Most Information Doesn't Trickle, Down or Up

There are some severe problems relating to information here in East Africa, even lifesaving information about healthcare, nutrition, water and sanitation, infrastructure and education, you name it. For a start, access to information is not particularly good; books are expensive and scarce, especially recently published and highly technical books. Journals are even less accessible, unless they happen to be available free of charge online (the majority are not), which means some are accessible to those who can use the internet, can access the internet and can select, evaluate and utilize the information.

Aside from the many logistical problems, even the issue of low educational standards which renders most information useless to many people, how does information get to influence people's lives, in any way? Health information relating to mass male circumcision is easy enough to find at the moment. But if you're a parent, guardian, teacher, peer educator, community health worker, volunteer or otherwise engaged in the field, you will probably be bombarded with fairly one-sided 'information'. You may be aware that things are not straightforward, but what can you do about it?

The newspapers interview top politicians, bureaucrats, heads of NGOs, doctors and other professionals, but they rarely mention dissenting views. When they do mention them, it tends to be a long way through the article, often juxtaposed with views that seem to contradict, rather than disagree with the dissenting views. So any opinion or even data opposed to the mainstream may possibly become known to people working in the field; but what would the status of that data or opinion be?

Over the years, I have talked to a mixture of people working in various fields that somehow relate to HIV, healthcare or even circumcision, along with people whose connection is on a personal level, or on a level that relates to family, friends and associates. But circumcision goes beyond being a mere medical procedure, especially in countries where some groups circumcise and some don't. Kenya is such a country; many of the tribes circumcise boys when they are in their early teens. But there are some groups who don't traditionally circumcise, such as the Luo, who make up one of the biggest tribes in terms of numbers.

Despite the issue of mass male circumcision programs being potentially very thorny, culturally, medically, politically, etc, a number of foreign donors have weighed in with funding for research, advice, manpower, equipment and anything else required to carry out their aim of circumcising between 800,000 and a million Kenyan (Luos) and between 22 and 38 million Africans (depending on which figures you use). In other words, those supplying finance and anything else have already decided that mass male circumcision is going to go ahead; they seem to be steaming through men in Kenya as if they are afraid the whole thing will lose momentum.

As the money is behind doing research that shows MMC is the right thing to do, that it will, definitely and unquestionably reduce HIV transmission (from females to males, male to female transmission may increase as a result), who is in a position to carry out research that may not find what the donors want them to find? Who will fund research that verifies previous research, that even investigates how that research was carried out and how current campaigns are being carried out? I doubt if anyone will.

So if a health professional, NGO worker, professional of any kind or anyone else wishes to express a dissenting view, it is unlikely anyone will be listening. If they receive public funding, which many do when their work relates to HIV or even health, they risk losing their funding. And if people in positions of even some slight influence are unlikely to say anything, those with no influence at all, and that's most people, are even less likely. And it's highly unlikely that anyone will take any notice if they do say anything. If we are going the wrong way, how will we know and when? And what will be done about it, if anything?

Over the next few days I hope to be able to write up some notes from talking to people about HIV, healthcare, circumcision and development in Western Kenya and Nyanza province.

[For more about non-sexual HIV transmission and mass male circumcision, see the Don't Get Stuck With HIV site.]