Reading Time: 18 minutes
- In a new draft proposal, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) say they will end their program of infant circumcision in Africa.
- They have been using an unsafe circumcision device that was sued out of business after causing too many botches – the Mogen Clamp.
- They now plan to use the ShangRing device: an untested device that will be tested for its botch rate on African adolescents.
PEPFAR has used millions of tax dollars in a campaign to circumcise Africa under the guise of reducing HIV risks, based on some very controversial studies.
The Studies, backed up by the United Nations World Health Organisation (WHO) have been criticised around the world for being incomplete, too small to be of significance and even measuring the wrong thing.
The film American Circumcision interviewed the authors of those studies and their critics, opening up the disaster to a wider audience than those in the men’s rights movement who had raised the issue up to then.
Yet many ‘charities’, business interests and NGOs have expended many millions of dollars in mutilation of genitals: something which, done to females, has been attracting equally large amounts of money to stop.
Brendon Marotta, director of the documentary American Circumcision, reveals what PEPFAR is planning.
In the documentary American Circumcision, we covered the studies that claimed circumcision reduces HIV risk, and the mass African circumcision campaign carried out based on those studies.Brendon Marotta, director of the documentary American Circumcision
The draft of PEPFAR’s 2020 Country Operational Plan Guidance (COP20) says they are ending their support of infant circumcision due to a high rate of “adverse events” and circumcision complications.⇩1PEPFAR 2020; Country Operational Plan Guidance for all PEPFAR Countries; DRAFT 2019
Based on analysis of adverse events and impact on future incidence, circumcision of males under age 15 (including EIMC) and those not reaching Tanner stage 3 development will no longer be funded by PEPFAR.PEPFAR 2020 Country Operational Plan Guidance for all PEPFAR Countries, DRAFT, p2
In other words, PEPFAR is stopping funding for infant circumcision because the botch rate was too high. But that’s not the only bombshell in these new guidelines.
The Mogen Clamp has been claimed by its manufacturers that is was entirely safe, despite reports of injuries by 1996 and successful lawsuits going back at least as far as 2011⇩2Daily Breeze, Boy’s botched circumcision leads to $4.6 million award; July 18, 2011.
In August 2000, the U. S. Food and Drug Administration (FDA) had issued a bulletin warning of the dangers of both the Mogen Clamp and the Gomco Glamp.⇩3U. S. Food and Drug Administration, Potential for Injury from Circumcision Clamps; August 29, 2000
A study held on the US National Library of Medicine openly admits that every manner of cutting up a boy’s genitals has risks (apart from the obvious damage done in cutting up a boy’s genitals):⇩4Scientific World Journal 2011; 11: 2458–2468; Complications of Circumcision; published online 2011 Dec 26; doi: 10.1100/2011/373829
Various methods of circumcision are commonly used in the United States today. … Each instrument and technique carries its own benefits and complication risks.Scientific World Journal 2011; Complications of Circumcision
A manufacturer of the Mogen Clamp was finally driven out of business after another huge lawsuit in 2015. They were already in default over a lawsuit from 2007. Yet they had continued to manufacture the device and claim that it was safe.
Despite all the known dangers, the warnings and the law suits, PEPFAR had continued using the Mogen clamp on infants.
The global health bodies that have publicly made statements against male genital mutilation include The Canadian Pediatric Society, the Canadian Urological Association, the Royal Australasian College of Physicians and the Royal Dutch Medical Association. In recent years, Germany, Tasmania and Iceland have all been close to a specific legal ban on it. Many countries outlaw it under generic assault laws but, so far, the criminals are only occasionally pursued.
The language that PEPFAR continue to use to describe the butchery they promote and pay for is VMMC (voluntary medical male circumcision). They continue to rely on the three flawed studies that say male circumcision is a way to prevent HIV, and ignore dozens of rigorous, large-scale, investigations that prove otherwise.
The very use of the term VMMC (voluntary medical male circumcision) in relation to infants is a misnomer and mis-description in itself. There are various UN treaties and international laws that make it very clear that an infant is unable to volunteer for something to which they have not been asked, could not understand even if they were, or does not have the fullest available information available to make an informed decision.
Infant genital mutilation, of both boys and girls, is not “voluntary”. An amputation which is not for immediate and clear benefit is not “medical” (this is why routine appendectomies are not longer carried out). Any unnecessary amputation of any part of male or female genitals is not “circumcision” but is genital mutilation.
