The UNAIDS has just released a report (story | report) saying that "between five and fifteen men will need to be circumcised to prevent one HIV infection in the ten following years, at a cost of between $150 and $900 per infection prevented." Their conclusion: circumcision is a "cost-effective" intervention strategy for HIV prevention. In this report, there is no consideration for whether this procedure is ethical. Nor is there any consideration of what kinds of cultural meanings might be attached to the foreskin in communities they're ready to scalpel -- or how a mass program to remove their foreskins might be interpreted and expressed culturally.

I like to use the example that reader Thomas Kraemer provided a few weeks back in the comments: We could cure breast cancer tomorrow if we could just institutionalize double mastectomies for young girls. Or as my professor cynically joked the other day, "Why stop at the tip of the penis? If we could remove the whole shebang we could rid society of any number of not just medical, but social ills as well!" Oh, sure, some folks out there will resent the comparisons. "The breast is more important than the foreskin!" To this response, I have just one question: "Says who?"

I think we desperately need to be mobilizing against this movement towards circumcision. It's wrong-headed, poorly thought-through, and is really aimed at circumscribing any need for creative prevention approaches by creating a biomedical intervention. The crisis is clear: Prevention specialists -- trained in the too-often culturally incompetent fields of health and biomedicine -- are just downright flummoxed by the inability of their interventions to stem the rise in new infections. If you've ever worked in the field, you've undoubtedly seen their red-faced angst before: "Why won't these people just use condoms, goddammit?" Nevermind the structural constraints of poverty and gender. Nevermind the meanings implicitly and inadvertently attached to condoms by Western medicine (e.g. distrust, fear, etc.).

Thus, in an era when classical prevention strategies are failing globally, old-school prevention types have opted to search for a biomedical intervention that would avoid any need for dealing with the messy realm of the social. "If we can just chop something off, then we won't have to deal with compliance!" Ta-dah! The magical solution! Obviously, this logic is outrageously problematic. It presumes that circumcision will not be rife with cultural meanings and dilemmas, and it also presumes a hostile population that is "non-compliant." It never allows for the consideration that perhaps it is prevention that is the problem -- not the communities it seeks to change.

I am amazed by the number of studies in epidemiology -- the sheer mass of publications -- that continue to rely on behavioral survey instruments that unreflexively presume a set of concerns worth asking about that stem from an understanding of the epidemic in which it is people's behaviors that fuels the HIV/AIDS epidemic. This is downright shameful given the massive amounts of data that demonstrate how obviously correlated new infections are with social-structural factors like race, class, gender, and sexuality. It's like trying to telling people in Detroit to eat better when there is no grocery store -- not a single one -- within city limits.

It's past the point of naivety -- since the amount of data demonstrating the epidemic's social-structural roots is so compelling. It amounts to a kind of willful ignorance to continue trying what you know will likely fail because it is easily funded and requires little critical thought. It's easy. It's lazy. It would all be a bit humorous if it wasn't resulting in a body of prevention literature that does very little to actually work towards meaningful prevention. People are dying. Scientists are laughing their way to the CDC-NIH bank.

Removing foreskin in the name of health promotion is unconscionable. It amounts to a kind of cultural imperialism that will undoubtedly stir up backlash against Western Public Health. The idea is not seen as radical because we in the US already practice it so commonly. But believe me: If circumcision was virtually unknown in the United States as it is in other areas around the Globe, we would not be having this debate. But because it is such an institution here, the idea of promoting it elsewhere seems totally sensible. It's the worst kind of ethnocentrism, and it needs to stop.

Joining a host of other countries that have decided to bocott the event due to alleged fears that the conference's planning documents are offensive to Israel, the US announced that it too will not attend the UN's upcoming conference on racism -- capitulating to Israel's outrageous demands. The conference is slated to "review" the 2001 Durban "World Conference Against Racism." I presume everyone's in a tizzy over part of that conference's "Programme of Action", in which they declare Palestine's right to self-determination:

63. We are concerned about the plight of the Palestinian people under foreign occupation. We recognize the inalienable right of the Palestinian people to self-determination and to the establishment of an independent State and we recognize the right to security for all States in the region, including Israel, and call upon all States to support the peace process and bring it to an early conclusion;

The US also joined Israel in a walkout of this 2001 conference. This is the problem with the US' perverse relationship with Israel: it stands beside it even in Israel's most blatantly Zionist moments. It seems that any statement advocating self-determination for Palestine can be construed under this rubric as anti-Semitic, which demonstrates how deeply problematic this kind of rhetoric is for politics. It can only work under a theocratic Byzantine view of the state in which a threat to national sovereignty is concurrently a threat to religion. But it doesn't just stop there, it uses the highly politicized vocabulary of "anti-Semitic" to cushion the impact of critics, and to manipulate through rhetoric their attacks into bigotry. This isn't just heinously fucked up, but it also erodes the power of future uses of "anti-Semitic" to actually refer to prejudice against Jewish people.

Saying that Palestine deserves self-determination is not and cannot on its face be rendered anti-Semitic, and arguing that it is is zealous religious-nationalism. Israel is wrong on this, and using religion as a rationale for their occupation of Palestine is disgusting and must end. It's no different than Christians embarking to "recapture" Jerusalem under the banner of the Crusades. It's political occupation of a people justified by religion, and it cannot be tolerated.