In March of this year, Penguin Press published Tinderbox: How the West Sparked the AIDS Epidemic and How the World Can Finally Overcome It, by Washington Post journalist Craig Timberg and University of North Carolina epidemiologist and medical anthropologist Daniel Halperin.
Tinderbox explores the role of the West in igniting and helping to spread the HIV epidemic. From HIV’s emergence in central Africa and its later transplantation to Haiti, Western colonialism helped create the conditions and policies in which the lethal virus was able to spread across the world, taking tens of millions of lives with it. During the “Scramble for Africa” near the turn of the 20th century, commercial adventurers blazed new routes through the jungle in search of rubber and riches, sending African porters into remote regions rarely traveled before. It was here, during the age of European conquest, that humans first contracted the strain of HIV that would eventually cause 99 percent of AIDS deaths around the world.
Subsequent Western donor policies further cemented the epidemic’s grip on countries where the disease spread fastest. For example, George W. Bush created the President’s Emergency Plan for AIDS Relief (PEPFAR), which greatly expanded access to AIDS treatment, but at the same time his administration insisted on abstinence as a major method of HIV prevention instead of more realistic measures.
One of the preventive measures discussed in the book, male circumcision, has become an unexpected source of controversy. Anti-circumcision activists have hijacked Amazon.com’s “peer review” comments section, which allows readers to vote on which book reviews are helpful. This system has morphed into a vicious game of character assassination by conspiracy theorists who reject decades’ worth of scientific evidence, showing how easy it is for a concerted crusade to squelch good science.
The evidence that circumcision can prevent the spread of HIV is unequivocal. Circumcision reduces the risk of HIV infection by about 70 percent—making it more effective than most flu vaccines—and it is being promoted by global health authorities such as the World Health Organization and the Centers for Disease Control and Prevention as a simple, permanent, and effective way to help prevent HIV infection. The American Academy of Pediatrics issued a statement last month emphasizing that the health benefits of newborn male circumcision outweigh the risks, and recommended physicians discuss circumcision’s benefits and risks with new parents nationwide.
Even more than using condoms alone—which must be used correctly every time one has sex over the course of a lifetime—male circumcision as part of a range of HIV prevention interventions has the potential to significantly slow the spread of AIDS in the worst-affected parts of Africa. At a fraction of what it would cost to maintain AIDS treatment for an HIV-positive individual over the course of a lifetime, male circumcision is a permanent and inexpensive prevention method that, when coupled with condoms and counseling, makes sense for countries where HIV is spread mainly through heterosexual intercourse.
Many men in regions with high incidence of HIV are interested in undergoing the procedure. In western Kenya, for example, more than 400,000 men have volunteered for the procedure over the past two years.
Professional reviews of Tinderbox, such as an Editor’s Choice selection by the New York Times, have been favorable, and several media outlets, such as PBS News and the BBC, interviewed the authors. Most of the initial readers’ reviews on Amazon gave the book the maximum number of five possible stars. After co-author Craig Timberg was interviewed for NPR’s Fresh Air, Tinderbox’s ranking on the Amazon sales site jumped to within the top 150 and stayed high in the rankings for several weeks.
Although male circumcision occupies less than 10 percent of the book’s pages, it was enough to spark outrage among a tiny but passionately vocal fringe group, many of whom call themselves “intactivists.” They argue that the procedure is a grave human rights violation and are lobbying to ban the procedure in many countries.
Although tens of thousands of men who were circumcised as adults and were studied in several large-scale clinical trials (and in a Slate series) reported no loss—and in many cases an increase—in sexual pleasure and function, the intactivists claim that male circumcision is equivalent to female genital mutilation, a practice whose purpose is to constrain a woman’s sexuality and impair sexual function. In one of its worst forms, a pre-teen girl’s clitoris and entire external genitalia are cut, scraped, or burned out, which can cause severe pain, infection, life-long incontinence, obstructed labor and delivery, and even death. To be truly equivalent, one would have to cut off a man’s entire penis in order to produce the same effect, rather than a small flap of skin.