Wednesday, August 5, 2009

Why are we so Averse to Basic Needs?

Further to earlier postings on this blog about mass male circumcision (MMC) as a strategy to reduce HIV transmission, a recent mathematical model shows that the use of condoms and antiretroviral therapy (ART) would have a far greater impact. The data used was for South Africa so it does not necessarily apply directly to other African countries.

The lead researcher expressed surprise at how little effect MMC would have. I have long been curious to know why anyone would think MMC would have such a profound effect. In Kenya, where there has been much talk of MMC, circumcision rates are already much higher than in South Africa, so they have even less to gain from such a strategy.

The percentage of people on ART in Kenya is also higher, as is condom use, though they are nowhere near as high as they need to be. But this paper gives a lot of support to people who are questioning the wisdom of rolling out MMC as a HIV reduction strategy for developing countries.

The results are preliminary but it is good to see the MMC orthodoxy challenged and found wanting.

Meanwhile, I have also raised questions about proposals to test everyone and treat everyone found to be HIV positive. Another piece of mathematical modelling shows that if such a strategy were to be implemented in Washington, DC (which has the highest HIV prevalence in the developed world), it would be unlikely to halt the epidemic.

Even assuming that 100% of people were tested, that they returned to be tested at regular intervals and that anyone found to be HIV positive was put on ART immediately, HIV transmission would not be reduced enough to eradicate the disease and the rate of transmission would eventually return to present levels. And these are big assumptions.

Again, these results would not be directly applicable to African countries such as Kenya. But one the main problems in Africa would be the difficulty of getting large numbers of people, not just to test, but to test regularly. There would also be the problem of getting large numbers of people on treatment and keeping them on treatment in countries that are seriously resource poor.

There is plenty of evidence to show that reasonable standards of health, education, infrastructure, water and sanitation and other social services would have a great impact on all diseases, not just HIV. People need assured livelihoods, food security and good governance. No large scale, expensive and high technology HIV intervention will have much impact until all these other issues are addressed.



Markoel said...

I looked at this issue in some detail in a post last week where the statistics in South Africa are absolutely horrifying. I honestly believe that corporate Africa needs to stand up in front of Governments and start taking responsibility when it comes to educating Africa on these issues.

Simon said...

Hi, thanks for your comments, I believe things are really bad in SA. But I don't see corporate Africa doing anything for anyone, they are the ones paying the governments to do what suits their corporate interests. Politicians don't receive bribes from martians, they get them from rich people who want to stay that way.

Anonymous said...

There is no medical reason for routine circumcision of boys or men.

The primary zones of male erotogenous sensitivity are the frenulum and the ridged band. These zones are orgasmic triggers. Most people are surprised to learn that the glans penis is one of the least sensitive parts of the entire body. We therefore see: so-called voluntary medical male circumcision (VMMC) in fact is genital mutilation.

There is no evidence that lack of circumcision is a risk factor for HIV infection. Quite the contrary, male circumcision may increase male-to-female transmission of HIV.

CONDOMS protect against HIV, circumcision does NOT.

Simon said...

Thank you for your comment. However, condoms only protect against SEXUALLY transmitted HIV, not against non-sexually transmitted HIV, via unsafe healthcare, cosmetic or traditional skin-piercing procedures, circumcision being a possible example.