Syphilis 1855 and HIV-AIDS 2007: Historical reflections on the tendency to blame human anatomy for the action of micro-organisms

Abstract

In this paper, I discuss the parallels between responses to syphilis in nineteenth century Britain and HIV/AIDS in contemporary Africa. In each case, an incurable disease connected with sexual behaviour aroused fear, stigmatisation and moralistic responses, as well as a desperate scramble to find an effective means of control. In both cases, circumcision of adult males, and then of children or infants, was proposed as the key tactic. In the ensuing debates over the effectiveness and propriety of this approach, three questions occupied health authorities in both Victorian Britain and the contemporary world: (1) Were circumcised men at significantly lower risk of these diseases? (2) If there was evidence pointing to an affirmative answer, was it altered anatomy or different behaviour that explained the difference? (3) Given that circumcision was a surgical procedure with attendant risks of infection, was it possible that circumcision spread syphilis or HIV? I show that in both situations the answers to these questions were inconclusive, argue that circumcision played little or no role in the eventual control of syphilis and suggest that attention to nineteenth century debates may assist contemporary policy-makers to avoid the treatment dead-ends and ethical transgressions that marked the war on syphilis.

Keywords:

• syphilis
• HIV/AIDS
• circumcision
• Africa
• Britain

Acknowledgements

This paper is entirely my own work and has not been offered for publication to any other journal. Sections of the paper are based on and adapted from previously published material deriving from my research in nineteenth century medical history as detailed in footnotes in the text.

Notes

1. Doubt has been thrown on this theory by Sawers and Stillwaggon (2010), but it remains the dominant paradigm.

2. In 1986, an official in Botswana stated that AIDS would never be a problem there because ‘AIDS is primarily a disease of homosexuals, and there is no homosexual in Botswana’ (Iliffe, 2006, p. 38). For the role of homophobia is hindering HIV prevention, see Barnett-Vanes (2014) and Epstein (2014).

3. The following discussion is adapted and condensed from Darby (2005, Ch. 12).

4. The following two sections are adapted and condensed from Darby (2003).

5. There is not space here to provide details, but Glass (2013), Douglas (2014) and Joseph4GI (2014) provide links to numerous media reports and other evidence.