Sunday, September 28, 2008



while suturing a cut on the hand of a 75-year old Texas rancher whose hand was caught in a gate while working cattle, the doctor struck up a conversation with the old man.
Eventually the topic got around to Sarah Palin and her bid to be a heartbeat away from being President.
The old rancher said, 'Well, ya know, Palin is a post turtle.'
Not being familiar with the term, the doctor asked him what a post turtle was.
The old rancher said, 'When you're driving down a country road and you come across a fence post with a turtle balanced on top, it's a post turtle.'
The old rancher saw a puzzled look on the doctor's face, so he continued to explain.
'You know she didn't get up there by herself, she doesn't belong up there, she doesn't know what to do while she is up there, and you just wonder what kind of dumb a*s put her up there to begin with.



After listening and reading most of the reactions from news pundits, blogs, news-both cable and e-news and having watched the debate live as it proceeded. It became increasingly clear that the Democratic candidate did a good job! And maybe-just maybe this country could be ready for a change and make history while at it.

At this point I am willing to bet a democratic presidency this time around. I usually don’t bet and as a matter of fact, I am anti-betting. But history is looking at me in the face and I want to be a tiny part of it, even if it means breaking my own rules.

Having said the above, given that the “right leanings” said the debate was a tie and the “left leanings” and “in-betweens” said Obama won I am going to go with Mr. Mark Halperin’s of US TIMES grading. I think he summed it up pretty good-What do you think!

Here we go….

John McCain
Substance: His arguments were hard to follow at the beginning, but he found his voice as the debate progressed, although he never seemed fully in control of his message. He had plenty to say about the economy, Iraq, Afghanistan, and Russia, but often bogged down his own answers when trying to unfurl quips and sound bites. Stuck with bumper sticker slogans on the economy, and while he got a bit more detailed on foreign policy, he stayed at his usual level of abstraction. If he truly knows more about the world than Obama, he didn't show it in this debate.
Grade: B-

Style: Cluttered, jumpy, and often muddled. Frequent coughing early on helped neither his arguments nor his image. Jokes about being deaf and anecdotes about Normandy and George Shultz seemed ill-advised — even his pen was old. His presentation was further hindered by his wandering discussion of the differing heights of North and South Koreans and his angry assertion about how well he knows Henry Kissinger. Fell into the classic politician's trap of inserting familiar stump speech applause lines into debate responses — which only works if done with enthusiasm and clarity (and if received by applause — a big No-No in Lehrer's auditorium, which the audience obeyed seriously and silently). Keenly aware of the grand, grave occasion, McCain wavered between respectful and domineering, and ended up awkward and edgy.
Grade: C-

Offense: Emphasized his bread and butter issues of taxes and spending, and hit Obama on his failure to visit Iraq and his expressed willingness to meet with dictators. But while mocking his opponent on a few occasions, which reflected his acute disrespect for Obama, he did so in an insufficiently sharp and detailed manner — and unevenly worked elements of his rival's record into his attacks. Still he was utterly confident about his own experience, knowledge, and policies, even when tripped by his own tongue and distracted by the strains of debate practice. The main problem: Obama's obvious preparation and sharp answers contradicted McCain's frequent claims that the Democrat was uninformed and "didn't understand" key issues.
Grade: C+

Defense: He managed to ignore most of Obama's jibes, but was eventually baited into giving an extended answer about his policy differences with President Bush, after his opponent repeatedly mentioned McCain's regular support of Bush's budgets. Was visibly riled when clashing with Obama over a variety of issues, including Iraq, sanctions, and spending. He also chose to boast about Sarah Palin (although not by name) as his maverick partner, who, after her shaky week, may no longer be his ace in the hole.
Grade: B-

Overall: McCain was McCain — evocative, intense, and at times emotional, but also vague, elliptical, and atonal. Failed to deliver his "country first versus Obama first" message cleanly, even when offered several opportunities. Surprisingly, did not talk much about "change," virtually ceding the dominant issue of the race.
Overall grade: B-

Barack Obama
Substance: Quite manifestly immersed in the past, present, and future details of policy, and eager to express his views, which have been expanded, honed, and solidified during the last 18 months of hard campaigning. Still, he did avoid the nitty-gritty details of policy positions in favor of broad principles and references to working Americans, thereby not presenting the kind of specifics that some voters are waiting to hear from him.
Grade: B+

Style: Polished, confident, focused. Fully prepared, and able to convey a real depth of knowledge on nearly every issue. He was unhurried, and rarely lost his train of thought even when the debate wended and winded — and uttered far fewer of his trademark, distracting, "ums." At times, however, Obama revealed the level of his preparation by faltering over a rehearsed answer. He seemed to deliberately focus on the moderator and the home audience, with McCain as an afterthought — except when on the attack. Chose to avoid humor, for the most part, in favor of a stern demeanor, and in the process, came off as cool as a cucumber.
Grade: A

Offense: Linking McCain to Bush in his very first answer, he kept it up as his primary line of attack. Forcefully hit McCain for his early support of the Iraq War. Though he never drew blood, he did keep McCain a bit off balance, often with clever references to McCain's recent statements.
Grade: B

Defense: Had a reasonable answer for every charge that came his way — with little anger, bluster, or anxiety. Often interrupting McCain attacks with swift explanations and comebacks, he managed to spin accusations of being liberal as evidence of his relentless opposition to George Bush (in replies that were clearly planned). Offered a rather clumsy alternative to McCain's well-known, moving story of wearing the bracelet of a soldier lost in Iraq (a gift from the soldier's mother), with a story about a bracelet of his own. Fearless, without condescension, he attempted the gracious move of agreeing with or complimenting a McCain position, occasionally to his own detriment.
Grade: A-

Overall: Went for a solid, consistent performance to introduce himself to the country. He did not seem nervous, tentative, or intimidated by the event, and avoided mistakes from his weak debate performances during nomination season (a professorial tone and long winded answers). Standing comfortably on the stage with his rival, he showed he belonged — evocative of Reagan, circa 1980. He was so confident by the end that he reminded his biggest audience yet that his father was from Kenya. Two more performances like that and he will be very tough to beat on Election Day.
Overall grade: A-

Saturday, September 27, 2008




Why? (1)-In most of the western countries-Circumcision has sometimes been described as a solution in search of a problem. In the mid-19th century the problem was masturbation. Towards the end of that century it was syphilis. In the 1930s it was penile cancer. In the 1950s it was cervical cancer. 1980s - Urinary tract infections. And don’t forget the phimosis, the balanitis, and the cleanliness part.

