Monday, July 11, 2011

Do Ugandans Still Believe All That Stuff About Abstinence?

In a letter to the editor of the International Journal of STD and AIDS, Gisselquist, Potterat and others note a finding from 2006 which estimates that "circumcising all African men by 2015 would reduce HIV incidence during the ensuing 2015–2035 period by a very modest 13%". And this estimate was made by some of the most rabidly pro-circumcision people in the industry.

Yet you still find articles, such as this one from Uganda, bemoaning the fact that governments are not doing enough to get as many men (and boys) as possible circumcised. Many of these articles are written about countries where safe healthcare can not be guaranteed and transmission of HIV and other pathogens through unsafe healthcare may spread more of the disease than it prevents.

Uganda itself is a good example of such a country. And the author doesn't seem to realize that 'up to' 60% means that the operation will give a lot less protection outside of randomised controlled trial conditions, where participants are given regular coaching about safe sex. Coupled with this, many men and women believe circumcision = no danger.

In addition to mass male circumcision, the author argues for 'combined' prevention, in particular, wider antiretroviral coverage. Those responding to antiretroviral drugs are significantly less likely to transmit HIV to their partners. But this apparent belt and braces approach may be deceptive. Circumcision already gives rise to false beliefs about protection, it may increase transmission from males to females and conditions in hospitals may make invasive procedures more risky than sex.

In truth, the fact that some evidence suggests male circumcision may give a little protection against HIV and other diseases does not address many of the very serious doubts. For example, in a number of countries, such as Malawi and Zambia, HIV rates are higher among circumcised than uncircumcised men. The figures bandied about are carefully selected.

The author of the Uganda article oversteps himself when he conflates childhood immunization against diseases like polio with infant circumcision to 'prevent' HIV: polio is an immediate danger against which polio vaccinations have had a huge influence in eradicating. Circumcision will not 'prevent' HIV in infants and children who are not sexually active. It may even prevent little or no HIV in sexually active adults.

Uganda may gain a lot more by improving its ailing health services. And while they are at it, they could improve education, infrastructure and other social services. This would help the country to address many of its immdiate needs. They shouldn't take their eye off HIV, of course, but mass male circumcision seems like a strategy of pure desperation.

It appears that a lot of Uganda's 'success' in reducing HIV transmission in the 1980s was due to improvements in injection safety. This would explain the utter implausibility of all the articles about abstinence and other changes in sexual behavior, which seem to be entirely without substance. Perhaps it's time for Ugandans, rather than the HIV industry, to take an unbiased look at the history of the HIV epidemic in their country.



Paddy O'Gorman said...

Hi Stephen

You have great energy, even as the hyper-sexually-active African myth continues to hold sway, promoted by such paragons of chastity as Bill Clinton and Ryan Giggs.

The triumph of spin over substance is so complete with Aids that is difficult to get people to notice how little substance there really is in Aids orthodoxy and how silly quack cures such as circumcision really are.

I hope to rejoin the fight publicly again soon but it is difficult to do this as the media is nor receptive to having its mind changed.

Best wishes for now

Paddy O'Gorman

Simon said...

Hi Paddy
Thanks for your support! Talking of hyper-sexual activity, I saw some articles about Mike Meegan in the papers again. Apparently he's up to the usual, funded by donors. I read an academic paper recently that got some of its data from one written by Meegan! I wonder how he did his research.

Circumcision is bad enough, but all the hype about pre-exposure prophylaxis now is quite sickening. The aid industry has never managed to get even half the HIV positive people on antiretroviral drugs because they are far too expensive. So they certainly won't be able to get all the HIV negative Africans who are considered to be 'at risk', given UNAIDS's view that most of them are at risk.

I don't know if they will be embarrassed by the fact that putting almost everyone on drugs for a disease that most of them won't be infected by while continuing to fail to identify how HIV positive people were infected with a difficult to transmit virus.

I hope you can rejoin the fight. People here don't seem to be fighting, they just passively accept the scorn, the prejudice, the patronizing attitudes, the funding that should be used for something else and whatever else they have been getting for centuries.

All the best