Mandatory neonatal male circumcision in Sub-Saharan Africa: medical and ethical analysis.

The majority of those infected with HIV in sub-Saharan Africa do not have access to antiretroviral therapy, which is known to prolong the lives of HIV-positive persons in industrialized countries. Although the availability of antiretroviral therapy for those infected with HIV has increased worldwide, the infection rate out surpasses those started on such treatment. Without an AIDS vaccine or curative treatment, and given the difficulty in getting persons at risk to adopt healthy sexual behaviors, alternative approaches to decrease the spread of HIV infection are urgently needed. Three recent randomized controlled trials undertaken in Kisumu, Kenya, Raki District, Uganda and Orange Farm, South Africa have confirmed that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 51% to 60%. These three studies provide a solid evidence-base for future health policy. The procedure for adolescents and adults is expensive compared to abstinence, condoms or other methods; and the surgery is not without serious risks if performed by traditional healers using unsterilized blades as often happens in rural Africa. However, neonatally, the procedure is relatively inexpensive and the risks diminish considerably. Mandating neonatal male circumcision is an effective therapy that has minimal risks, is cost efficient and will save human lives. To deny individuals access to this effective therapy is to deny them the dignity and respect all persons deserve. Neonatal male circumcision is medically necessary and ethically imperative.