Thursday, September 16, 2010

HIV Has Always Been Good News for Ambulance Chasers

I recently mentioned that there is some evidence that the aims of the mass male circumcision campaigns currently taking place in some African countries might also be achieved by provision of soap and water. But yesterday, I mentioned that soap and water are not even available in most health facilities in Kenya. Those findings are pretty shocking, but some researchers recently found that fishermen operating in Lake Victoria are reluctant to ensure their own genital hygiene for various reasons, including that they don't wish to wash their genitalia in public.

This is quite understandable. Few people would wish to wash their genitalia in public. But the authors of the paper recommend penile microbicides, which they can apply in the 'privacy of their bedrooms'. People who do not have the privacy to wash themselves properly probably do not have privacy in their own bedrooms, either. Many people, by no means the poorest, live in one and two room houses, shared with other members of their family.

If the problem is lack of hygiene, and soap and water is adequate to solve the problem, why bring in penile mcirobicides (unless you are trying to promote them for commercial reasons)? UNAIDS review the article in their weekly 'Good News for Ambulance Chasers' and note that penile wipes have been used in the past. Great. But if people can find a private place to use a penile wipe, with or without a microbicide, then they can also apply soap and water.

Lack of penile hygiene is cited as an argument for mass male circumcision. But this research claims that there is also a traditional proscription against fishermen washing with soap and water. I don't really see how this would make the case for penile wipes or topical microbicides. But there is also a traditional proscription against circumcision among the dominant Luo population.

If the stories about the success of mass male circumcision campaigns in Luo areas are true, the proscription against use of soap and water can also be overcome. But the HIV industry seems very keen on circumcision, regardless of how little it may affect HIV transmission in the long run. The Ugandan government is now also offering 'free' circumcision. Rates of circumcision are even lower in Uganda than they are in Kenya, but conditions in hospitals are similar.

Would you go for an operation on your penis in a country where health services don't guarantee running water, soap and adequate supplies of latex gloves, injecting equipment, sterilizing equipment, disinfectant and pain killers? Consider the question rhetorical. But the point that needs to be made (apparently) is that people are in need of things like water and sanitation more than they are in need of pharmaceutical products and trendy cosmetic operations.

As for privacy, this points to a need for improved housing conditions. But that need, like the need for water and sanitation (education, infrastructure, health and other social services), long predates the need for HIV interventions. Indeed, they are all prerequisites for the success of HIV interventions and it is their lack that has resulted in many HIV interventions having no impact on HIV transmission. The more technical solutions can wait. In fact, they have to wait until far more basic rights have been provided for.

(For discussions of Pre-Exposure Prophylaxis, seem my PrEP Blog.)



Simon said...

The Malawian government has said it will not promote male circumcision for the prevention of HIV transmission because there isn't enough evidence for its effectiveness.

I'd love to see the report they based their decision on as most of the publications you will find on male circumcision seem to be overwhelmingly in favor.

The article says that HIV prevalence is high in areas where circumcision is also common.

It will be interesting to see now whether the HIV industry clams up and ignores this article or rushes to condemn the Malawian government.

Claire said...

An excellent post, I'm glad you're still trying so hard to redress the balance away from received opinion and trendy ideas, we should all keep our minds more open and you're helping.

Simon said...

Thanks Claire, it's becoming a bit of a problem to read everything I should be reading! The industry churns out so much stuff. Hope you're keeping well.