Tuesday, July 5, 2011

When Soap and Water Would do the Job Better, Why Circumcise?

It's not that long ago that Zimbabwe was experiencing one of the worst cholera epidemics in many years. This demonstrated the fragile condition of their health system, as well as their water, sanitation and hygiene infrastructure. Thousands of people died of this preventable and treatable illness.

But now the country is embarking on a drive to circumcise 1.2 million men by 2015. So let's hope they have got their health services back in shape. It seems foolhardy for a health service that saw so many die from lack of clean water to attempt to carry out an invasive operation when the benefits will certainly be small, if not negative.

Countries with very high levels of HIV prevalence, which Zimbabwe had until recent high death rates significantly reduced levels, probably need to check their health service's ability to provide people with safe health care. It is likely that unsafe practices, such as reuse of injecting and other invasive equipment, was responsible for a lot of HIV transmission.

Mass male circumcision is a curious thing to spend HIV prevention money on, especially considering how little money has been spent on this area so far. In fact, you could say that no money at all has been spent on prevention, although millions of dollars were spent on programs that purported to reduce HIV transmission.

Sizeable resources are being thrown at circumcision, of course. Perhaps this will allow the program to go ahead without causing more HIV transmission than it prevents. But what then? Women are infected in far higher numbers than men and male circumcision doesn't protect them. It may even increase the risks they face.

The article gives the usual 'interview' with someone who says he expected it to be painful but it wasn't at all. There's even a photograph of someone supposedly having the operation and reading a brochure about HIV/AIDS, or at least balancing it for the camera. Another article not long ago depicted someone reading a newspaper. I wonder if that will make Zimbabwean men rush out to get circumcised?

The population control experts, Population Services International (PSI), are involved. How they think this will reduce fertility I hate to imagine, but they receive huge amounts of HIV money to spend on all sorts of dubious projects. So it's no surprise that they should be behind mass circumcision. Apparently they have managed to find a surprising number of health personnel, which means they have diverted them from more vital health work.

Anyhow, the operation has been reduced to 15 minutes, which is said to be a good thing. And there's even one and a half hours of counselling. All that is a lot more than the majority of women get for their immediate and life-threatening conditions, which results in many women dying during or just after childbirth, and many infants and under fives also dying unnecessarily.

Even children are not spared this zealous campaign, with boys over 13 eligible for the operation and schools being actively targeted. Any worries about widespread circumcision resulting in men (and women) failing to take other precautions to avoid infection with HIV, sexually transmitted infections and unplanned pregnancy, precautions which are all still required, have been brushed aside.

International donors who shy away from highly beneficial programs to improve health systems, which would benefit whole populations and reduce all sorts of life-threatening conditions, seem to be falling over themselves to pay whatever mass circumcision campaigns cost. They seem unconcerned about any damage that will result and about the very small benefit of such an intervention.

Meanwhile, Uganda is beginning to notice the results of ignoring health services for too long. Maternal and child health are among the first areas to suffer. While Uganda is constantly praised for reducing HIV prevalence in the 1980s, they seem to have had little success since then, with rates remaining lower, but steady, ever since.

There are shortages of personnel in all facilities, also poor hygiene conditions, shortages of drugs and equipment, with the result that patients have to supply their own. But even still, they die from conditions that are easy to prevent and treat. Yet Uganda too will be pressed into a mass male circumcision campaign, which has already started in many areas.

Penile hygiene may be an important part of overall sexual health, for both men and women, but since when was it more important than basic health services that everyone depends on? Why are so many health resources and so much aid money being spent on an operation that will have a minimal impact on HIV transmission?


No comments: