Miriam Mannak
Miriam Mannak

Chopping off foreskins NOT the answer to HIV in our prisons

In an attempt to curb the spread of HIV in its overcrowded prisons the authorities of Kwa-Zulu Natal have come up with a Plan d’Excellence Supreme Edition. Instead of focusing on key problems that form the root of HIV pandemic in its prisons, the province put all their eggs in the ‘let’s treat the symptoms’ basket by circumcising inmates. Epic fail, as far as I am concerned.

Look, we all are aware – myself included – that circumcision can make a man less vulnerable for HIV infection compared to their counterparts who have their penises intact. As a 2009 International Aids Society fellow (which does not make me an expert by the way), I am not disputing that the link between circumcision and HIV infection.

However, by going through the various studies and reports, I have come to the conclusion that chopping off a man’s foreskin does not make the patient invincible for the virus. It neither prevents a circumcised man living with HIV, whether the infection happened before or after his operation, from passing on the disease to someone else.

Just have a closer look at South Africa. In this country, circumcision is pretty much a custom in all segments of society. Whites, blacks, coloureds, Indians, Jews, Christians, Muslims – it happens everywhere and it is not something of the past recent years. If circumcision would be the answer, why are there over 5 million South Africans, little less then half is male, living with HIV?

“But studies show that circumcision does make males 50% less receptive to the virus,” you’d say.  Yes indeed, and I acknowledge these studies, which form part of the key in finding a proper solution to this dreadful disease.

However, without being a pessimist, “50% effective” means that infection can still very much occur. It is basically comparable to handing out condoms that work half of the time: there might a 50% chance you are protected, and there is a 50% chance you won’t be. Would you use such ‘Russian Roulette 2010 style’ condom? Not me.

In addition, please note that the “50% effectiveness rate” of circumcision applies to men who are involved in heterosexual relationships (non anal). The stats therefore do not and cannot apply to our prison environment – where woman and men are strictly separated and where HIV is spreading from man to man to man to man (various explanations exist why men who are engaged in anal sex are more prone to the virus compared to men who ‘do it’ with women and their female bits).

So based on the above: even if male inmates would be circumcised en masse, what are the chances they will not end up popping ARV pills every single day after all?

Just to be clear on this matter: I do appreciate the fact that the KZN authorities are thinking about ways to fight HIV in our prisons. I however,  don’t agree with their shortsighted plans. Circumcision can be part of the strategy, but I think much more time and energy should be spent on fighting what causes the high HIV infection rates in our prisons.

To name a few: rape and other forms of violence, drugs, gangs, and overcrowding.  Abuse by wardens. Condoning of rape by wardens. Overworked wardens who are not equipped to deal with violence and rape in their prisons.

Sending inmates to the doctor for an operation will simply not eradicate these said elements.

“Ag, but why bother? They are just inmates right? We do not owe them anything as they broke the law,” could be a reply to this blog post, one I do not agree with.

Firstly, at some point inmates will pay their dues and make their way back into society; to their wives and girlfriends or partners to be. By protecting inmates from an HIV infection, you help protecting innocent outsiders from this nasty virus too. Circumcision alone just does not make the cut. More is needed.

Secondly, you cannot forcefully subject people to circumcision. That would be a contravention of their human rights. Yes, inmates have human rights.

Thirdly, circumcision might make men less prone to an infection, but it does not prevent someone who is already HIV positive to give the disease to someone else

Finally, my main reason why I think KZN should elaborate on their strategy: an inmate’s punishment is to serve X number of weeks, months, years behind bars – not the exposure to a fatal virus (death sentence) which will eventually kill them – and the others they will infect in due course.

  • http://www.victimempowermentsa.wordpress.com Vesa

    It is just like when governments try to censor women’s dress, or behaviour, to combat rape. Rape is a symptom of a deeper and violent patriarchal culture in South Africa, that must seek ‘power over’ a weaker subject to validate its masculinity. This is definitely a case of symptom treatment.

    As for the reintegration of inmates, you might want to have a look at our piece on parole today. Quite interesting. http://wp.me/pWIrY-cr

  • Nondumiso

    As a health professional who works in HIV prevention,this is an example of a writer not doing their homework. The writer makes no reference to the comprehensive HIV prevention strategies eg.condom distribution that are CURRENTLY being implemented by the DCS and assumes there are none.A little bit of research even on opinion pieces is always a good idea.I just think you wanted to use the word ‘wiener’ and lost all objectivity in the process.And if you cannot discuss sex or even gay sex candidly you should definitely not be writing about HIV.

