Ethical, medical and public health perspectives on male circumcision
| Ethical issue | Age group targeted for male circumcision | ||
|---|---|---|---|
| Infants | Pre-adolescent | Adult | |
| Consent | Parental (proxy) consent only | Assent and parental consent | Informed consent for competent adults |
| Feasibility | High: integration in existing reproductive care | Low: possible difficulties in reaching target population | Low: infrequent use of health services by male adults |
| Risk compensation | Not significant | Significant | Significant |
| Epidemiological impact | Distal: 15–20 years | Potentially immediate | Potentially immediate, but lost opportunities for prevention among sexually active adults |
| HIV testing | Not applicable | Potential stigma, inadvertent disclosure of parental status | Appropriateness of circumcision when the adult is HIV positive |
| Burden on health services | Lowest: integration into existing reproductive care | High: demand may require substantial investment and involvement of traditional healers | High: demand may require substantial investment and involvement of traditional healers |