Audrey Alejandro, London: On Technicisation: Male Circumcision from Social Practice to a Transnational Object of Medical Expertise

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Voluntary Medical Male Circumcision
(VMMC): a controversial anti-HIV global health policy legitimised by
International Organizations

‘Male circumcision’ refers to a wide range of practices of genital cutting and modification from 1 or 2 cm cuts to complete removal of the skin surrounding the penis, to urethrotomy. It has been used for millennia to structure social organisation and produce social norms. In 2007, the World Health Organisation (WHO) and the Joint United Nations Programme on HIV and AIDS (UNAIDS) established this ancestral practice as the 1st surgery ever used as a preventive health policy as part of their anti-HIV voluntary medical male circumcision programme (VMMC). In the midst of global protests to recognize male circumcision as a violation of human rights and despite literature showing how the beliefs associated with male circumcision in countries beneficiary of the programme b could lead to an increase of HIV transmission, 22 million VMMC surgeries have been performed on men aged 10-29 years in Eastern and Southern Africa since the beginning of the programme.

Taking this policy as a case study, I explore how discourse and knowledge dynamics — such as resemantisation and technicisation — have contributed to the implementation and legitimation of this very controversial programme, which in turns ends up producing norms and legitimising practices through the knowledge and discourse it contributes to naturalise.

At first sight, the desociologisation and legitimation of medicalised circumcision by WHO by UNAIDS through “evidence-based” discourse and rhetoric of expertise might seem a perfect case to illustrate the current debates happening in the field of IOs and knowledge. However, the fact that the global medical community itself has denounced the lack of evidence supporting the policy and the (denied) cultural dimension of medicalised circumcision – practised only in the United States before this Global Health initiatives – is not easily accommodated by the literature.