Thursday, January 19, 2012
According to an article on IRIN's PlusNews there is 'good progress' being made in the male circumcision program in Tanzania, which presumably means that they are going to get away with performing hundreds of thousands, perhaps millions of operations, knowing that the overall positive result will be small at best and there will be a lot of adverse events, perhaps even serious ones. It's clear that people pushing for these programs are not in the least bit worried that they will have to bear the costs of any adverse events. Who knows, perhaps they'll even profit from them.
But it's not unusual for circumcision 'experts' to make light of the subject. It is also claimed that the goal is to circumcise 2.8 million men by 2015 in a country where many people die of cheaply and easily preventable and treatable conditions every day. Many tens of circumcisions will need to be carried out just to prevent a single HIV infection, if the figures we are constantly blasted with are right. Where prevalence is particlularly low, hundreds of circumcisions will need to be carried out to prevent a single infection.
The program is being rolled out in Iringa at the moment, where HIV prevalence is much higher than anywhere else in the country. Yet it's certainly not the only area where circumcision rates are low. There are many areas within high HIV prevalence countries where circumcision and HIV are positively correlated, as well as areas where they are negatively correlated. In other words, we don't know what the connection is between HIV and circumcision and we certainly don't know why so many people are becoming infected in just some areas.
Are we supposed to believe that people in Iringa have amazing amounts of sex, unlike, say, the people in Arusha, Moshi or Kigoma, where HIV prevalence is far lower than the national average? Or perhaps we are supposed to believe that HIV prevalence in cities, particularly Dar es Salaam, are high just because of love levels of circumcision. In some places where birth rates are very high, such as the Northeastern province in Kenya, HIV prevalence is less than one percent. People there are clearly having sex, unless there has been a sustained outbreak of virgin births in the area. But the claim that there has been such an outbreak is no less ludicrous than the claim that HIV prevalence is high in some countries purely because of sexual behavior or, even worse, because some of the men are not circumcised. Circumcision rates are very high in Northeastern province, but they are also high in Western Kenya, where HIV rates are high too.
There is some evidence of mission creep in this program: originally these crazy claims were about adult male circumcision. Now, some articles mention infant circumcision and this one about Tanzania says that the 2.8 million people includes men from 10 years old to 34 years old. The cost of all this is estimated at between 28 and 47 million dollars, which would probably be enough to completely eradicate far more serious conditions, such as obstetric fistula, and still leave some change to train some much needed health professionals. By the way, nurses have been trained to do the operation in Tanzania and elsewhere, as there are not enough doctors.
It's worth bearing in mind that circumcisions are more common in urban areas, where HIV is less common. But that might change. Earlier circumcision programs suggested that some men could have been infected with HIV as a result of unsafe healthcare they received. This was very inconvenient and the embarrassing results were not published for journalists and other commentators to rant about, but I wonder if they would even have bothered. It's too late for the hundreds of thousands of Kenyans claimed to have already had the operation, probably unnecessarily, and the tens of thousands of people in other African countries. But there is still time for some African countries, or African people, to get some impartial advice about this subject, which is now top heavy with industry lies.