We receive frequent reports that many of these African circumcision programs, intended for consenting adult men, are in fact influencing North American parents to impose forced circumcision on their newborn male infants. Since these children will not become sexually active for many years, subjecting them to a permanent surgical alteration, in a misguided attempt to prevent future disease, violates their personal autonomy and robs them of their right to physical integrity as guaranteed in the Canadian Charter of Rights and Freedoms.<\/p>\n
Canadian human rights law and treatises maintain that all children have equal protection under the law. These include:<\/p>\n
The Universal Declaration of Human Rights (UDHR), adopted by Canada in 1948 (http:\/\/www.un.org\/en\/documents\/udhr\/<\/a>)<\/p>\n The United Nations Convention on the Rights of the Child (CRC) ratified by Canada in December 1991. Specifically, Article 24.3 declares, \u201cState Parties shall take all effective and appropriate measures with a view to abolishing traditional practices prejudicial to the health of children.\u201d (http:\/\/www.un.org\/documents\/ga\/res\/44\/a44r025.htm<\/a>)<\/p>\n The Canadian Charter of Rights and Freedoms, enshrined in the Canadian constitution in 1982 (http:\/\/laws-lois.justice.gc.ca\/eng\/Const\/page-15.html<\/a>)<\/p>\n Any form of non-consensual female genital cutting\u2014equal to or less invasive than male infant circumcision, including removal of the female prepuce\u2014for any reason, including the potential to reduce vulvar cancer or sexually transmitted diseases, has been illegal in Canada since 1997.1011 Circumcision of otherwise normal healthy boys is in direct conflict with gender equality rights spelled out in the above documents.<\/p>\n <\/p>\n \u201cThe prepuce [foreskin] is an integral, normal part of the external genitalia that forms the anatomical covering of the glans penis and clitoris\u2026 The prepuce is richly innervated, erogenous tissue.\u201d12\u00a0\u00a0It also serves an important mechanical function, providing a linear bearing mechanism during sexual intercourse.1314\u00a0For further information on the form and function of the penis and the mechanics of intercourse please visit the cited references.<\/p>\n Respect for a child\u2019s developing sexuality, regardless of gender, is recognized in the 1997 Valencia Declaration of Sexual Rights adopted by the XIII World Congress of Sexology, which states:<\/p>\n \u201cWe urge that societies create the conditions to satisfy the needs for the full development of the individual and respect the following sexual rights: \u2026The right to autonomy, integrity and safety of the body<\/b>. This right encompasses control and enjoyment of our own bodies, free from torture, mutilation and\u00a0violence of any sort.\u201d15<\/p>\n <\/p>\n CHHRP invites the CAS to join thousands of people around the world in efforts to define, expand, and protect human rights in health relevant settings\u2014such as sexual rights and health\u2014and to uncover substantial inconsistencies in health thinking. One such inconsistency is the unquestioned respect for a female child\u2019s right to genital integrity and autonomy that has thus far been ignored for the male child.<\/p>\n It is our hope that the CAS will recognize that male circumcision is not an effective tool in the fight against HIV\/AIDS. We also hope that the CAS recognizes the human rights and possible Canadian legal implications of suggesting male circumcision as part of a HIV\/AIDS prevention strategy. We look forward to a continuing dialogue with the CAS.<\/p>\n <\/p>\n Respectfully submitted by,<\/p>\n Christopher L. Guest M.D., F.R.C.P.C.<\/p>\n Medical Director, Children\u2019s Health & Human Rights Partnership<\/p>\n <\/p>\n 1300 King St E PO Box 31011 <\/p>\n <\/p>\n <\/p>\n 1 Bailey, R.C., Moses, S., Parker, C.B., Agot, K., Maclean, I., Krieger, J.N., et al. Male circumcisi1on for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet 2007; 369: 643-56 doi: 10.1016\/S0140-6736(07)60312-2 pmid: 17321310.<\/p>\n 2\u00a0Auvert, B., Taljaard, D, Lagarde, E., Sobngwi\u2010Tambekou, J., Sitta, R., & Puren, A. (2005). Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS medicine, 2 (11), e298.<\/p>\n 3\u00a0Gray, R. H., Kigozi, G., Serwadda, D., Makumbi, F., Watya, S., Nalugoda, F., et al. (2007). Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. The Lancet, 369 (9562), 657\u2010666.<\/p>\n 4\u00a0Wilton, J. (2013). Condoms: Tried, tested and true? From CATIE: Canada\u2019s source for HIV and hepatitis C information:http:\/\/www.catie.ca\/pif\/spring<\/a>\u20102013\/condoms\u2010tried\u2010tested\u2010and\u2010true<\/p>\n 5\u00a0Boyle, G. J., & Hill, G. (2011). Sub\u2010Saharan African randomised clinical trials into male circumcision and HIV transmission: methodological, ethical and legal concerns. Journal of law and medicine, 19 (2), 316.<\/p>\n 6\u00a0Green, et al., (2010). Male Circumcision and HIV Prevention: Insufficient Evidence and Neglected External Validity. Am J Prev Med 2010;39(5):479\u2013482<\/p>\n 7\u00a0Darby, R. & Van Howe, R. (2011), Not a surgical vaccine: there is no case for boosting infant male circumcision to combat heterosexual transmission of HIV in Australia. Australian and New Zealand Journal of Public Health, 35: 459\u2013465. doi: 10.1111\/j.1753\u2010 6405.2011.00761.x<\/p>\n 8Frisch, M., Aigrain, Y., Barauskas, V., Bjarnason, R., Boddy, S. A., Czauderna, P., et al. (2013). Cultural bias in the AAP\u2019s 2012 technical report and policy statement on male circumcision. Pediatrics , 131 (4), 796\u2010800.