  • http://hivinkenya.blogspot.com/ Simon Collery

    Hi Miriam
    Good to see people questioning the wisdom of mass male circumcision as a solution to HIV transmission in prison populations. But sadly, the evidence for the effectiveness of such campaigns among non-prison populations is also slight and needs to be treated with far more scepticism than it has received in the past among mainstream media sources. Perhaps ‘scepticism’ and ‘mainstream media’ are contradictory terms!

    Anyhow, I have mentioned your article in my blog, I hope you continue being critical. So much writing about HIV in African seems to see Africans as completely different from the rest of humanity and this has really biased how HIV prevention programs have been developed. As a result, HIV transmission is still rife in countries most affected by the pandemic.
    Regards
    Simon

  • Taff

    Your blogger is quite right “more is needed”-approximately six inches more- that should solve the problem!

  • http://www.RestoringForeskin.org Restoring Tally

    I think the writer has done a good job questioning why inmates are being circumcised for HIV control. The 3 studies commonly relied upon showed that male circumcision was only protective for female to male transmission. Other studies show that male circumcision has no effect on transmission rate for male to male sex, which predominates in prison.

  • Rhubarb

    The efefctivenes sof the circumcision may be impacted on when it took place. Early childhood circumcision = effective. Adulthood = less efefctive.
    Of course my info is a bit out of date.

  • http://theladyfingers.blogspot.com/ Ladyfingers

    Circumcision seems to be working brilliantly as an HIV prevention strategy for the Xhosa.

  • Victor

    NOTHING justifies genital mutilation.

  • Haiwa Tigere

    Critics everywhere. Not one constructive .As a 2009 International aids fellow how would you go about the Prison HIV problem.
    Circumsision, condoms seems to be a good start.
    Why are prisoners getting special mention anyway.Lets start with normal society then extend this olive branch to prisoners. How is that?

  • http://thoughtleader.co.za/miriammannak Miriam Mannak

    @ladyfuingers: Didn’t you read my blog? Because – as I explained – these prisoners sometime down the line will be part of ‘normal society’. If they are infected with HIV in prison, the chances are they will give it to someone else. I did not reject the option of circumcision, I said it should be integrated in an overall approach that tackles the causes of the high infection rate. That means: More wardens (so more funds for our prisons), less people in a cell, severe punishment for rapists, etc. Whether you want it or not: prisoners will make their way back into society so you might as well invest in them. Prisons are not only about retribution.

  • http://thoughtleader.co.za/miriammannak Miriam Mannak

    My reply was not meant for Ladyfingers (sorry!) – was meant for Haiwa Tigere.

  • Lesego

    I always laugh when people talk about Aids prevention as they always come through as somewhat unintelligent. It’s like Dumb and Dumber.

    NOTHING justifies genital mutilation.

    Victor on November 2nd, 2010 at 7:32 am

    Exactly, I don’t understand why only female genital mutilation is condemned but not male. Why oh why?

  • johnsimonsy

    @Haiwa Tigere on November 2nd, 2010 at 10:43 am

    just wondering what your definition of “normal society” would be?

  • Lesego

    The constant talk about Aids in Africa goes to show that the Aids concept was meant for the ethnic cleansing of the African race.

  • Rob

    Hypothetically…. let us imagine South Africa engaged in a state of war. Liberties would be restricted; priorities focussed and the country would unite to defeat the threat to national security. The public response to the threat of war would be pragmatic – accepting of some possible collateral damage for the good of the majority.

    To the present… what is South Africa’s reality? An alarming percentage of South Africans are HIV positive. The ignorant, irresponsible, selfish or vindictive of whom, continue to engage in sexual relations with the to-be infected. This has been going on for decades. The death rate is higher than the worst war we have ever known. The suffering is on a grander scale. The economic cost to the nation and impact on South Africa’s health system are huge.

    When balancing the theoretical increase in illegal prejudice/ bigoted attacks on some individuals, against the sure-thing infection of our youth; shouldn’t it be no contest!? A strong measure would save countless lives; I cannot imagine how anyone could argue for more continued secrecy and the rights of potential violators.

