Thursday, January 19, 2012

Is it Already Too Late For People to Reconsider this Circumcision Farce in Africa?

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.



Shinobe said...

Millions of dollars wasted on circumcision campaigns would pay for anti-retroviral medications for all the people infected with HIV, thereby virtually eliminating secondary transmission of HIV. The HIV studies and circumcision campaigns prove that Tuskegee has moved to Africa. Cultural colonialism lives! See the Rebecca Project website. Look at the article in The Journal of Public Health in Africa by Van Howe and Storms. Look at Boyle and Hill's article in the Journal of Law and Medicine on the African RCT's. Good Work!

Petit Poulet said...

Condoms cost 2.5¢ each. For the cost of one circumcision in Africa (about $75) you can buy a two- or three-lifetime supply of condoms. If you believe the numbers from the circumcision trials you need to circumcise about 75 to 100 men to prevent one HIV infection. The problem is that you can't believe the numbers from the trials because half of these men probably were infected through non-sexual means. Consequently, we have no idea what impact on circumcision had on sexually transmitted HIV because we don't know which infections in the trial were sexually transmitted. So if half of the infections had nothing to do with sex, then the number needed to treat would be 200 or higher for the men in the trial.

The numbers are much different outside the trial as several African countries have higher HIV prevalence in their circumcised men than in their normal men. In other words, if circumcision is so effective why has it failed in so many countries?

We know that condoms and treating HIV-infected person with ARTs for all practical purposes eliminates the sexual spread of the virus. Why waste money on something that is less effective, more expensive, and more invasive?

Let's focus on the things that work: clean needles, clean medical equipment, condoms, and ART.

Simon said...

Thank you both for your comments, very much to the point. Let's hope the word gets around, there's a lot more to circumcision than public health disinformation.