Calling it “VMMC” is an insult to the millions of damaged children around the world, who never had a say in whether they would prefer to stay intact.
Obviously, the baby did not grant consent for this irreversible surgery performed for usually non-medical and even hazy reasons.Molly Walker, Staff Writer, MedPage Today
Now maim differently
PEPFAR’s new guidelines don’t give much hope for the children of the world, given that their reasoning to stop mutilating boys seems to be based less on care for the boys than on recognition of the potential repercussions.
The role of infant VMMC may be revisited once modeling data are available to determine potential benefits, but current techniques using the Mogen clamp will not be supported because of the rate and severity of adverse events.PEPFAR 2020 Country Operational Plan Guidance for all PEPFAR Countries, DRAFT, p172
As Brendon Marotta, says, even PEPFAR’s 487-page document leaves many questions unanswered.
In other words – PEPFAR has decided to stop using the Mogen clamp, a device sued out of business for causing botches, because it caused too many botches. This report leaves some questions unanswered. Why did PEPFAR pick a circumcision instrument sued out of business for causing botches? Who picked the Mogen clamp? What approval process did it go through? How many botches were there? How many botches were there? What percentage did they consider a high percent? How did they decide to stop?Brendon Marotta, director of the documentary American Circumcision
Human Rights And Wrongs suspect that most of these questions will never be publicly answered. Mutilating African boys is not about health, nor is it about what is good for them in any way. From our investigations, it seems part of an ideological war on men, combined with Social Darwinist objectives to reduce the number of people on the whole African continent.
Far from intending to stop harming African males, PEPFAR make a commitment to continue.
Voluntary medical male circumcision (VMMC) remains a priority HIV prevention service for PEPFAR and accesses hundreds of thousands of men a year. Men targeted through VMMC services who are at substantial risk for HIV infection can also benefit from PrEP services as an additional prevention strategy. Men in any age range with elevated HIV risk should be referred for VMMC and could also consider using PrEP to prevent HIV acquisition, if inconsistently using condoms. Opportunities to reach partners, friends, and/or family members who may benefit from PrEP should also be leveraged.PEPFAR 2020 Country Operational Plan Guidance for all PEPFAR Countries, DRAFT, p180
Pre-exposure prophylaxis (PrEP) is a medical approach that appears to work well if taken regularly and as directed. Unfortunately, with so many millions of dollars being poured into ineffective surgery, the availability of the drug is patchy in most parts of Africa. Unless the drug is taken continuously by anyone at risk, they are exposed to HIV. The preponderance of scientific evidence indicates that chopping off bits of their penis will not help.
A show of scientific rigour
Perhaps for the first time, PEPFAR are insisting that there is some checking done on the activities of their field agents around the world.
Programs must have definable objectives that contribute to sustainable epidemic control, including addressing stigma and discrimination, HIV/AIDS prevention, care, and/or (indirectly) treatment.Objectives must be measurable.PEPFAR 2020 Country Operational Plan Guidance for all PEPFAR Countries, DRAFT, p472
Although the end of PEPFAR-supported infant circumcision in Africa is a win for African males, the new plan contains a potentially dangerous proposal. Brendon Marotta reports:
However, their draft contains a new plan that could cause additional harm.Brendon Marotta, director of the documentary American Circumcision
PEPFAR is planning to use the ShangRing for future circumcisions – and testing on African populations to find out what the botch rate is.
The ShangRing is a device manufactured by a Chinese company. In 2015, it was fast-tracked through the WHO for clearance in medical processes. It was cleared for use within the European Union in March 2019.
The ShangRing device underwent clinical trials in Kenya in 2015 but has never used on a wide-scale project such as is being done against males in Africa. It is not suitable for infants, only for adolescents and older: those at Tanner Stage 3 or above. (Tanner Stage 3 is mid-puberty. This typically occurs around age 12 to 13. ⇩5Vermont Department of Health; The Tanner Stages; VDH 10/99)
While confirmation of age can be difficult, VMMC should not be performed in adolescents under age 15 in the absence of Tanner stage 3 of development. Programs may propose exceptions to the new age policy for the routine use of only the ShangRing device in adolescents aged 10-14 years/below Tanner stage 4. These must include plans for long-term enhanced safety monitoring in this group with complete followup within 14 days, recognizing that very large volumes may be needed to identify any increased risks. The ShangRing mechanism may protect against risks of glans injury and fistula for immature genitalia, but sufficient volumes have not yet been done in VMMC settings to rule out other injury risks in young adolescents that may be similarly uncommon, especially during the device’s in situ period. [Emphasis added.]PEPFAR 2020 Country Operational Plan Guidance for all PEPFAR Countries, DRAFT, p172
In other words, PEPFAR wants to do a lot of circumcisions with the ShangRing to find out what the risk is.