    Over to you: Shouldn’t HIV testing be mandatory and the condition notifiable?

  • Percipient

    @ Lesego on November 2nd, 2010 at 2:12 pm: have you ever wondered why? – that’s if your claim is in fact true.

  • Haiwa Tigere

    The idea of a rapist being raped himself has a certain quality about it.The only” less people in a cell” that would definitely prevent prison rape is one man one cell-why dont you add an ensuite with a jaccuzi while you are about it huh?
    These guys are muggers and killers and rapists and a nasty lot.These are the same guys who did not care if they passed on HIV or not when they were raping a woman somewhere.
    Your point is valid about them getting back into society.Maybe introducing the death penalty will reduce this overcrowding and they would certainly not be going back into society.

    Normal society is the men being bludgeoned, the women being raped,the people who have to cower behind 6 foot walls just for protection from them.
    I would take 4 rapists and 4 murderers and put them in one cell and wait. What happens happens

  • Joseph4GI

    @Nondumiso
    As a “health professional” (are you one? I’d like to see your license), you don’t seem to be too bright. Let’s “do our homework” as it were. Even if “studies” were correct, circumcision only “reduces the risk” of HIV by 60%, only for MEN who have heterosexual sex. Not men who have sex with men, which would be the bulk of sexual activity in prisons where men and women are kept separately, and not the man’s partner be it a man or a woman who are 100% exposed to the viral load in an HIV+ man’s semen. A condom protects from HIV 95% of the time in both the man AND his partner. Why on EARTH would you want to provide an alternative to the more effective mode of HIV prevention? Why on EARTH would you ever want to distribute permanent, EXPENSIVE condoms that fail 50% of the time, when condoms are cheaper and worlds more effective? Circumcision to prevent HIV is a mistake. The WHO should have NEVER approved it as a “prevention method.” They are not endorsing HIV prevention, they are endorsing its DISTRIBUTION through unsafe sex practices.

  • Joseph4GI

    @Ladyfingers
    IS it working for South Africa? Because it’s not working for these countries, where HIV is more prevalent in circumcised males:

    Cameroon http://www.measuredhs.com/pubs/pdf/FR163/16chapitre16.pdf table 16.9, p17 (4.1% v 1.1%)
    Ghana http://www.measuredhs.com/pubs/pdf/FR152/13Chapter13.pdf table 13.9 (1.6% v 1.4%)
    Lesotho http://www.measuredhs.com/pubs/pdf/FR171/12Chapter12.pdf table 12.9 (22.8% v 15.2%)
    Malawi http://www.measuredhs.com/pubs/pdf/FR175/FR-175-MW04.pdf table 12.6, p257 (13.2% v 9.5%)
    Rwanda http://www.measuredhs.com/pubs/pdf/FR183/15Chapter15.pdf , table 15.11 (3.5% v 2.1%)
    Swaziland http://www.measuredhs.com/pubs/pdf/FR202/FR202.pdf table 14.10 (21.8% v 19.5%)

  • Joseph4GI

    Where circumcision ISN’T preventing HIV:

    Cameroon: 4.1% of circumcised men are HIV+ vs 1.1% non-circumcised men.

    In Ghana, the ratio is: 1.6% vs 1.4%

    Lesotho: 22.8% vs 15.2%

    Malawi: 13.2% vs 9.5%

    Rwanda: 3.5% vs 2.1%

    Swaziland: 21.8% v 19.5%

    Source: www dot measuredhs dot com

    This June, Malaysian AIDS Council vice-president Datuk Zaman Khan announced that more than 70% of the 87,710 HIV/AIDS sufferers in the country are Muslim. (in other words, CIRCUMCISED)

    In America, the majority of men are circumcised, close to 80% of all men. And yet, we have THE HIGHEST HIV transmission rate in the industrialized world. We have a higher tranmission rate than various countries in Europe and Asia where the majority of men aren’t circumcised, such as the UK, Denmark, Germany and Japan. With so many uncircumcised men in those countries, why isn’t HIV rampant there?

    I have my doubts about studies that fail to correlate with reality.

    I have qualms with studies that want to provide condoms, which protect over 95% in both partners, with a flimsy alternative which would only “reduce the risk” of HIV by 60% in males ONLY, leaving their partners vulnerable.

    Promoting circumcision is a fatal mistake. This policy is mistaken, and anyone who thinks this is a good idea cannot possibly be thinking clearly.