For example, outside the Jewish community, where it’s a religious rite, circumcision was practically unheard of in America until 1870, when Lewis Sayre, M.D., claimed to have cured a 5-year-old boy of paralysis by stretching out his foreskin and snipping it off. For the next two decades, Dr. Sayre and his associates crusaded for circumcision, claiming it could cure hip-joint disease, epilepsy, hernia, convulsions, elephantiasis, poor eyesight, tuberculosis, and rectal prolapse, among other things. This was all disproved, of course, and circumcision would probably have vanished from the American medical scene had its backers not found a compelling new way to sell it: as a cure for masturbation. To the publicly puritanical but privately lascivious Victorians, masturbation was the root of numerous social maladies and physical illnesses, including blindness and even insanity. Naturally, they believed, if circumcision could prevent masturbation, it would prevent other diseases as well.

Doctors of the time reported that “removal of the protective covering of the glans tends to dull the sensibility” of the penis and “thereby diminishes sexual appetite.” In 1888, John Harvey Kellogg, M.D., of cereal fame, summed up the medical profession’s opinion and gave justification for the next 60 years of foreskin removal. “A remedy for masturbation which is almost always successful in small boys is circumcision. The operation should be performed by a surgeon without administering an anesthetic, as the pain attending the operation will have a salutary effect upon the mind since the infant wouldn’t be able to remember anything at this stage in his life-meaning-infants don’t feel pain.” By the end of World War II it was clear that circumcision was not stopping men from masturbating; but, by then, the procedure was institutionalized in America’s medical system. It had become the norm for white, middle-class American men. The uncircumcised were often recent immigrants or “African-Americans”. Probably as a result of racial prejudice, the uncircumcised penis was viewed as unhygienic and unclean. But this, too, turns out to be false.

It seemed that with the passing of time, the purported problems had gotten more trivial. It’s no Small wonder then that circumcision’s on the wane. But suddenly, there comes another big one–HIV/AIDS! Several eminent scientists and medical researchers have determined that a link exists between circumcision status and the rate of HIV transmission and they are urging universal adults/infants circumcision to help combat the disease. Circumcision promoters appear to have suddenly and finally found the mother of all problems’ solution. Regrettably, Smoke-screens, half truths and flat out lies have ensured. The issue is so enmeshed in emotion and advocacy that it's hard to know/tell where the truth is.
“The uncircumcised penis is self-cleaning,” explained Robert Van Howe, M.D., a pediatrician from Wisconsin who had been studying the causes of circumcision for 20 Years. “Every time you urinate, you flush out the preputial cavity. The hygiene issue was just another excuse. Since its inception, circumcision has been a surgery looking for a rationale. First it was disease, then masturbation, then hygiene; now it’s back to disease.” In 1971 the American Academy of Pediatrics (AAP) stated that circumcision was medically unnecessary. At the time more than 80 percent of American baby boys were circumcised. Then in 1989, the AAP released a new position paper that equivocated: “Newborn circumcision has potential medical benefits, as well as disadvantages and risks.” Still, by the following year, the rate was down to 59 percent.

Dr. Schoen chaired the AAP task force that made that reversal. He still stands by the position, claiming that the foreskin is the genital equivalent of the appendix, and that newborn circumcision is “a preventive health measure analogous to immunization.”

“The most important health benefit of circumcision is the decreased risk of urinary-tract infections,” explains Dr. Schoen, citing a well-known 1985 study, which he said has since been “overwhelmingly confirmed” by other studies. But Martin Altschul, M.D., a pediatrician and M.I.T.-trained mathematician, has reexamined the evidence and finds it fraught with problems “The whole body of research on this issue is a how-to-lie-with-statistics classic,” argues Dr. Altschul. “Depending on how you collect the data, you can get almost any result you want.” Dr. Altschul’s own research also found that many of the urinary-tract infections in uncircumcised boys were “attributable to congenital anomalies.” Recently, several studies have suggested that neonatal circumcision may actually increase the infection rate.
Dr. Schoen cited two other medical benefits of circumcision, namely decreased risks of developing penile cancer and contracting sexually transmitted diseases, such as HIV and syphilis.

“You’re more likely to be struck by lightning than to suffer from penile cancer,” counters Dr. Van Howe. “Japan, Norway, Finland, and Denmark all have lower rates than the United States, and they don’t circumcise their boys.”
In fact, in 1996, representatives of the American Cancer Society wrote a letter to the AAP in which they pointed out that “fatalities caused by circumcision accidents may approximate the mortality rate from penile cancer.” The letter also stated that “perpetuating the mistaken belief that circumcision prevents cancer is inappropriate.” Altschul. “It’s preposterous to even suggest that because we have some minuscule risk of disease, we should cut off the foreskin of every little boy.”

“Breast cancer in women is common,” says Dr. Denniston, “more common than all the purported health risks of the foreskin combined. Does that justify cutting off all breasts at puberty?”

What about circumcised men and STDs? A study published in the Journal of the American Medical Association around that time found that circumcised men did have a lower incidence of syphilis and HIV. But they had a higher rate of infection with herpes, hepatitis, and Chlamydia. Overall, the study authors wrote, “We found no evidence of a prophylactic role for circumcision, and a slight tendency in the opposite direction.”

“The bottom line,” says Dr. Denniston “is that the alleged benefits of circumcision don’t approach the risks.”

“Penile cancer is extremely rare-less than one case for every 100,000 men,” adds the Dr.
“Why is this procedure still covered by HMOs and health-insurance companies in America? The simple answer is, because parents want it,” says Patricia Wald, M.D., regional coordinating chief of pediatrics for Kaiser Permanente Medical Center in southern California. The doctors counsel parents so they’re making an informed decision, and don’t perform the operation unless asked. “We cover it as a courtesy. But to me it’s cosmetic surgery, like ear piercing.”

“After you counsel the parents appropriately and do the procedure,” Dr. Shoemaker explained, “it’s not a profitable use of time.”
Circumcision is the only surgery in America routinely performed without anesthesia. Sixty-four to 96 percent of circumcised infants endure the procedure with nothing to deaden the pain. Until recently, doctors often told parents they didn’t feel the same pain as adults.

