Saturday, January 21, 2012

How Many Dictatorial Bureaucrats Can You Fit in a Five Star Luxury Hotel?

It's discomfiting to hear that Uganda's male circumcision program is being described as 'failing' by a journalist. However, what the journalist actually says about the program is that they really haven't a clue how it is going. Of course, the journalist may know something that is not mentioned in the article. But knowing very little about an expensive, highly politicized 'health' campaign, and one that is concerned (ostensibly) with reducing HIV transmission, is certainly a failure of sorts; think of the publicity.

The Ugandans should take a leaf out of the Kenyans' book and just make up the figures. There's nothing a foreign donor likes more than to hear that everything is going well and few things they hate more than to hear that those involved are indiscreet enough to tell the truth, even if it's an admission that they really don't know how many people have been operated on.

The Ugandans could even just adopt their current strategy on reporting numbers of people on HIV drugs; they don't take too much notice of the substantial percentage that is lost to follow-up every year, those who die or those who develop resistance to the 'cheap' drugs, if they even notice the last issue at all. Many of those being counted could have died or could be getting double counted because they are registered for drugs in several places, which is done because Uganda has never been able to get its drug supply capacity quite right.

The article claims that there is a high demand for circumcisions, which is surprising when the same sentence also says it's not known how many men are receiving the operation. Apparently "most of the institutions carrying out circumcision don't share their data with the ministry of Health". So the journalist and those interviewed are, effectively, just guessing. Which is not really a problem, after all, as those publishing 'figures' purporting to show that male circumcision has any appreciable impact on HIV transmission are entirely unable to say why such an operation should work in the way they say it does, nor why it only seems to work as often as it clearly doesn't work. They too are just guessing.

As for various health facilities not sharing data, I guess that's no more horrifying than the admission that data is not always even shared with people taking part in some of these studies. HIV positive people are not always told they are HIV positive, their partners are not always warned, etc. This wouldn't happen in the countries from where the money emanates for this research, but it appears that ethical standards paid for by big donors, such as Gates and whoever he fronts for, don't apply to Africans. Like Tuskegee (which is so often mentioned in these contexts), it may come out in a few decades time, but for now, people who are known by medical professionals to be HIV positive are allowed to leave health facilities and infect their partner or partners, and no parties need be informed.

The commissioner for National Disease Control, Dr Alex Opio, does "not have a single figure on the great work being done": so how does he know how great it is? I'm glad he has spotted that there is a need to "address this immediately", but shouldn't he wait till he knows what is going on before commenting so liberally? Aren't there laws about telling the truth to journalists when there are important international donors involved?

In a sense the commissioner is right: such 'data' is being used for 'evidence-based medicine'; the whole circumcision (for Africans) program is based on such questionable evidence. Despite citing the rather far-fetched figures ("4.2 million adult/adolescent men need to be circumcised in five years to avert 340,000 new HIV infections by 2025"), the commissioner does realize that a lot of foreign money is pulling out. But enthusiasm for circumcision still seems to be as keen as ever. Other figures cited are equally disturbing, such as the 20.3 million Africans that 'need' to be circumcised, which we are assured will 'prevent' several million infections and save 16.5 billion dollars in treatment costs.

In stark contrast to all the rhetoric about democracy, good governance, accountability and the like that we hear from some of the more pompous and sanctimonious representatives of the HIV industry, some of the least accountable and most undemocratic institutions the world has ever known (as for governance, we don't know, they are unaccountable) have developed a framework 'in consultation' with national ministries of health.

Institutions listed include "the World Health Organization, the Joint United National Programme on HIV/AIDS (UNAIDS), the US President's Emergency Plan for AIDS Relief (PEPFAR), the Bill & Melinda Gates Foundation and the World Bank". While we have little idea how many Ugandan men have been circumcised under the current program, we can gain some idea of how much of the HIV industry funding will be spent, given that particular bunch of overpaid bureaucrats.

[For more about non-sexual HIV transmission, such as through unsafe healthcare and cosmetic services, see the Don't Get Stuck With HIV site and blog.]



Petit Poulet said...

If I get $75 for doing a circumcision and I get $75 for telling someone I did a circumcision without doing a circumcision, the choice is easy: take the $75 and don't do the circumcision. The profit margin is higher because you have decreased your costs.

Circumcision is the intervention of choice for people who have more money than brains.

Simon said...

You think some of the claims about the 'success' of circumcision programs is like the rollout of antiretroviral treatment? A lot of digital manipulation? If you have any evidence, HIV in Kenya would treat it with the discretion it deserves.