August 14, 2014

Manganya Slams medical Male Circumcision

by Munthu Wakuda Leo
The incomprehensible messages about medical male circumcision exercise pose great danger of creating a group of innocent victims of the ongoing flying pestilence of HIV and Aids, Malawi's own top notch comedian, Michael "Manganya" Usi has varned.

During a press briefing in Blantyre on Wednesday, Usi said the information package about male circumcision, an exercise which is currently taking place in 6 districts of Malawi and targets 35,000 sexually active males lacks the necessary embodiment as on how long one should take to resume sexual activity after undergoing the surgery.

In his series of arguments, Usi said that the historical background of male circumcision which [d]ates way back to the biblical days portrays the cultural and traditional aspect of practice to have been designed for children and could only take place 8 days after birth.

He said this provided enough space for the wound to heal completely and most importantly the lengthy period for the foreskin of the male member to harden enough before indulging in sexual activity.

He said, more less, the same applied to the ethnic Yao and Lhomwe cultures where boys in their tender ages are circumcised.

Against this background, Usi wondered if at all, the media was aware that a lot of people (who are already sexually active) are opting for medical male circumcision primarily because they are fascinated by the much talked about value that circumcision adds to their sexual enjoyment hence that their chances of contracting Sexually Transmitted Infections (STl's) including HIV and AIDS would be minimlsed. He said it is frightening to learn that many a jack out there are not so clear about the message coming forth with male circumcision.

"In my research I have heard some of those that got circumcised boasting about their unprotected sexual exploits on women because they believe they can not contract any STI vith HIV and AIDS inclusive," said Usi adding "this is enough cause for fear that a new group of innocent victims can be created."

The think tank also argued that medical male circumcision is a misplaced allocation of medical resources at the expense of many serious emergencies like High Blood Pressure and Diabetes.

Why a misplaced allocation? Usi explained: "It is because the resources used would greatly help those suffering from ailments that are killing our people nowadays not only those that report at hospital but by using the same initiative of going to various places of the country to commence health camps to treat those most challenging ailments."

Various commentators have since hailed Manganya for his timely intervention in this national undertaking if not properly handled can negatively impact many innocent lives.

"This Manganya has come out again from his normal busy schedule to make us wake up from our slumber and I know he's doing so because he has the interest of Malawians at heart," said Hastings Chikankheni, a Blantyre based academician.

"We need more of people like Manganya, a modem day patriot who uses brain power to spark a debate for the benefit of all our people not just a a few that are hiding in their selfish minds," said the other, Florence Majamanda, a house wife in the city of Lilongwe.

According to The Ministry of Health Spokesperson, Henry Chimbali, Medical Male Circumcision project was launched in October, 2011 with the aim of reducing risk of contracting srrs including HIV and AIDS among sexually active males The project is expected to roll out to all districts of Malawi.

[It is not clear whether the Michael Manganya Usi of this story is the same as Michael Usi in the next.]

MALAWI: Adventists query circumcision messages

The Nation (Malawi)
August 15, 2014

Circumcision campaign worries Adra

by Frank Namangale

Adventist Development Relief Agency (Adra) has warned of unprecedented new wave of HIV infections in the country if campaign messages on circumcision are not disseminated correctly. Adra, at a news conference in Blantyre on Wednesday, said despite the emphasis by the campaigners that circumcision only reduces the risk of contracting the virus, the information management on the subject is poor. Adra deputy country director Michael Usi told the media that the circumcision campaigners that include government and other health-related non-governmental organisations (NGOs), do not, for example, tell when one may have sex after being circumcised. Usi, whose organisation implements HIV and Aids projects among other programmes, said he was concerned that a lot of men are excited with circumcision and indulge in unprotected sex immediately the wound heals, believing they are safe. “Malawi should not be alarmed if it is to wake up one day and face a new wave of infections. It is time we improved on circumcision campaign messages,” he said. Usi regretted that other men were going for circumcision to enhance sex pleasure and that circumcision campaigners have failed to encourage people to continue abstaining, remain faithful or use a condom. “The other thing is that when you go for circumcision, they don’t bother to ask you if you are HIV positive or not. There should have been direct messages warning women about this and it is regrettable that women have been completely left out of the campaign,” he said.