“Very large volumes may be needed to identify any increased risks” is an INSANE statement. The way to find out if a medical device is safe is not to experiment on millions of African children. Ring devices are known to be unsafe. A pediatric urologist in my documentary American Circumcision, who does both circumcision and botch repair, said he regularly sees damage from these types of devices and believes they should not be on the market. You don’t need to botch millions of children to find out if your medical device known to cause botches will cause botches!Brendon Marotta, director of the documentary American Circumcision
Even the WHO public report admitted that 1% of circumcision attempts with the ShangRing did not go smoothly.⇩6WHO; Prequalification of Male Circumcision Devices, public report, Product: ShangRing™; Number: PQMC0003-003-00, page 4
The PEPFAR guidelines reported here are only a draft. They are open for public comment until 13 December 2019.
Brendon Marotta writes:
Your comments on the guidance are welcome and encouraged, and it is recommended that you are as specific as possible when submitting feedback.Brendon Marotta
In an email, Brendon adds:
PEPFAR will only read specific comments on specific parts of the guidelines. They are not interested in your long philosophical rant. They may not even be interested in public comments at all, and their request for comments is only a formality.
If you want to leave a specific, well thought-out and polite comment, you could include something regarding section “18.104.22.168. Voluntary Medical Male Circumcision” (p.171) on a positive note. Brendon Marotta suggests offering support for their decision to end their infant circumcision campaign. Often, public officials only hear from activists when they are angry. When people do the right thing, they deserve support and praise.
Putting an end to a program that was hurting children is a good idea, and you should make sure any message you send reinforces that decision on their part.
If you are genuinely interested, ask for more data on adverse events: how many adverse events were there? What types of adverse events? To what age children? PEPFAR claims to have done 22.8 million circumcisions. At even a 1% botch rate, that is 200,000 damaged children. PEPFAR is a USA public body. The U.S. public has a right to know this data and the exact results of how their tax dollars have been spent.
You may want to tell PEPFAR not test the ShangRing on African people to find out what the botch rate is. The right way to find out if a medical device is dangerous is NOT to test it on vulnerable populations. PEPFAR’s plan to use the ShangRing on Africans to find out what the risks are is human experimentation and a clear human rights violation that should be opposed.
Take action to save male dignity
Leave a respectful, well-thought-out comment on PEPFAR’s guidelines.
Remember, people like to hear praise and are then more open to criticism.
If you are outside of the USA, don’t pretend to be in it. It is preferable to be clear that, as a foreigner, you are asking the USA to be better.
(Note: at the time of writing, the submission form could not be accessed.)
Brendon Marotta will continue to report on this issue. He can be followed on Facebook, and on Twitter. His blog can be tracked on the Men Webs global RSS feed here or using his own RSS Blog Feed. His blog can also be subscribed to for email updates.
► PEPFAR 2020 Country Operational Plan Guidance for all PEPFAR Countries, DRAFT
► PEPFAR Plans To End Infant Circumcision Campaign In Africa
► PEPFAR To Experiment On African Children With The ShangRing
► Brendon Marotta: In a new draft proposal, PEPFAR says they will end their infant circumcision program in Africa
► PEPFAR public comments page
References [ + ]
|1.||⇧||PEPFAR 2020; Country Operational Plan Guidance for all PEPFAR Countries; DRAFT 2019|
|2.||⇧||Daily Breeze, Boy’s botched circumcision leads to $4.6 million award; July 18, 2011|
|3.||⇧||U. S. Food and Drug Administration, Potential for Injury from Circumcision Clamps; August 29, 2000|
|4.||⇧||Scientific World Journal 2011; 11: 2458–2468; Complications of Circumcision; published online 2011 Dec 26; doi: 10.1100/2011/373829|
|5.||⇧||Vermont Department of Health; The Tanner Stages; VDH 10/99|
|6.||⇧||WHO; Prequalification of Male Circumcision Devices, public report, Product: ShangRing™; Number: PQMC0003-003-00, page 4|