“I didn’t know what circumcision really was when I consented to have my three sons circumcised,” says Marilyn Milos, founder and executive director of the National Organization of Circumcision Information Resource Centers (NOCIRC). “My doctor told me it was necessary, that it didn’t hurt, and that it took only a moment to perform-like cutting the umbilical cord, I thought.”
Ten years after her last son was born, Milos went back to school to become a registered nurse. As a student, she was asked to assist at a circumcision. “To see a part of a baby’s penis being cut off – without an anesthetic – was devastating.” Later, while working as a nurse, she made a videotape of the procedure and called it Informed Consent.

“Parents had no idea what was happening to their baby boys,” she explains. “The point was to show them what circumcision really entailed.” The hospital, Marin General in California, refused to allow expectant parents to view the tape. “They said it was too much for parents to see. I said, ‘then perhaps it’s too much for babies to experience.’”

In 1985, Milos founded NOCIRC. “It’s all such an unspeakable cover-up. The doctors are in denial, so the hospitals are in denial, so the parents are intentionally, illegally uninformed. Circumcision is the worst fraud in American medical history.” Recent studies support Milos’ gut reaction to unanesthetized circumcision. A issue of the Journal of the American Medical Association reported that “newborns...who did not receive an anesthetic suffered great distress during and following the circumcision, and they were exposed to unnecessary risk (from choking or apnea).” The report goes on to say that the skill of the surgeon did not reduce the pain, and that infantile amnesia (the “he-won’t-remember-it-anyway” argument) can’t justify it.
But even if doctors did use anesthesia, the reduction in pain would have to be measured against other concerns, such as the danger of using potent painkillers on day-old babies.

Then there is the question about how long the hurt lasts. “Circumcision causes such traumatic pain in newborns that it may have damaging effects upon the developing brain,” says James Prescott, Ph.D., director of the Institute of Humanistic Science in Long Beach, California. A psychologist who has written extensively on childhood trauma and its long-term effects, Prescott says the stress of circumcision damages the neural systems that mediate genital pleasure. In effect, he says, the baby’s brain is encoded to associate pain with pleasure. In fact, the pain is so severe that it’s not unusual for babies to go into a kind of shock, suddenly becoming silent and ceasing to struggle.

Most of the world’s leading medical establishments have come out against this surgery. “Circumcision of newborns should not be routinely performed,” says the Canadian Pediatric Society. “To circumcise...would be unethical and inappropriate,” says the British Medical Association. The Australasian [Australia and New Zealand] Association of Pediatric Surgeons states: “Neonatal male circumcision has no medical indication. It is a traumatic procedure performed without anesthesia to remove a normal, functional and protective prepuce.”

Kent Kleppinger, M.D., a pediatrician who performs circumcisions, says, “I tell parents circumcision is cosmetic surgery. It isn’t difficult to dissuade the mothers, but the fathers generally override their decisions. They want their boys to look like other boys in the locker room. They want their boys to look like them.”
Like father, like son. This may be one of the hidden reasons why infant boys are still being circumcised in America and may be a round the globe!

It may all come down to the basic human rights of the child. In 1996, the Canadian Medical Association approved a code of ethics that instructs doctors to “refuse to participate in or support practices that violate basic human rights.” This suggests that, in the case of circumcision, parental preference should not override the child’s physical rights to his body.

Margaret Somerville, professor of law and medicine at McGill University in Montreal –Canada and founding director of the Centre for Medicine, Ethics and Law, raised eyebrows at all North American pediatricians by declaring circumcision “technically criminal assault.”
“Once you decide that circumcision is not medically necessary, you take away the therapeutic intent. Take away therapeutic intent, and circumcision becomes an unjustified wounding,” she said.

Leo Sorger, M.D., writing in ObGYN News, is even more explicit: “Circumcision causes pain, trauma, and a permanent loss of protective and erogenous tissue. Removing normal, healthy, functioning tissue [for no medical reason]... violates the United Nations Universal Declaration of Human Rights (Article 5) and the United Nations Convention on the Rights of the Child (Article 13).”
In September 1996, the United States Congress passed a law banning the mutilation of female genitalia. “Americans are horrified by female genital mutilation,” said attorney Svoboda, “but they somehow don’t/didn’t recognize the routine torture going on in their own culture.” He acknowledged that a clitoridectomy is a more serious and detrimental surgery than circumcision, but he argued that “human-rights law doesn’t say if you cut off four toes, it’s a human rights violation, but if you cut off only three, it’s okay. That’s not how human-rights law works. If it’s wrong, it’s wrong. Involuntary circumcision is wrong.”

Why?-(2) Research studies-the most cited studies and probably the most referenced to date. As proving to have broken the camel’s back on circumcision - HIV/AIDS correlation are the two “researches” done in East Africa (Kenya and Uganda). The reports go like this: Adult Male Circumcision Studies-One study included nearly 5,000 men in Rakai, Uganda; the other almost 2,800 men in Kisumu, Kenya. Both were funded by the U.S. National Institute of Allergy and Infectious Diseases (NIAID). The NIAID should ring a loud bell here for those who are interested in looking at its affiliations/intentions and the facts thoroughly!

None of the study participants had been circumcised before the studies started. The report notes. The Ugandan men were 15 to 49 years old; the Kenyan men 18 to 24. They were randomly assigned to get circumcision (surgical removal of the foreskin) right away or after a two-year delay. Both studies enrolled participants by September 2005 and were scheduled to last until the middle of 2007.
That plan changed on Dec. 12, 2006, when researchers reviewed the studies' interim results, which showed that the men who had gotten circumcised were about half as likely to contract HIV. In the Ugandan study, the circumcised men were 48% less likely to acquire HIV. In the Kenyan study, they were 53% less likely.
Based on those results, the trials were stopped early so any participant who wanted to could get circumcised.

Let's start with the evidence. Several other studies carried out in Africa including the above two examples are reported to have found a positive correlation between HIV infection and non-circumcised status. Of note is that there are also some studies that have found a negative (read circumcision to increasing the risks of contracting HIV/AIDS) correlation. None of these studies are flawless, however. In some cases the sample size are either too small to give meaningful conclusions, or in some, the methodology are suspect and in others the logical inferences are unsupported by the evidence. That doesn't mean these studies are without merit. In the best of situations it's very difficult to conduct a controlled experiment with living human beings. People lie, change/modify their behavior, move, quit, die and worst of all for experimenters – people have rights.

An "ideal" experiment would be to randomly select a large sample of uncircumcised, non-HIV positive participants, circumcise half of them, force them all to repeatedly have sex with HIV infected partners, then conduct tests to see which group (circumcised or uncircumcised) has the highest rate of infection. That would be definitive. This is the only way we could confidently assert that a correlation exists. Alas, any conclusions drawn from any study that falls short of this "ideal" will have to be taken with at least some degree of analytic skepticism i.e. a pinch of salt-maybe?