    HIV prevention organizations need to be promoting CONDOMS and forget about circumcision.

  • Joseph4GI

    The “studies” being used to promote circumcision in Africa are fraught with problems.

    The most prominent problem is the bias and conflict of interest of the researchers. The headers of these “studies” all belong to cultures and/or ethnic groups to whom circumcision is an important cultural or religious custom, and have an interest in finding a positive outcome for circumcision.

    Robert Bailey has been trying to find a legitimate medical justification for INFANT circumcision since 1995, a whole decade before the latest “studies.”

    Daniel Halperin is Jewish and he is on record saying he wants to continue his grandfather’s legacy (grandpa was a mohel).

    There are others onboard the “circumcision study” train with similar interest.

    I don’t mean to be racist at all, but could we trust people with an interest in protecting and legitimizing circumcision, with producing trustworthy and objective results? If there were a negative outcome, could we trust them with properly reporting it? Why weren’t the negative outcomes in six African countries properly reported? (See post above)

    Why “studies” to promote genital mutilation?

    Shouldn’t “researchers” be trying to find an alternative for surgery, not a necessity?

    These “studies” are backwards in every way imaginable.

    Promoting circumcision is going to be the demise of Africa.

  • Joseph4GI

    The “studies” being used to promote circumcision are based on debunked hypotheses.

    Promoters of circumcision can’t overstate that “circumcision reduces the risk of HIV by 60%,” but as of yet, there hasn’t yet been a single explanation as to how exactly removing the foreskin “reduces the risk” of HIV infection, only assertion that it just “does.”

    After the “studies,” “researchers” have unsuccessfuly tried to give post-hoc explanations for their “results.” Let us observe:

    Myth#1: “The Langerhans cells facilitate HIV infection. Circumcision ‘reduces the risk of HIV’ by removing the Langerhans cells in the foreskin.”

    Reality: Langerhans cells are found all over the body; their removal is virtually impossible. AND –

    “Langerin is a natural barrier to HIV-1 transmission by Langerhans cells”
    (de Witte 2007)

    Myth#2: “Circumcision ‘reduces the risk of HIV’ because it’s harder for the virus to get through the keratinized glans.”

    “CONCLUSION: We found no difference between the keratinization of the inner and outer aspects of the adult male foreskin. Keratin layers alone are unlikely to explain why uncircumcised men are at higher risk for HIV infection.”
    (Division of Infectious Diseases, Department of Medicine, Chicago 2010)

    So these “studies” are based on debunked hypotheses, and reality conflicts with their “results.”

    It is these “studies” which fervent circumcision advocates are using to promote circumcision as HIV “prevention.”

    The time has come to wake up and call these “studies” out for the ridiculous and dangerous hoax that they are.

    ENOUGH with circumcision “studies” already.

  • Joseph4GI

    @Rhubarb

    You wrote:

    “The effectiveness of the circumcision may be impacted on when it took place. Early childhood circumcision = effective. Adulthood = less effective.”

    But of course, the supposed “studies” were carried out on consenting ADULTS, not in children.

    And, circumcision “to protect from HIV” is kind of pointless in children who DON’T ENGAGE IN SEX and are therefore at ZERO RISK anyway.

    Let’s say the supposed “studies” carried out on ADULT MEN by the way are correct; why couldn’t it be a grown, informed MAN’S choice whether he wants to get circumcised or not?

    There are “studies” that say that female circumcision halves HIV transmission (Stallings 2009).

    Somehow, I don’t think that even if “studies showed” that female circumcision “reduced the risk of AIDS” by 90% or higher, would organizations proceed to endorse it as “HIV prevention.”

    Nay, I think that there would be an uproar around the world.

    Researchers should be looking for ways to prevent HIV, not to legitimize their favorite torture method.

    Circumcision “research” is as backwards as “research” can get. Medical “research” is supposed to be looking for ways to AVOID surgery, not NECESSITATE it.

    Africa is being raped by charlatans.

  • Nguni

    Excellent, critical review of this project for prisoners. (@the HIV health professional who commented on the author ignoring the condom program: read carefully, she did not!) Think about the idea of circumcising penises to prevent HIV infection. In the prison situation, it’s a protection FOR the rapist. Outside the prison, it could theoretically help prevent HIV transmission to a man banging a positive woman. Not his wife, whom he married as a young girl. Whores (sorry, sex workers is the PC term) more likely, or at least the ‘floating trophy’ lady at work. Bottom line: it may prevent multi-partner males from bringing unwanted souvenirs home.. Is the effort worth it? If we are a predominantly multi-partner society, then it is. But not in prisons.