<\/p>\n 9Van Howe, R. S. & Storms, M. R. (2011). How the circumcision solution in Africa will increase HIV infections. Journal of Public Health in Africa 2011; 2:e4 doi: 10.4081\/jphia.2011.e4<\/p>\n 10\u00a0Government of Canada. (2013, July 15). Justice Laws Website. From Criminal Code s 266 Assault:\u00a0http:\/\/laws<\/a>\u2010lois.justice.gc.ca\/eng\/acts\/C\u201046\/page\u2010131.html#docCont<\/p>\n 11Parliament of Canada. (n.d.). BILL C\u201027. From Parliament of Canada:http:\/\/www.parl.gc.ca\/HousePublications\/Publication.aspx?DocId=2329459&File=16<\/a><\/p>\n 12\u00a0Cold, C. J., & Taylor, J. R. (1999). The prepuce. BJU international , 83 (S1), 34\u201044.<\/p>\n 13\u00a0Anatomy of the Penis, Mechanics of Intercourse (http:\/\/www.cirp.org\/pages\/anat\/<\/a>)<\/p>\n 14\u00a0Animation on the foreskin linear bearing mechanism during sexual intercourse (http:\/\/www.circumstitions.com\/Works.html<\/a>)<\/p>\n 15\u00a0World Association for Sexology. (2007, November). Valencia Declaration on Sexual Rights.<\/p>\n <\/p>\n The misleading Relative Risk Ratio<\/p>\n Newspapers like big numbers and eye-catching headlines. They need miracle cures and hidden scares, and small percentage shifts in risk will never be enough for them to sell readers to advertisers (because that is the business model). To this end they pick the single most melodramatic and misleading way of describing any statistical increase in risk, [Or \u201cReduction\u201d in the case of circumcision and HIV] which is called the \u2018relative risk increase\u2019.<\/p>\n Let\u2019s say the risk of having a heart attack in your fifties is 50 per cent higher if you have high cholesterol. That sounds pretty bad. Let\u2019s say the extra risk of having a heart attack if you have high cholesterol is only 2 per cent. That sounds OK to me. But they\u2019re the same (hypothetical) figures. Let\u2019s try this. Out of a hundred men in their fifties with normal cholesterol, four will be expected to have a heart attack; whereas out of a hundred men with high cholesterol, six will be expected to have a heart attack. That\u2019s two extra heart attacks per hundred. Those are called \u2018natural frequencies\u2019.<\/p>\n Natural frequencies are readily understandable, because instead of using probabilities, or percentages, or anything even slightly technical or difficult, they use concrete numbers, just like the ones you use every day to check if you\u2019ve lost a kid on a coach trip, or got the right change in a shop. Lots of people have argued that we evolved to reason and do maths with concrete numbers like these, and not with probabilities, so we find them more intuitive. Simple numbers are simple.<\/p>\n The other methods of describing the increase have names too. From our example above, with high cholesterol, you could have a 50 per cent increase in risk (the \u2018relative risk increase\u2019); or a 2 per cent increase in risk (the \u2018absolute risk increase\u2019); or, let me ram it home, the easy one, the informative one, an extra two heart attacks for every hundred men, the natural frequency.<\/p>\n As well as being the most comprehensible option, natural frequencies also Excerpt from \u201cBad Science\u201d by Ben Goldacre, Fourth Estate, London (2008), p 256-9<\/p>\n <\/p>\n <\/p>\n \u201cThere appears to be\u00a0no clear pattern of association<\/b>\u00a0between male circumcision and HIV prevalence. In 8 of 18 countries with data, as expected, HIV prevalence is lower among circumcised men, while in the remaining 10 countries HIV prevalence is higher among circumcised men\u2026<\/p>\n Findings from the 18 countries with data present a mixed picture of the association between male circumcision and HIV prevalence. In eight of the countries (Burkina Faso, Cambodia, C\u00f4te d\u2019Ivoire, Ethiopia, Ghana, India, Kenya, and Uganda), HIV prevalence is higher among men who are not circumcised, although the difference between circumcised and non-circumcised men is slight, except in Kenya, where the difference is substantial (HIV prevalence of 11.5 percent for non-circumcised men compared with 3.1 percent for circumcised men). In 10 of the countries (Cameroon, Guinea, Haiti, Lesotho, Malawi, Niger, Rwanda, Senegal, Tanzania, and Zimbabwe) HIV prevalence is higher among circumcised men.\u201d<\/p>\n United States Agency for International Development (USAID) February 2009<\/p>\n <\/p>\nThe Valid Function of the Foreskin<\/h5>\n
Summary<\/h5>\n
\nKingsway Village PO
\nOshawa, ON L1H 8N9<\/p>\nReferences<\/b><\/h5>\n
<\/h5>\n
Appendix A<\/b><\/h5>\n
WHAT DOES RELATIVE RISK REDUCTION AND ABSOLUTE RISK REDUCTION MEAN?<\/h6>\n
\ncontain more information than the journalists\u2019 \u201crelative risk increase\u201d.<\/p>\nAppendix B<\/b><\/h5>\n
Male circumcision and HIV prevalence in Africa
\n<\/b><\/h5>\n
![\"HIV-africa-vs-c\"](\"https:\/\/chhrp.cirp.org\/wp-content\/uploads\/2012\/07\/HIV-africa-vs-c.png\")
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