The studies which allegedly show a reduction in HIV among circumcised men are highly questionable. Not one of them was finished, despite the protective affect appearing to decline well below the often-reported 65%, and several of the subjects disappearing. The fact that one study described circumcision as “comparable to a vaccine of high efficacy” seems to show clear bias. They appear to have been seeking a certain result. One has to wonder how many of the people promoting circumcision in Africa are themselves circumcised. Daniel Halperin is the grandson of a mohel, and seems to think that “maybe in some small way (he’s) destined to help pass along (circumcision)” so his objectivity is questionable.
Other epidemiological studies have shown no correlation between HIV and circumcision, but rather with the numbers of sex workers, or the prevalence of “dry sex”.

The two continents with the highest rates of AIDS are the same two continents with the highest rates of male circumcision. Rwanda has almost double the rate of HIV in circumcised men than the uncircumcised men, yet they’ve just started a nationwide circumcision campaign. Other countries where circumcised men are “more” likely to be HIV+ are Cameroon, Ghana, Lesotho, Malawi, and Tanzania. That’s six countries where men are more likely to be HIV+ if they’ve been circumcised.

Something isn’t right somewhere. Or could it be that these people aren’t interested in fighting HIV, but in promoting circumcision (or sometimes anything-but-condoms), and their actions will cost lives not save them in the long run? Think about it. Given the fact that NIAID doesn’t think there are any implications for U.S. Thus the “African studies will likely not have a large impact on the incidence of HIV/AIDS in the United States or Europe, where heterosexual transmission is low compared with areas like sub-Saharan Africa and parts of Asia," Bailey one of the two groups who conducted the East Africa “researches” said.

**Below are some of the lists of those who conducted the much cited “African experiment-research”**

1) Weiss HA, Quigley M, Hayes R. [Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis. AIDS 2000; 14:2361-70.]

2) Bailey C, Moses S, Parker CB, et al. [Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomized controlled trial. Lancet 2007; 369: 643-56.]

3) Gray H, Kigozi G, Serwadda D, et al. [Male circumcision for HIV prevention in young men in Rakai, Uganda: a randomized trial. Lancet 2007; 369:657-66.]

4)Auvert B, Taljaard D, Lagarde E, et al. Randomized, controlled intervention trial of [male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med 2005; 2(11):e298.]

**Remember the CDC clarifies that it hasn't made any recommendations on male circumcision to reduce HIV transmission and is studying risks and benefits of circumcision as an HIV prevention strategy.***

If you read those reports, the level of knowledge about HIV is quite frightening. In Malawi for instance, only 57% know that condoms protect against HIV/AIDS, and only 68% know that limiting sexual partners to only trusted and with known HIV negative status protects against HIV/AIDS. There are people who haven’t even heard of condoms. It just seems really misguided to be hailing male circumcision as the way forward. It would help if some of the aid donors didn’t refuse to fund condom education, or work that involves talking to prostitutes. There are prostitutes that sleep with 20-50 men a day, and some of them say that hardly any of the men use a condom. If anyone really cares about men, women, and children dying in Africa, they’d be focusing on education as a toll to teach about safe sex rather than surgery that offers limited protection at best, and runs a high risk of risk compensatory behavior.

**Somebody needs to tell politicians to stick to what they know and do best and not misguide the citizens about health issues. It is not helping, especially Kenyan’s politicians hailing from around the Lake Region- when they promote something that they seem not to have knowledge about or careless to know without consideration of cultural/customs ramifications attached. It is reckless! Hon., the PM. Raila Odinga and others promoting circumcision as a cure/prevention of HIV/IDS. I have to say respectfully , here you are wrong! Citizens need proper and appropriate measures/programs-educational, cultural or otherwise and safe ways to prevent and contain this tragedy. Stop the gimmick already! ****

Some findings have suggested that circumcised male virgins are more likely to be HIV+ than intact male virgins, as the operation sometimes infects men. The latest news is that circumcised HIV+ men appear more likely to transmit the virus to women than intact HIV+ men (even after the healing period is over). Eight additional women appear to have been infected during that study, solely because their husbands were circumcised. This is not the first time that HIV in women has been linked to partner circumcision.
ABC works against HIV. Circumcision appears not to. Remember that circumcision won’t make any difference unless someone isn't having unsafe sex with an HIV+ partner.

******Why? (3)- TO BE CONTINUED*********

Sunday, September 21, 2008



Circumcision -The practice has been performed since ancient times, when it was done as a religious rite or as an initiation of boys into adulthood. Most Jewish and Muslim parents throughout the world today continue to have their sons circumcised for religious and cultural reasons. In the United States overall, the practice is somewhat less common today than it was 50 years ago, but is still done almost routinely with parental consent of course. In the 1800s, it was believed that circumcision helped prevent masturbation. Any circumcised man, however, will tell you this is not true.

Health Issues:

Researchers have attempted to learn more about whether circumcision prevents infection and certain types of cancer, but more studies need to be done to answer these questions. It is known that circumcision prevents infection and inflammation of the foreskin. It seems to decrease the risk of cancer of the penis. This disease occurs in less than one of every 100,000 men in the United States and probably in other countries too. But there has been a lot of argument in the medical community about circumcision and the risk of cancer.

Some reports quote studies having shown a greater risk of cervical cancer in female sexual partners of uncircumcised men who are infected with human papillomavirus. Circumcision might also have a role in reducing the risk of sexually transmitted diseases. But using a condom is a far more important factor in preventing these diseases than whether a man is circumcised or not!


Some physicians say circumcision makes it easy to keep the end of the penis clean and easier for the parents of infant boys to keep them clean also. This may be one reason why so many parents were told to circumcise their sons. (This is nothing but, just another speculation)

Other Reasons

Circumcision is often chosen by parents so that their son will not "look different" from his father or peers. The belief is that an intact (uncircumcised) boy will feel uncomfortable if he does not "match" or look-like his others. Many parents say they don't want their son to feel "strange" or "weird" in the locker room at school.


