Another problem is that the randomized controlled trials did not show that circumcision protects against sexual transmission of HIV. Some people on the trial may have been infected through unsafe healthcare, or one of several other routes. This could mean that circumcision is even more effective than previously thought, of course. But it also means that we don't have a clue why or how circumcision may protect against the virus. What we do know is that the operation is unlikely to reduce transmission from HIV positive men to women, and that it probably even increases transmission. HIV positive men may already be circumcised. If they are not, they are eligible for the mass circumcision programs; so the net benefit may be negative.
But back to Zimbabwe, where HIV prevalence is higher among circumcised men. Why would circumcising anyone be beneficial? If 'the science' is behind circumcision in Kenya, Uganda and South Africa, where the randomized controlled trials suggest that the operation may be beneficial, shouldn't Zimbabwe recommend that parents do not allow their infant boys to be circumcised? Shouldn't plans to circumcise millions of Zimbabwean people, at a cost of hundreds of millions of dollars, be shelved? A spokesperson said infant circumcision was 'more sustainable' than adult circumcision. But does that mean it's cheaper? Because that is not the same things as sustainability.
The HIV industry finds Zimbabwe's HIV epidemic quite mystifying anyhow. HIV prevalence figures were estimated to be among the highest in the world in the late 90s, at almost 30%, but dropped to half that in the following 10 years. Of course, much of that drop could probably be explained by massive death rates. But it is likely that incidence, the annual rate of new infections, also dropped. The industry claims that almost all transmission is a result of 'unsafe' sexual behavior. Therefore, they are forced to believe that levels of 'unsafe' sexual behavior were reduced radically at a time when the country was experiencing political, social and economic turbulence.
There are probably several reasons why incidence declined. Radical changes in sexual behavior seem unlikely to be a result of the HIV industry's interventions because the same interventions have never been shown to have had much impact elsewhere (though the industry is loath to admit that), also because there is little evidence that Zimbabwe (or any other country) ever followed the industry's 'advice' particularly faithfully. The puzzled authors of the PLOS Medicine article above can do little but scratch their heads, but they don't even mention the possibility that health facilities may have been responsible for a significant proportion of transmission at one time in Zimbabwe and that this reduced as health facilities became less accessible.
That may be unfair to Zimbabwe health services. After all, transmission in health facilities may have reduced because conditions were improved. These are empirical questions, and ones unlikely to be answered by the HIV industry because they simply refuse to ask them, or to allow others to do so. Perhaps we'll never know. But it would seem like a smart question to ask. If HIV transmission is sometimes a result of unsafe healthcare, and it may almost never be, as UNAIDS claim, will circumcising adults make any difference? Will circumcising infants? Wouldn't it be better to reduce unnecessary operations in health facilities and concentrate on more urgent matters?
Tomorrow is World AIDS Day and one of the industry's offerings is a rather sickening song from 'Champions for an HIV-Free Generation'. It asks us what we are waiting for, tells us that circumcision is cool and clean and protects lives, that it's what the smarter generation does and advises us that if we are champions we should get circumcised. The song even mentions Zimbabwe and several other countries where HIV prevalence is higher among circumcised than uncircumcised men. This is not about whether people should or should not circumcise for religious or any other reasons, it's about the ethics of aggressively marketing circumcision for its protective benefits against HIV in countries where HIV prevalence is higher among circumcised men.
[For more about non-sexual HIV transmission and mass male circumcision, see the Don't Get Stuck With HIV site.]