SOUTH AFRICA: Israeli circumcision device boycotted

Right action, wrong reason

Times Live (South Africa)
August 14, 2014

Circumcision clip faces chop

by Rea Khoabane and Reitumetse Pitso
The Department of Health's plan to make the male circumcision device PrePex available has been put on ice - because it is an Israeli product.

The device was to have been introduced at clinics and hospitals next year to help fast-track male circumcision, which has been shown to reduce the likelihood of a man contracting HIV.

The department has a target of 4.3 million male circumcisions by 2016.

The department's deputy director-general for medical male circumcision, Dayanund Loykissoonlal, said the launch was being affected by the conflict between Israel and Hamas in the Gaza Strip, which has led to trade union federation Cosatu calling for a boycott of Israeli products.

Loykissoonlal said that though medical male circumcision needed boosting, and PrePex was a good option, "we don't want Cosatu on our backs about this".

Cosatu spokesman Patrick Craven said the federation welcomed the department's decision to delay introducing the device.

"We're going to put pressure on businesses to prevent anything that comes from Israel being sold in this country," Craven said.

Mpho Maraisane, a director of the Aurum Institute, an HIV and TB consultancy, said the institute was involved in testing the device.

In the past two months it has run three studies in Gauteng, Mpumalanga and North West.
Eight hundred men were circumcised using the Israeli device.

Maraisane said the institute was unaware of the call for a product boycott.

The device was developed by Israeli healthcare company Circ Med Tech and has been prequalified and endorsed by the World Health Organisation.

The device consists of an elastic band that compresses [crushes] the foreskin against a rigid plastic ring.

The elastic band cuts off the blood supply to the foreskin, which loses sensation and withers[, rots - with an unpleasant smell - and dies].

The device has to be worn for a week, after which the dead foreskin is cut away by a doctor.

SOUTH AFRICA: Men refuse, so babies to be cut

health-e (South Africa)
August 13, 2014

Government to promote infant male circumcision

by Ayanda Mkhwanazi
With government still far off its goal to medically circumcise 4.3 million by 2016, Department of Health officials say they plan to begin promoting medical male circumcision (MMC) among infants and young boys.

[So when men resist, do it to people who can't resist - how cynical is that?]

Since the 2010 launch of the HIV Counselling and Testing (HCT) campaign, almost 1.4 million men have been circumcised. This means that with only two years to go until the 2016 deadline, government has only reached about a third of its target.

“We need to improve our performance in the next two years,” said Dayanund Loykissoonlal, MMC programme manager at the National Health Department. “We did nearly half a million (circumcisions) in 2014 so we are moving but not fast enough.”

He added that the department planned to explore approaches to encourage parents to medically circumcise boys after birth and as young children.

[This is illegal:]
Children's Act, 2005 (Act No. 38 of 2005)
…Chapter 2 : General Principles
12. Social, cultural and religious practices
1) Every child has the right not to be subjected to social, cultural and religious practices which are detrimental to his or her well-being.
2) ... [age of marriage]
3) Genital mutilation or the circumcision of female children is prohibited.
4)[-7)] Virginity testing ...
8) Circumcision of male children under the age of 16 is prohibited, except when-
a) circumcision is performed for religious purposes in accordance with the practices of the religion concerned and in the manner prescribed; or
b) circumcision is performed for medical reasons on the recommendation of a medical practitioner.
9) Circumcision of male children older than 16 may only be performed-
a) if the child has given consent to the circumcision in the prescribed manner;
b) after proper counselling of the child; and
c) in the manner prescribed.
10) Taking into consideration the child’s age, maturity and stage of development, every male child has the right to refuse circumcision.

The department also continues to work with the traditional sector to improve safety and links with the HCT campaign, Loykissoonlal added.

