Friday, June 8, 2012
According to one source, Uganda plans to circumcise 4.2 million men by 2015 in the hope that this will reduce transmission of HIV from women to men (there is evidence that it increases transmission from men to women). At around $120 dollars per operation (probably a low estimate), that comes to 500 million dollars or so. And that's just 15-49 year olds; there's no telling how many infants and children will also face the same treatment.
Just to put those ludicrous figures in perspective, Uganda is short of surgeons by an estimated 3,300. It's said that the problem is not a shortage of trained medical personnel, but rather brain drain. But with fewer than 100 specialist surgeons for 34 million people, it might strike one as strange to add such an almighty burden to an already overstretched health service.
The cost of each circumcision will probably be about 25 times per capita spending on health by government and donors combined. The $150 million said to be spent on treating government officials abroad seems diminished beside what will be spent on a mass male circumcision program that, even according to enthusiasts, may only prevent one infection in every 100 men circumcised.
Perhaps we should not worry so much. There are plans to train people who are not surgeons, who are not even doctors, to carry out the bulk of the operations. But, rather than spending so much on what will effectively be a parallel health system, dedicated entirely to circumcising men, it might seem better to provide incentives for some of the tens of thousands of trained Ugandan health professionals currently working in the US to return to their home country for a while?
In fact, $500 million could do a lot for health in Uganda. Instead of blowing it on an operation that is more risky, more expensive and less effective in reducing HIV transmission than correct penile hygiene, many of the most common diseases that cause the highest proportion of morbidity and mortality could probably be cut to a fraction with that kind of money. So why the continued insistence on circumcision at all costs?
[For more about non-sexual HIV transmission and mass male circumcision, see the Don't Get Stuck With HIV site.]