Phimosis –a condition where the male foreskin cannot be fully retracted from the head of the penis. As most boys are born with a non-retracting foreskin, the term is confusing because it denotes both a normal stage of development, and a pathological condition (i.e. a condition that causes problems for a person). This confusion is particularly pronounced in regard to infants. Conflicting incidence reports and widely varying post-neonatal circumcision rates reflect looseness in the diagnostic criteria Phimosis has become a topic of contention in circumcision debates. It is normal for a baby's foreskin not to retract, but as the child grows the foreskin is expected to become retractable. Some have suggested that physiological infantile phimosis be referred to as developmental nonretractility of the foreskin to more clearly distinguish this normal stage of development from pathological forms of phimosis. Different management is appropriate. In other words, there are different degrees of phimosis, and treatment may vary on the degree of phimosis.
Women also can suffer from clitoral phimosis.

Infantile or congenital phimosis

For most of the Twentieth Century, most of the medical profession had recognized that most male infants have foreskins which are still attached to the epithelium of the glans penis and cannot easily be retracted. There have been four types of medical responses and attitudes toward this fact:

1.In the first half of the Twentieth Century, some physicians recommended that the foreskin be repeatedly retracted, if necessary with some force, to free it from the glans. It was thought that this could prevent later (pathological) phimosis and urinary problems in older boys by permitting washing of the glans and foreskin. Poor hygiene was thought to predispose to pathological phimosis. This approach has not been recommended by physicians for many decades.
2.Particularly in the middle of the Twentieth Century, some physicians promoted routine neonatal circumcision to avoid phimosis. While circumcision prevents phimosis, at least 10 to 20 infants must be circumcised to prevent each case of potential phimosis according to some incidence statistics. If one believes even lower phimosis incidence estimates, far more must be circumcised to prevent each case of phimosis. While some still promote this view, most pediatricians do not considered it a compelling argument for routine neonatal circumcision.
3.In the last three decades, as the circumcision rate in North America has declined, the most common official recommendations and guidelines from medical societies, as well as infant care books written by experts, have emphasized that it is normal not to be able to retract an infant's foreskin fully and that it need not be done. The American Academy of Pediatrics recommends gentle soap and water cleaning, but specifically recommends against forcible retraction. There is now some suspicion that forceful retraction that results in inflammation may actually contribute to pathological phimosis at an older age. Although the rate of surgical treatment of phimosis (usually circumcision) is falling, some pediatric urologists have argued that many physicians continue to have trouble distinguishing developmental non-retractility from pathological phimosis, and that phimosis is over diagnosed. Phimosis is sometimes used as a justification for circumcision, so that it will be covered by a national health system or insurance plan. The definition may be stretched by a physician for an older child; particularly where (as in North America), post-neonatal circumcision is usually outpatient surgery by a pediatric urologist, more expensive than the neonatal procedure. Most infantile phimosis is simply physiological.

Though uncommon, phimosis can occasionally lead to urinary obstruction or pain. Causes of pathological phimosis in infancy are varied. Some cases may arise from balanitis (inflammation of the glans penis), perhaps due in turn to inappropriate efforts to separate and retract an infant foreskin. Other cases of non-retractile foreskin may be caused by preputial stenosis or narrowness that prevents retraction, by fusion of the foreskin with the glans penis in children, or by frenulum breve, which prevents retraction. In some cases a cause may not be clear, or it may be difficult to distinguish physiological phimosis from pathological if an infant appears to be in pain with urination or has obvious ballooning of the foreskin with urination or apparent discomfort. However, even ballooning does not always indicate urinary obstruction. There are several management approaches to infant phimosis. Most cases of simple physiological phimosis need no "management" but will disappear with time or simple stretching of the foreskin. Various topical steroid ointments have been effective at hastening separation without surgery. Several surgical techniques have been devised, which range from simple slitting of a segment of the foreskin to removal of it (circumcision).

Acquired phimosis

Phimosis in older children and adults can vary in severity, with some men able to retract their foreskin partially ("relative phimosis"), and some completely unable to retract their foreskin even in the flaccid state ("full phimosis").
Because of the "elasticity" of the diagnostic criteria, there has been considerable variation in the reported prevalence of pathological phimosis. An incidence rate of 1% to 2% of the uncircumcised adult male population is often cited, though some studies of older children or adolescents have reported higher rates. Relative phimosis is more common, with estimates of its frequency at approximately 8% of uncircumcised men. When phimosis develops in an uncircumcised adult who was previously able to retract his foreskin, it is nearly always due to a pathological cause, and is far more likely to cause problems for the man.
An important cause of acquired, pathological phimosis is chronic balanitis xerotica obliterans (BXO), a skin condition of unknown origin that causes a whitish ring of indurated tissue (a cicatrix) to form near the tip of the prepuce. This inelastic tissue prevents retraction. Some evidence suggests that BXO may be the same disease as lichen sclerosus et atrophicus of the vulva in females. Infectious, inflammatory, and hormonal factors have all been implicated or proposed as contributing factors. Circumcision is usually recommended though alternatives have been advocated.
Phimosis may occur after other types of chronic inflammation (e.g., balanoposthitis), repeated catheterization, or forceful foreskin retraction. Phimosis may also sometimes be brought on by diabetes, due to high levels of sugar being present in the urine of some diabetics, which creates the right conditions for bacteria to breed, under the foreskin.

Potential complications of acquired phimosis

Chronic complications of acquired (pathological) phimosis can include discomfort or pain during urination or sexual intercourse. The urinary stream can be impeded, resulting in dribbling and wetness after urination. Harmful urinary obstruction is possible but uncommon. Pain may occur when a partially retractable foreskin retracts during intercourse and chokes the glans penis. A totally non-retractable foreskin is rarely painful. There is some evidence that phimosis may be a risk factor for penile cancer. The most acute complication is paraphimosis (Paraphimosis image). In this acute condition, the glans is swollen and painful, and the foreskin is immobilized by the swelling in a partially retracted position. The proximal penis is flaccid. Paraphimosis is considered an emergency.

Treatment of phimosis

Phimosis in infancy is nearly always physiological, and needs to be treated only if it is causing obvious problems such as urinary discomfort or obstruction. In older children and adults phimosis should be distinguished from frenulum breve, which more often requires surgery, though the two conditions can occur together.
If phimosis in older children or adults is not causing acute and severe problems, nonsurgical measures may be effective. Choice of treatment is often determined by whether the patient (or doctor) views circumcision as an option of last resort to be avoided or as the preferred course. Some adults with nonretractile foreskins have no difficulties and see no need for correction.
•Circumcision is the traditional surgical solution for pathological phimosis, and is effective. Serious complications from circumcision are very rare, but minor complication rates (e.g., having to perform a second procedure or meatotomy to revise the first or to re-open the urethra) have been reported in about 0.2-0.6% in most reported series, though others quote higher rates. Preputioplasty, in which a limited dorsal slit with transverse closure is made along the constricting band of skin, can be an effective alternative to full circumcision. It has the advantage of only extremely limited pain and a very short time of healing relative to the rather more traumatic circumcision, together with no cosmetic effects.