Soweto general practitioner Dr Don Pupuma said he always encourages patients to circumcise their little ones as early as possible because the after effects are less severe.

“It is distinctly painless when you are a youngster (because) you have less erections,” said Pupuma speaking to journalists and medical professionals in Johannesburg yesterday.



Large clinical trials in South Africa, Kenya and Uganda found that medical male circumcision could reduce a man’s risk of contracting HIV by up to 60 percent.

[But no studies anywhere have shown any effect of infant genital cutting on HIV acquisition.]

With about six million people living with HIV in South Africa, CEO of the specialist HIV care and training company Careworks Harry Lake said the country must prioritise resources for medical male circumcision.

“We have got to put as many resources as possible into MMC so that we can reverse these numbers,” Lake said.

[There is no evidence anywhere yet that mass-circumcision has had any effect on HIV numbers.]

NEW YORK: Metzitzah: Two mohelim stopped after babies get herpes

The Jewish Daily Forward
August 8, 2014

2 Mohels Banned After Infants Contract Herpes in Circumcision Rite

Just One Consent Form Collected by City in Two Years
by Paul Berger
New York City has banned two mohels from performing a controversial circumcision rite after they were suspected of infecting babies with herpes.

But the city's health department will not reveal their names.

Five infants have contracted herpes since September 2012, when the health department passed a regulation requiring mohels to get written consent from parents before using their mouth to suction blood from a circumcision wound - a religious rite known as metzitzah b'peh, or MBP.

MBP can transmit a strain of herpes from the mouth of a mohel to the infant and is potentially fatal to newborns, whose immune systems are underdeveloped. Infants who contract the disease can also suffer brain damage. The MBP rite is common in the ultra-Orthodox community.

In the past, some parents whose babies contracted herpes have refused to identify their mohel to city health officials. Of the five cases since the autumn of 2012, the health department has been able to identify just two mohels.

Only one of those mohels obtained written consent before performing the circumcision.

"In all of the cases, we have asked whether there were forms and, in the two cases where we were able to identify the mohel, we have requested them from him," a health department spokeswoman told the Forward on July 24. Of these two cases, one had a form, which he provided, the spokeswoman said. The other one did not. "The department issued orders banning both mohelim" from practicing MBP, she said.

The spokeswoman would not name the mohels, citing privacy concerns. She also did not respond to several emails asking how the ban would be enforced and how the public could know the mohels in question were banned if their names were not made public.

More liberal Orthodox Jewish leaders do not support the MBP practice and deplored the latest news about its consequences. "I would hope that any mohel who unfortunately has transmitted a disease via metzitzah b'peh would stop practicing metzitzah b'peh because of the safety of our children," said Rabbi Leonard Matanky, president of the Modern Orthodox Rabbinical Council of America.

But Matanky stopped short of calling for the health department to release the names of the banned mohels. The rabbinic leader said it would be presumptuous of him to comment, because he did not have enough information about the cases or the legal reasoning behind the city's decision.

Earlier story

MALAWI: World Bank funds genital cutting

Star Africa
August 8, 2014

World Bank funds Malawi circumcision programme

The World Bank has agreed to fund Malawi's voluntary medical male circumcision (VMMC) programme to the tune of MK6 billion (about US$15million) for the next four years, the Ministry of Health announced Friday.Ministry spokesperson Henry Chimbali said the funding would enable the Malawian government to roll-out the programme in remaining districts.

"We have been unable to expand the service to other districts due to inadequate resources to train service providers, formulation of communication messages and purchase of supplies therefore the funding will help fill this gap," he said.

He said the ministry would take the VMMC programme to the districts of Nkhotakota and Lilongwe in Central Region and Blantyre, Phalombe and Zomba in Southern Region, targeting 45,000 adult males aged 15 to 49 years.

He said VMMC was one of the HIV and AIDS interventions in the country. It reduces chances of contracting the virus by up to 60 percent.