  • brad

    Have a look at the book “the Wisdom of Whores” written by the head of UN-AIDS stats. Very interesting.

    Apparently condoms and lubrication are key (and not been raped).

  • Ash

    Male circumcision simply cannot be compared with female genital mutilation, not by any vast stretch of imagination even. And even less so wrt prevention of HIV infections!

  • Lesego

    Male circumcision simply cannot be compared with female genital mutilation, not by any vast stretch of imagination even.

    Ash on November 3rd, 2010 at 10:01 am

    Why so? You know you have to explain your statement. And you have to use the same term for both which is Male Genital Mutilation.

  • Victor

    @ Ash: We are not comparing male and female genital mutilation here. We are objecting to any kind of genital mutilation.

    Just a thought: Could the “AIDS prevention by circumcision” campaign be driven the great money-making potential of millions of unnecessary surgical procedures?

    Am I pointing out the obvious?

  • Lesego

    And how actually does a circumcised man get prevent from getting infected?

  • Ginny

    //”…Yes indeed, and I acknowledge these studies…”//

    Interesting question – why support these studies?

    Many people have looked at these studies and found them to be deeply flawed in sampling and methodology. When practising safe sex, there is no benefit to men in being circumcised, and circumcised HIV+ men are far MORE likely to pass the disease onto their partners than intact HIV+ men.

    Circumcision has no part to play in preventing the spread of HIV – edcuation, safe sex, better women’s rights and remedying rape and other societal ills is proven to help stop AIDS. Circumcision in the developed world is highest in the US. So is HIV. Circumcision definitely does not work, and should not be promoted.

  • Joseph4GI

    Male and female genital mutilation can too be compared. That people choose to euphemize the mutilation of one sex with the more couched term “circumcision” does not change the fact that you are taking a healthy individual and cutting of his normal, healthy body parts against his will.

    That it may or not “prevent HIV” (and it does NOT), is secondary.

    There are a few “studies” that say that female circumcision can half HIV infection.

    What do you say to that?

    To take a normal, healthy individual and forcefully cut off part of his/her genitals is the exact same principle, male or female.

    Keeping a set of different standards for boys and girls, men and women, is sexist.

    It’s either ALL “mutilation,” or none at all.

    You can’t have it both ways.

    Whether or not a man should be circumcised should be his decision and his decision only.

    Oh, and no, circumcision does not, cannot prevent HIV.

    There is not a single doctor, “study,” or “researcher” who can refute this simple fact.

    The bottom line is, even if circumcision DID “reduce the risk of HIV,” a circumcised man would still have to wear a condom.

    So then why even promote circumcision, when there are already cheaper, less invasive, more effective modes of prevention?

    Men already look for reasons not to wear condoms. Why provide them with a fatally poor alternative?

    Africans are going to regret having ever listened to self-interested charlatans from the west.

  • Joseph4GI

    With all these “studies” surrounding the penis and circumcision, one would think that “researchers” could find a better way to prevent HIV.

    Anyone ever wonder why studies focus on legitimizing circumcision, and not finding a better alternative?

    Usually medical science tries to find ways to make a person healthy so that he DOESN’T need surgery. Nobody strives for a breast removal. No doctor tries to find ways to remove the testicles. Even when surgery is necessary, measures are taken to lessen the severity and lessen scars. This is why we have laproscopic therapy.

    Science is always advancing, always working to make itself absolete.

    What are circumcision “researchers” doing to eventually displace circumcision?

    Do they have that in mind?

    Or is mutilating men and children all they have on the brain?

  • Joseph4GI

    People like to justify male circumcision because “it is performed at a hospital, by professionals, with anaesthetic, on babies so that they don’t remember.”

    Female circumcision is “worse” because “it is performed in the nasty bush by amateurs with rusty blades or glass shards, on grown women and they can feel all the pain.”

    Well, what if female circumcision were performed in a hospital, by professional with pristine utensils with pain killers? Would that make it better?

    What if it were performed on baby girls like they do in Malaysia so that they “don’t remember?” Would that make it “better?” Why? Why not?

