Wednesday, May 30, 2012
I am in sympathy with the popular notion that people in developing countries need access to information, especially about health and other matters that profoundly affect their lives. But I wonder how people are to filter out the noise and only act on the information that really is to their benefit. How are people to know the difference between truth and lies, usage guidance and sales pitch, campaigns to promote health and campaigns to fulfill the sordid aims of some overfunded eugenicist (for example) or a power crazed imperialist? You could spend a lifetime doing some of these.
Take for example the CIA's fake polio vaccination drive to get Osama Bin Laden's DNA: clearly this had nothing at all to do with health, but was related to the aims of the very people who trained and supported Bin Laden for a long time. But how can anyone tell? Organizations that started out as overtly eugenicist later became covert eugenicists and many of them went on to be some of the biggest recipients, first of 'reproductive health' funding, at least some of which consisted of aggressively marketing various birth control methods, then of HIV 'prevention' funding, some of which consisted of, well, pretty much the same thing.
Aggressive marketing of Depo Provera and other injectable hormonal contraceptives is just one of the more recent campaigns that is based on a highly questionable mix of information, disinformation and sales puff. Mass male circumcision campaigns are similar: people have been told all sorts of things and the result seems to be terrible confusion. Research in Zambia and Swaziland finds that many men and women don't actually know the difference between a circumcised and an uncircumcised penis, even when they are shown pictures. Yet those who have been circumcised are said to have given their 'informed consent'.
Even comfortably off, well educated people in Western countries seem to be confused. Dubious arguments about circumcision reducing men's risk of being infected with HIV through heterosexual intercourse are understood as also meaning that women are partially protected, even though research has shown that it actually increases the risk to women. Arguments for mass male circumcision campaigns for sexually active adults, who may possibly be able to give their consent if given correct information (which is unlikely to happen), are used for infant circumcision. But infants tend not to engage in heterosexual sex and are unlikely to do so for many years. As adults they may be able to give their consent to the operation, though possibly with as little likelihood of that consent being informed as it was for their parents.
Apparently some bright spark has introduced 'moonlight circumcision' on the border between Kenya and Uganda. Voluntary Counselling and Testing clinics have been providing moonlight services for some time but they tend to attract a lot of people who have had a few drinks first. The notion of pressganging comes readily to mind. The excuse is that it's for people who have to work during the day. One of the 'mobilizers' is quoted as saying "It's encouraging to note that chiefs, their assistants and church priests have also presented themselves, albeit secretly". Are the priests so misinformed that they think they can have risk free unprotected sex once they are circumcised? Or do they think they are at risk even though they are celibate?
The mobilizer also "urged the youth to remain faithful to one partner, use a condom, abstain from sex and know their HIV status", which suggests that he is not very familiar with the published literature that claims circumcision reduces the risk of being infected with HIV: firstly, the literature assumes, as the mobilizer does, that all HIV transmission is sexual; secondly, that the level of protection is high when it is actually very low (1.3% absolute risk reduction); thirdly, the research also found that correct penile hygiene gives far better protection than circumcision, etc, you get the point.
Much of what is dressed up as health promotion is really just some kind of propaganda, from those who believe population control is the key to development, those who want to sell pharmaceutical products that they find difficult to shift back home (injectable Depo Provera), those who recognize the damage that genetically modified organisms can do, but also the profits that can be amassed, and those who really don't give a damn about the ill-effects of their programs (Tuskegee, mass male circumcision) as long as they get to satisfy their own needs, however pathological.
Clearly, getting information out is not the only problem. I met people in Kenya who had heard all about agricultural products that cost very little and are guaranteed to give high yields every year, no matter what the prevailing conditions are, all from someone working from a company called Syngenta. It clearly matters who is providing the information, or even access to it, why they are doing so and what ulterior motives they may have. Not that it's always wrong for them to have ulterior motives, but it's hard to evaluate the information without knowing such things.
So it remains to be seen whether access to information campaigns will result in a free-for-all of 'providers' hawking their infomercials dressed up as training courses, free samples designed to get people hooked on things they don't need and can't afford, evangelists selling salvation, or worse, get rich quick schemes, technocrats, quacks, supremacists, megalomaniacs, pseudo-philanthropists, etc, which is the status quo but with better delivery channels, or something else entirely. What kind of information provision campaign can avoid these pitfalls?
[For more about non-sexual HIV transmission, circumcision and injectable Depo Provera, see the Don't Get Stuck With HIV site.]