HIV Rates:
Circumcised men
Intact men
Source: p207

VMMC also has other benefits such as hygiene and helps a man from developing cancer, he said.

[Ah yes, always the bait and switch.]

The World Health Organisation recommended the inclusion of male circumcision for countries with generalised HIV epidemics like Malawi in their national HIV prevention strategy.

KENYA: 12 men circum-raped

NewsFix (Kenya)
August [7], 2014

Dozen Kenyans forced to undergo circumcision after wives complain

MOI’S BRIDGE, KENYA – Are some men a cut above the rest? A few tribes in Kenya seems to think so after they forced at least a dozen dudes to undergo circumcisions as part of a traditional ceremony. And who tipped-off the tribes that these men hadn’t gone under the knife before? Their unsatisfied wives.

Kenyan radio station West FM reports many tribal woman believe unsnipped men are dirty and don’t perform in bed as well as circumcised men do. Luckily for the wives [and unluckily for the husbands], the first three weeks of August marks “Circumcision Season” in Kenya and so they volunteered their unsuspecting husbands to take part in the festivities.

A happy mob sang circumcision songs, while the men were ambushed and then stripped naked. The men were then forced to take a mud bath before going to their local clinic for the quick snip. This might make the wives happier, but not everyone is thrilled with the trimming. About 50 tribal men have asked the local police to help them hide from the clippers. Hopefully, they can stay out of sight until the end of circumcision season, still a few weeks away.

[None of the many little jocularities will change this event from being a mass rape.]

UGANDA: "Circumcision reduces risks behaviour" - study (and wakes you in the morning with a nice cup of tea)

Is there NOTHING too foolish about male genital cutting for its advocates to believe?

July 27, 2014

Male Circumcision Reduces HIV Risk Behaviour, Says Study

Men who opt for circumcision are more likely to engage in responsible sexual behaviour than their uncircumcised counterparts, a new study shows.

The study was published in the current July issue of the prestigious AIDS and Behaviour Journal titled Risk Compensation Following Male Circumcision: Results from a Two-Year Prospective Cohort Study of Recently Circumcised and Uncircumcised Men in Nyanza Province, Kenya.

The long term study compared the behaviours of 1, 588 newly circumcised men with 1,598 uncircumcised men for a period of 24 months in Nyanza province.

Researchers found that condom use among the newly circumcised men increased by 30 percent compared to the uncircumcised group where the use rose by only 6 percent.

This is consistent with earlier research which found that circumcised men consider condoms more comfortable and easier to use.

[This nonsense is of a piece with male genital cutting preventing tuberculosis or epilepsy, or sustaining the universe.]

Dr Robert Bailey, Principal Investigator of the study from the University of Illinois stated that the results of the study also showed that circumcised men reported declines in other HIV risk behaviours.

They included less frequent casual sex, reduced incidence of transactional (paid) sex and fewer sexual partners.

There have been concerns from some policy makers and stakeholders that VMMC could increase the spread of HIV by encouraging risky behaviours - such as indulgence in unprotected sex - among circumcised men who believe that the ‘cut’ offers them immunity against the disease.

“We hope that these findings will convince all those who’ve been sceptical about Voluntary Medical Male Circumcision (VMMC) to finally embrace it,” noted Professor Walter Jaoko, Chair of the University Of Nairobi Medical Microbiology Department and the Deputy Director of the Kenya Aids Vaccine Initiative (KAVI), who participated in the study.

He noted that the new study has significantly reinforced the effectiveness of VMMC with regards to it reducing HIV transmission.

[Indeed if all these side effects are true, they are not due to circumcision, but to the education/counselling that goes with it, and may be entirely responsible for all the reduction in HIV supposedly due to circumcision.]
Mr James Macharia, Cabinet Secretary of Health stated that the government will continue rolling out VMMC programmes in regions where male circumcision has historically been low, especially in Nyanza province.

He noted that advocacy and sensitisation on the significance of VMMC is crucial to reduce stigma linked to the practice (mainly due to cultural beliefs) and promote its acceptance.