There is a school of opinion among the medical profession that advocates and promotes a number of alternative methods where surgery, with all the attendant risks, can be avoided.

High rates of success have been reported with several nonsurgical measures:
•Application of topical steroid cream for 4-6 weeks to the narrow part of the foreskin is relatively simple and less expensive than surgical treatments. It has replaced circumcision as the preferred treatment method for some physicians in the U.K. National Health Service. Stretching of the foreskin can be accomplished manually, sometimes with masturbation, also known as the Beaugé method. The stretching can also be accomplished with balloons placed under the foreskin skin under anaesthesia, or with a tool. The tissue expansion promotes the growth of new skin cells to permanently expand the narrow preputial ring that prevents retraction.

Dilation and Stretching

Skin that is under tension expands by growing additional cells. A permanent increase in size occurs by gentle stretching over a period of time. The treatment is non-traumatic and non-destructive. Manual stretching may be carried out without the aid of a medical doctor. The treatment is inexpensive. Relief of phimosis by a stretching technique has the advantage of preserving all foreskin tissue and the sexual pleasure nerves. The Beaugé Method has proved successful for many and also this method was elected the most efficient method by several physicians.


A number of medical reports of phimosis incidence have been published over the years. They vary widely because of the difficulties of distinguishing physiological phimosis (developmental nonretractility) from pathological phimosis, definitional differences, ascertainment problems, and the multiple additional influences on post-neonatal circumcision rates in cultures where most newborn males are circumcised. A commonly cited incidence statistic for pathological phimosis is 1% of uncircumcised males. When phimosis is simply equated with nonretractility of the foreskin after age 3 years, considerably higher incidence rates have been reported. Others have described incidences in adolescents and adults as high as 50%, though it is likely that many cases of physiological phimosis or partial nonretractility were included.

Phimosis in some historical references

•According to some accounts, phimosis prevented Louis XVI of France from impregnating his wife, Marie Antoinette, for the first seven years of their marriage. She was 14 and he was 15 when they married in 1770. However, the presence and nature of his genital anomaly is not considered certain, and some scholars (Vincent Cronin and Simone Bertiere) assert that surgical repair would have been mentioned in the records of his medical treatments if it had occurred
•US President James Garfield was assassinated by Charles Guiteau in 1881. The autopsy report for Guiteau indicated that he had phimosis. At the time, this led to the simplistic speculation that Guiteau's murderous behavior was due to phimosis-induced insanity.


Balanitis- is the inflammation of the glans penis. When the foreskin (or prepuce) is also affected, it is termed balanoposthitis. This may be due to the lack of aeration and irritation because of smegma and discharge surrounding the glans penis causes inflammation and edema.
Inflammation has many possible causes, including irritation by environmental substances, physical trauma, and infection by a wide variety of pathogens, including bacteria, virus, or fungus—each of which require a particular treatment.


Escala and Rickwood, in a 1989 examination of 100 cases of balanitis in childhood, concluded that the risk "in any individual, uncircumcised boy appears to be no greater than 4%.”Oster reported no balanitis in 9545 observations of uncircumcised Danish boys. Balanitis in boys still in nappies must be distinguished from the normal redness seen in boys caused by ammoniacal dermatitis. While any man can develop balanitis, the condition is most likely to occur in men who have a tight foreskin that is difficult to pull back, or who have poor hygiene. Diabetes can make balanitis more likely, especially if the blood sugar is poorly controlled.


Some studies indicate balanitis to be more common in uncircumcised boys but, Van Howe found balanitis only in circumcised boys. Van Howe's study has been criticized for the fact that few boys were uncircumcised.

Genital washing

Many studies of balanitis do not examine the subjects' genital washing habits. However, O'Farrell et al. report that failure to wash the whole penis, including retraction of the foreskin in uncircumcised men, is more common among balanitis sufferers. Birley et al., however, found that excessive genital washing with soap may be a strong contributing factor to balanitis.
Diagnosis may include careful identification of the cause with the aid of a good patient history, swabs and cultures, and pathological examination of a biopsy.


Balanitis may cause edema, resulting in phimosis, or inability to retract the foreskin from the glans penis. Adherence of the foreskin to the inflamed and edematous glans penis is the cause.

Zoon's balanitis

Zoon's balanitis also known as Balanitis Circumscripta Plasmacellularis or plasma cell balanitis (PCB) is an idiopathic, rare, benign penile dermatosis for which circumcision is often the preferred treatment. Zoon's balanitis has been successfully treated with the carbon dioxide laser and more recently Albertini and colleagues report the avoidance of circumcision and successful treatment of Zoon's balanitis with an Er: YAG laser. Another study, by Retamar and colleagues, found that 40 percent of those treated with CO2 laser relapsed.

Circinate balanitis

Circinate balantitis (also known as balanitis circinata) is a serpiginous annular dermatitis associated with Reiter’s syndrome.

Frenulum Breve

Frenulum Breve – is the condition in which the frenulum preputii penis, which is an elastic band of tissue under the glans penis that connects to the prepuce (foreskin) and helps contract the prepuce over the glans, is short and restricts the movement of the prepuce. The frenulum should normally be sufficiently long and supple to allow for the full retraction of the prepuce so that it lies smoothly back on the shaft of the erect penis. The frenulum is comparable to the small band between the tongue's lower surface and the lower jaw.

Frenulum breve is often complicated by tearing of the frenulum during sexual activity. The torn frenulum results in healing with scar tissue which is less flexible after the incident causing further difficulties.

The diagnosis of frenulum breve is frequently confounded with that of phimosis (an occurrence as well as phimosis is however possible). The condition may be easily treated without major surgery by threading a suture through the lower membrane, and then tying a tight knot around the frenulum itself. After a few days the frenulum will weaken and eventually break apart to allow the prepuce to fully retract. Stretching exercises and steroid creams may also be helpful. Alternatively, it may be treated by a reparative plastic surgery operation called a frenuloplasty, or by complete circumcision including removal of the frenulum (frenectomy).


It was once believed that circumcision would prevent masturbation, in the 1800s when masturbation was not looked upon as a healthy thing to be doing. Circumcision does not prevent masturbation or increase fertility. The belief that circumcision enhances the sexual experience for men or for their sexual partners may not necessarily be true, either. I can't confirm or deny this as I am not the only one born with a penis, but many men would say or attest to the fact that they believe they are more 'sensitive' because of having a foreskin.

