public discourse

A fatal irony: Why the “circumcision solution” to the AIDS epidemic in Africa may increase transmission of HIV

By Brian D. Earp

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A fatal irony: Why the “circumcision solution” to the AIDS epidemic in Africa may increase transmission of HIV

1. Experimental doubts 

A handful of circumcision advocates have recently begun haranguing the global health community to adopt widespread foreskin-removal as a way to fight AIDS. Their recommendations follow the publication of three [1] randomized controlled trials (RCTs) conducted in Africa between 2005 and 2007.

These studies have generated a lot of media attention. In part this is because they claim to show that circumcision reduces HIV transmission by about 60%, a figure that (interpreted out of context) is ripe for misunderstanding, as we’ll see. Nevertheless, as one editorial [2] concluded: “The proven efficacy of MC [male circumcision] and its high cost-effectiveness in the face of a persistent heterosexual HIV epidemic argues overwhelmingly for its immediate and rapid adoption.”

Well, hold your horses. The “randomized controlled trials” upon which these recommendations are based are not without their flaws. Their data have been harnessed to support public health recommendations on a massive scale whose implementation, it has been argued, may have the opposite of the claimed effect, with fatal consequences. As Gregory Boyle and George Hill explain in their extensive analysis of the RCTs:

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Choosing one’s own (sexual) identity: Shifting the terms of the ‘gay rights’ debate

Choosing one’s own (sexual) identity: Shifting the terms of the ‘gay rights’ debate

By Brian Earp (Follow Brian on Twitter by clicking here.)

UPDATE: See HuffPost Live debate on this topic here.

Can you be gay by choice? Consider the following, from the Huffington Post:

Former “Sex and the City” star Cynthia Nixon says she is gay by “choice” – a statement that has riled many gay rights activitists who insist that people don’t choose their sexual orientation.

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Is the non-therapeutic circumcision of infant boys morally permissible?

On the ethics of non-therapeutic circumcision of minors, with a pre-script on the law

By Brian D. Earp (Follow Brian on Twitter by clicking here.)

PRE-SCRIPT AS OF 25 SEPTEMBER 2012: The following blog post includes material from an informal article I wrote many years ago, in high school, in fact, for a college essay competition. I would like to think that my views have gained some nuance since that time, and indeed with increasing speed, as I have researched the topic in more detail over the past several months–specifically during the period of a little over a year since the blog post first appeared online. Since quite a few (truthfully: many thousands of) people have come across my writings in this area, and since I am now being asked to speak about circumcision ethics in more formal academic company, I feel it is necessary to bring up some of the ways in which my thinking has evolved over those many months.

The most significant evolution is away from my original emphasis on banning circumcision. I do maintain that it should be considered morally questionable to remove healthy tissue from another person’s genitals without first asking for, and then actually receiving, that person’s informed permission; but I also recognize that bringing in the heavy hand of the law to stamp out morally questionable practices is not always the best idea. It is a long road indeed from getting one’s ethical principles in order, to determining which social and legal changes might most sensibly and effectively bring about the outcome one hopes for, with minimal collateral damage incurred along the way. Until enough hearts and minds are shifted on this issue, any strong-armed ban would be a mistake.

In the long term, however, I think the moral goal remains: that each male newborn should have the same legal protections enjoyed by his sisters, designed to preserve his sex organs in their healthy, intact form until such time as he is mentally competent to make a decision about altering them, surgically or otherwise.

The project for the meantime is to work on hearts and minds.

I am grateful to the many hundreds of individuals who have left thoughtful comments on my sequence of posts on the ethics of circumcision, and I look forward to developing my arguments in ever more sophisticated ways in the coming months and years as this important debate continues. I am especially grateful to those of my interlocutors who have disagreed with me on various points, but who have done so in a thoughtful and productive manner. May we all aim at mutual understanding, so that the best arguments may emerge from both sides, and so that the underlying points of genuine disagreement may be most clearly identified. — B.D.E.

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Routine neonatal circumcision in boys is unethical, unnecessary, and should be made illegal in the United States. Or so I argue in this post.

Yet lawmakers in California, it is now being reported, have introduced a bill with the opposite end in mind. They wish to ban legislation that could forbid circumcision-without-consent. What could be going on?

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Sex or violence—Which is more harmful to children?

Serious warning: this post contains nudity as well as images and descriptions of graphic video-game violence. The intended audience for this post is adults.

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The U.S. Supreme Court ruled last week, in a 7-of-9 majority, that the State of California may not prohibit the sale of violent video games to minors. Such a ban, the majority argued, restricts the free speech rights of the video-game manufacturers, and is therefore unconstitutional. Read the ruling here.

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A Reflection on Confronting Evil

The New York state legislature has nearly approved a bill endorsing same-sex marriage, finally bringing the state in line with such bastions of extravagant liberalism as Argentina, Nepal, and Iowa. Taking to the airwaves in the tradition of Father Charles Coughlin, New York Archbishop Timothy Dolan declared the legislation an “ominous threat”. Same-sex marriage is “detrimental for the common good,” said the Archbishop; it violates “the natural law that’s embedded in every man and woman”.

This post is not about gay marriage; I will not present a positive argument for the moral necessity of marriage equality. Similarly, I will not write a post about the moral necessity of racial integration in public education, or about the moral necessity of women’s suffrage. The mere raising of such issues, in a context of argument, implies an open question about the simple human dignity of the people affected. My starting point is that marriage equality is such an issue. My question, instead, is this: how we are we to deal with those among us most responsible for our collective failure to decisively conclude this argument, the very existence of which is morally repugnant?

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Strauss-Kahn, Schwarzenegger, and the Failure of Public Discourse

First came Strauss-Kahn. Then Schwarzenegger. And now Goodwin. Three powerful men, all married, all accused of sexual impropriety. Cue the inevitable trend pieces in the press: why do influential men cheat? But something is wrong here: one of these does not belong. The accusations against Dominique Strauss-Kahn – that he sexually assaulted a housekeeper at his Manhattan luxury hotel – are vastly different from those confronting Arnold Schwarzenegger and Sir Fred Goodwin. The fact that our media culture seems incapable of properly distinguishing rape from simple adultery suggests a failure of moral sensitivity, and perhaps a triumph of prurient gossip-mongering over sincere ethical concern.

TRIGGER WARNING: if you experience discussion of sexual assault as potentially traumatizing, it may be best to read no further.

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