“We are also encouraging parents to circumcise their children while they are still young as it’s easier and beneficial to do so then,” he said.

Nyanza suffers the highest HIV prevalence in Kenya (15.1 percent) and contributes approximately one third of the nation’s new infections.

It is also the region with lowest rate of male circumcision (66 percent), based on the current Kenya Aids Indicator Survey (KAIS).

[And correlation is still not causation.]

SOUTH AFRICA: "Circumcising Men Cuts HIV Risk Among Women" - study

MedPage Today
July 26, 2014

Circumcising Men Cuts HIV Risk Among Women

by Michael Smith

Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
[That hasn't stopped the media from splashing it everywhere - as here - as headline news.]

MELBOURNE, Australia -- The HIV-preventing benefits of circumcision were not just restricted to men, researchers said.

In a region of South Africa where HIV prevalence is high, women whose only sexual partners were circumcised had a significantly lower prevalence of HIV, according to Kevin Jean, PhD, of the French National Institute for Health and Medical research in Villejuif, France, and colleagues.

Moreover, a mathematical model suggested that the incidence of HIV among those women was also lower than among women whose partners included uncircumcised men, Jean reported at the International AIDS Conference here.

The finding -- the first evidence that women also benefit -- is a "compelling argument" to speed up the roll-out of voluntary male circumcision in Africa, Jean argued.

[No mention of the Wawer study in Uganda, which suggested that circumcising men INcreases the risk to women.]
Three randomized trials have shown that men who are circumcised are at lower risk of acquiring HIV, including one in the Orange Farm township of South Africa.

Researchers have since demonstrated that a free program of voluntary circumcision could be widely accepted among men in the region, leading to lower HIV prevalence among circumcised men.

But the missing piece of the puzzle has been what happens to women when men are circumcised and the prevalence of HIV drops, as has happened in Orange Farm, a township of about 110,000 adults near Johannesburg.

[So this sample was also taken in Orange Farm. How many of the same men were used? Over-testing the same sample leads to less reliable data. The fact that ALL the studies claiming benefits emerge from the same three sites, and the same cluster of researchers, is increasingly suspicious.]

To find out, Jean and colleagues surveyed a total of 4,538 sexually active women, ages 15-49, in three waves, in 2007, 2010, and 2012.

Participants were asked about their age, ethnic group, occupation, age at first sexual intercourse, alcohol consumption, education, number of lifetime partners, and consistent condom use.

They also were asked about the circumcision status of their partners, and the researchers took a blood sample to analyze HIV prevalence in the cohort, Jean said.

Among the 1,363 women who reported only having had circumcised partners, the HIV prevalence was 22.4%, compared with 36.6% among the remaining 3,175.

[This is quite a loose association - women's HIV status vs her reporting of remembering ever had an intact partner. It can be confounded by faulty memory, lack of interest or misidentification.]

Mathematical modeling from the observed age-specific prevalence rates yielded estimated incidence, Jean said. Although the researchers have also measured new HIV cases in the cohort, that data is still being analyzed, he said.

The analysis showed that incidence among women who only had circumcised partners was 0.032 cases per person-year, compared with 0.039 per person-year among the remaining women.

[So circumcision reduces the risk by 0.006 cases per person-year? That's hardly impressive, even if true.]

The numbers yielded an incidence rate ratio of 0.83 and a risk reduction of 16.9% for the women who only had circumcised partners, Jean said. When the analysis was restricted to women 15 through 29, the risk reduction was 20.3%, he added.


The study extends previous research on circumcision in the region, commented Stefano Vella, MD, of the Istituto Superiore di Sanita in Rome, and a former president of the International AIDS Society.

Evidence is mounting that multiple prevention measures will be needed to slow the HIV/AIDS pandemic, he said, and circumcision seems likely to play an important role since it has been shown to offer partial protection for men.

The evidence that the procedure also reduces the risk of HIV among women is of "paramount importance," he told reporters.