Male Circumcision and HIV in Africa: Politics and Polemics

The paper presents a brief history of politics and polemics around the suspected relationship between male circumcision and HIV prevention in African countries. A first part describes the scientific itinerary of the author, from Niakhar, Senegal to Agincourt, South-Africa. A second part goes back to the history of male circumcision, and its relationship with various forms of power abuse, from traditional leaders, religious leaders, medical establishment, and recently from international organizations. A third part discusses the conflicting scientific evidence about the relationships between male circumcision and HIV infection, in particular the opposition between demographic evidence (the lack of long-term impact on HIV prevalence in populations) and the epidemiological evidence (the short-term effect on HIV incidence in trials). A fourth part discusses the contradictions between scientific evidence and political decision. It draws on several examples of wrong decisions or recommendations based on incomplete or partial scientific evidence, and sometimes on hidden facts. The issues raised by male circumcision draw the attention to more general issues: preconceived ideas, irrational behaviour, conflict of interest in political organizations or in the pharmaceutical industry, biases in scientific journals, dishonesty in science, propaganda in mass media, and the various forms of manipulation of people's mind.