    “But women often get infected and even die.”

    Well guess what, that happens to boys and men too. Just look at how many boys and men die yearly in South Africa due to circumcision initiations.

    “Women lose the ability to orgasm, men don’t.”

    No, I’m sorry, where are those “studies” when you need them?

    Did you know that “studies show” that even women who have undergone the WORST kind of FGM (There are degrees. Did you know that?) can experience orgasm?

    It’s true. Even women who have undergone infibulation where all the labia is cut out, along with the clitoris, and the area is sown up to leave a small hole, can orgasm.

    So what other lie are you going to tell me to justify the mutilation of boys and men?

    Disgusting liars.

    That’s what all circumcision advocates are.

  • Lesego

    @ Lesego on November 2nd, 2010 at 2:12 pm: have you ever wondered why? – that’s if your claim is in fact true.

    Percipient on November 2nd, 2010 at 8:47 pm

    For the same reason black people have been subjected to racism in many countries ruled by white people. Have you asked yourself why blacks are prejudiced upon?

  • GC

    Exactly what percentage of inmates were infected while in prison? How many were infected before going to jail?
    Perhaps the authorities are not that stupid so as to waste medical procedures on prisoners.
    What percentage leaves prison after the procedure are now not infected?
    These answers would silence or validate a lot of the comments!!

  • Joseph4GI

    Victor wrote:

    “We are not comparing male and female genital mutilation here. We are objecting to any kind of genital mutilation.”

    Excellent point.

    Are we going to compare male and female circumcision, or talk about the fact male circumcision can’t prevent AIDS?

    Whether it be “the same” or “less severe” than female circumicion, the point remains the same.

    Even if “studies” are correct, and this is questionable, circumcision does not, cannot prevent HIV transmission.

    These “studies”, even if they are correct, are a testament that circumcision FAILS.

    Circumcision FAILS so much that even advocates themseleves cannot stress the use of condoms enough.

    Any “doctor” or “researcher” that were to promote a condom that failed 40% of the time would be laughed out of the room!

    Circumcision does not, cannot prevent HIV. Only condoms can effectively do this. There is not a single doctor, “researcher” or “study” that can refute this fact.

    If “studies” are correct, circumcision does absolutely nothing for men who have sex with men; the category of these men in prison.

    Men in prison are being given dangerous misinformation that is not going to help them at all.

    Men, in and out of prison, need to be told to practice safe sex and employ the use of condoms.

    Promoting any alternative to this, especially an alternative that have been scientifically shown to FAIL, is a disservice in the fight against AIDS.

    Medical practicians that promote circumcision are spreading misinformation. Those that perform them are committing medical fraud.

  • maori

    There is ample anecdotal evidence that African men interpret the notorious randomised clinical trials as “proving” that circumcised men cannot contract HIV and so do not need to use condoms. The way the randomised clinical trials were conducted is a scientific scandal waiting to explode.

    There is also a distinct possibility that the reduction in sensation resulting from circumcision leads to greater resistence to using condoms. If this is the case, circumcision could be gravely counterproductive in the struggle against HIV. Finally, it bears repeating that HIV in prisons is transmitted anally, and circumcision has no effect on a man’s ability to contract HIV or to pass it on.

    In sum, hand out free condoms in prison, urge that they be used, and forget circumcision.

  • http://theladyfingers.blogspot.com/ Ladyfingers

    Joseph4GI

    I was being ironic. The Xhosa are raddled with HIV despite their universal circumcision.

  • Eric Parsons

    Thanks to Miriam Mannak and ‘twitter’ for putting the issues raised here out into the Public Arena so quickly and efficiently. I’m sure it takes the sight of the words ‘chop’ and ‘foreskin’ together (ouch, ouch!) to re-focus the male mind yet again on this horrendous and unyielding disease.
    If circumcision was really a medical solution to the spread of HIV what sane man would do less than
    volunteer for the operation? Clearly, no such emphatic medical opinion exists or there would be news of the mass circumcision of the uncircumcised male populations of places like the leafy suburbs of Pretoria SA or Cambridge UK & etc…
    In the 21st Century the suggestion that prisoners could still be subject to any kind of surgical mutilation as part of their sentence is yet another issue that should also be of concern to us all.

  • Marie

    Why grope further in the dark? The answer from the most authoritative source is simple – install more showers.