Cancer Risk

It is widely and falsely believed that uncircumcised men stand a greater risk of penile cancer. A big surprise- to many in the medical community who thought otherwise. But, In March of 1999, the American Academy of Pediatrics revised its circumcision policy statement and concluded that there is not sufficient data to support the supposed potential health benefits of circumcision. The organization no longer advocates routine neonatal circumcision. And after the analysis of almost 40 years of available medical research on circumcision in the US, the American Academy of Pediatrics (AAP) issued new recommendations stating that the benefits are not significant enough for the AAP to recommend circumcision as a routine procedure.

The new policy statement was published in the month's issue of Pediatrics, the journal of the AAP. “Circumcision is not essential to a child's well-being at birth, even though it does have some potential medical benefits. These benefits are not compelling enough to warrant the AAP to recommend routine newborn circumcision. Instead, we encourage parents to discuss the benefits and risks of circumcision with their pediatrician, and then make an informed decision about what is in the best interest of their child,” says Carole Lannon, M.D., MPH, FAAP, chair of the AAP's Task Force on Circumcision. The policy concluded, however, that it is legitimate for parents to take into account cultural, religious and ethnic traditions, in addition to medical factors, when making this decision. It states that to make an informed choice, parents of all male infants should be given accurate information and be provided the opportunity to discuss this decision with their pediatrician.” That was their conclusion at that time.

Either way, the eyelid/foreskin is naturally designed to protect the head of the penis from abrasion and infection. Its surface represents 50 percent of all penile skin, and folds around the opening of the penis. Its inside surface is composed of a soft mucosa that secretes antibacterial and antiviral lubricants called smegma, which further protect the glans from friction and infection. Because the glans is sheathed in this moist envelope, it retains its sensitivity. During sex, the foreskin glides along the penile shaft, providing lubrication and stimulation. And some spouses married to uncircumcised husband would say- “There’s a big industry in this country selling lubricants and jellies to enhance sex, but they’re unnecessary for those of us lucky enough to have married an uncircumcised man. An intact man’s glans is naturally moist and juicy.”


Saturday, September 20, 2008




Meningitis is an infection of the meninges, the thin lining that surrounds the brain and the spinal cord. There are reports that the causative agent, Neisseria meningitidis (the meningococcus), was first identified in 1887.

Infection within the subarachnoid space or through out the leptomininges is referred to as meningitis. Based on the host’s response to the invading microorganism, meningitis is divided into two major categories: Purulent and Aseptic meningitis.


A patient with purulent meningitis will typically have marked acute inflammatory exudates with large numbers of polymorpholonuclear cells. Frequently the underlying CNS tissue, in particular the ventricles, may be involved. If the ventricles become involved, then this process is referred to as ventriculitis. These infections are frequently cased by bacteria.


The outcome of a host-microbe interaction depends on the characteristics of both the host and the microorganism. An important host defense mechanism of the CNS is the blood-brain barrier; the choroids plexus, arachnoid’s membrane and the cerebral microvascular endothelium are the key structures. Because of the unique structural properties of the vascular endothelium, such as continuous intercellular tight junctions, this barrier minimizes the passage of infectious agents into CSF in addition to regulating the transport of plasma proteins, glucose, and electrolytes.


Age of the host and other underlying host factors also contribute to whether and individual will be predisposed to develop meningitis or not. Neonates have the highest prevalence of meningitis cases. This is probably due to their immature immune system, the organisms present in the colonized female vaginal tract, and the increased permeability of the blood –brain barrier of newborns. Lack of demonstrable humoral antibody against Haemophilus influenzae type [b] in children has been associated with increased incidence of meningitis. Before the age of widespread vaccination, most children developed measurable antibody by around age 5. Also adults without the necessary antibody to Neisseria meningitidis could be linked to epidemic meningitis-especially those who live in crowded areas/conditions (e.g. military barracks, high school/college dormitories). N. meningitidis has been associated with epidemic meningitis.

Because the respiratory tract is the primary portal of entry for many etiologic agents of meningitis, factors that predispose adults to meningitis are often the same as those that increase the likelihood that the adult will develop pneumonia or other respiratory tract infections/colonization. Alcoholism, splenectomy, diabetes mellitus, and immunosuppression contribute to increased risk. Patients with prosthetic devices- particularly central nervous system shunts are also at risk of developing meningitis.

For organisms to reach CNS-primarily through blood borne route, host defense mechanism must be overcome. Most cases of meningitis caused by bacteria share a similar pathogenesis. A successful meningeal pathogen must first sequentially colonize and cross the host’s mucosal epithelium and then enter and survive in the bloodstream. The most common causes of the meningitis possess the ability to evade the host’s defense mechanism at each of these levels. For example clinical isolates of the Strep. Pneumoniae and N. meningitidis secrete IgA proteases (enzymes) that destroy the action of the host’s secretory IgA, thereby facilitating bacterial attachment to the epithelium. In addition, all of the most common etiologic agents of bacterial meningitis possess an antiphagocytic capsule that helps the organisms evade the destruction by the host’s immune system.

Organisms appear to enter the CNS by interacting and subsequently breaking down the blood-brain barrier at the level of microvascular endothelium. To date one of the least understood processes in the pathogenesis of meningitis is how the organisms cross this barrier into the subarachnoid space. Nevertheless, there appear to be specific bacterial surface components, such as pili, that facilitate adhesion of the organisms to the microvascular endothelial cells and subsequent penetration into the CSF. Organisms can enter through-1) loss of capillary integrity by disrupting tight junctions of the blood-brain barrier, -2) transport within circulating phagocytic cells, or -3) by crossing the endothelial cell lining within endothelial cell vacuoles. After gaining access, the organism multiplies within the CSF, a site initially free of antimicrobial antibodies or phagocytic cells.

Clinical manifestations:
***** TO BE CONTINUED*****


Male circumcision as a tradition/or cultural practice.

Circumcision is very ancient - the oldest recorded operation - and traditional circumcision is found worldwide, in Africa, Asia, Australia, Europe and North and South America.


In North, South and West Africa, East Africa- Algeria, Cameroon, Chad, Egypt (Muslim and Christian), Ethiopia, Gabon, Gambia, Guinea, Ivory Coast, Kenya. Libya, Madagascar, Mali, Mauritius, Morocco, Niger, Nigeria, Senegal, Sierra Leone, Somalia, Sudan, Tanzania, Togo, Tunisia, Northern Uganda, South Africa, Zaire e.t.c e.t.c. all or part of their populations practiced circumcision as a form of their tradition.

Ancient Egypt

Ancient Egyptians carried out a complete circumcision, with the foreskin totally removed. It is believed that it is Egypt that most of the circumcision practices are traced back to.

The desert Arabs traditionally used a technique of constriction to minimize bleeding which has its counterparts in many modern surgical approaches. The foreskin was pulled forward as far as possible then tied up tightly with a cord. It was left like that for half an hour or so, then cut off in front of the knot. The string was then slipped off and the inner skin pushed back to meet the outer. The penis was bound up tightly to minimize bleeding, along with the operator's own idea of suitable bleeding remedy.

South Africa

In southern Africa the Xhosa, among others also carried/carry out a full circumcision (Umkhwetha) with a technique which is probably representative of many in AFRICAN traditions. The circumciser pulls the young man's foreskin forward, slipping it over his index finger like a glove and holding it in place with his thumb and middle finger. Stretching it tightly he cuts it around, cutting between his finger and the tip of the penis. The outer skin springs back down the shaft, and the remaining inner skin is pushed back down over the shaft to meet it.

Special herbs are applied and a tight leather bandage to control the bleeding. For Xhosa-speaking people who practice ritual circumcision as a cultural institution, alternatives are negligible to non-existent. Initiation is seen as the formal incorporation of males into Xhosa religious and societal life, and before circumcision, a male cannot marry or start a family, inherit possessions, nor officiate in ritual ceremonies.


Most of the Kenyan societies, with the exception of only in the NILOTES. Luo-as a Nilotic group, practiced removing six of their front lower teeth as a rite of passage initiation to adulthood -some Nilotic groups removed four lower front teeth, others pierced their ears-e.t.c..e.t.c... .All as a part of traditional initiation-rites of passage with similar belief fundamentals as of circumcision) and Turkana among other Kenya's main forty -three-groupings practiced circumcision. Among the groups who practiced it, it was/is the ultimate rite of passage initiation from childhood to adulthood. And it was/is also the barometer of testing one’s courage and of readiness to join the adult club.

Among the BANTU groups, the Agikuyu,(who practiced/s both female and male circumcision) it’s known as (irua). Of all the Agikuyu members’ life stages, circumcision was and remains by far the most important, signifying not only a child's passage into adulthood, but a whole wealth of other socially significant meanings and assumptions of responsibility. For both boys and girls, initiation into adulthood - through circumcision or clitoridectomy - marks their admission into full membership of Kikuyu society, and was thus a momentous occasion, both socially and individually. Through circumcision and the period of initiation and instruction that accompanied it, an individual became a full participant in society as a whole, beyond the scope of the village and their families. Their responsibilities, therefore, extended not just to their family, but to the Agikuyu as a group. On the most basic level, which is shared across the board –for example among other Bantu and few Nilotic groups- the social consequence of a boy's circumcision meant that he would now become a warrior, and would spend several years in the service of the entire people to defend and protect, and occasionally attack neighboring groups (tribes-derogatory- please we need to find a better term!). Uncircumcised, the boy - for he would remain a boy even if he lived to ninety years they believed, and he would also be barred from getting married and raising children. For a girl, circumcision meant that she was able to bear children, and marriage was usually swift to follow.

Traditionally, there was a circumcision ceremony for boys organized by age-sets of about five-year periods. Although boys could be circumcised throughout that period, they would become part of the same age-set, and all the men in that circumcision group would take an age-set name. Times in the history of Kikuyu and others society who followed the practice could be gauged by age-set names. Circumcision was traditionally a public affair, which only added to the anxiety - and determination - of the boys to pass the ordeal without showing the slightest trace of fear. The practice of circumcision is still followed, although now it is more likely to be performed in hospitals. Traditionally, boys who underwent circumcision became warriors- this institution is no longer the case. As in so many societies all over the world, sex was seen as a weakness, both spiritual and physical. For this reason, junior warriors were barred from sexual relations, though in compensation they were also given a lot of food to make them strong. Only senior warriors, who were preparing to leave warriorhood, were allowed to marry and raise children.


The Philippines-the Philippines stands out in ASIA as among the only group who took/take circumcision seriously. As almost 95% if not 99% are circumcised. Close to 90% use or used dorsal slit technique since most of them are done-or at least used be done in the rural setting with a minimal fee- the literature evidence points out that, this has/had been part of their culture even before Magellan landed the Philippines in 1521.

A few decades ago, genital incision of Filipino boys (pagtutuli) was purely a traditional custom. An amateur (manunuli) would perform it on local boys. It is a "coming of age" ritual, and traditional for a boy to prove his manhood properly (strong and fearless-as in many traditional beliefs), it was and thus- must be done without anesthetic. In some areas, the boys sit astride a banana log into which a wooden plug has been inserted as an "anvil". The traditional rite is only super incision, a dorsal slit, removing no tissue (but with variations).

More recently pagtutuli is becoming more western oriented-read (modern medicine) and commercialized.

The traditional Filipino circumcision had the strong elements of it-as being a rite of passage from childhood to manhood/adulthood, though once healed, very little about a boy's life actually changes. At present, peer-pressure, parental pressure, medical pressure and the stigma against being supót (intact) make childhood circumcision almost - but not quite - inevitable.

A wide variety of organizations now organize operation tuli - mass circumcision sessions - as a charitable venture. Now most of the Filipino boys aged 7 - 10 years old are being circumcised by the groups during summer time under the banana tree by a circumciser using dorsal slit method that takes only few seconds without anesthesia. They don't mind being seen by others kids to be circumcised. Probably one peculiar thing about the present circumcision is that the boys themselves choose to be circumcised the parents are sometimes caught with great surprise that their son had the procedure done without them knowing. And most people when asked about the significance of being circumcised or left intact will mostly certainly respond on the logic that- it greatly depends on the place where one live and what is considered norm for a particular group of people living together in that particular region.

History- the Filipinos were under Islamic rule when Spain took over. Magellan was killed by a Muslim chieftain. Under Islam any uncut guy that resisted conversion was to be killed. Christians and Jews were accepted as we are "of the book" meaning our religion stems from Abraham (Ibrahim). Pagans were to be converted or killed. When Spain took over they were unable to convince the locals to stop the practice which was illegal in Spain and the new world. Any Spanish citizen found practicing any form of Islamic or Jewish religious practice after baptism was tortured and then burned at the stake. This was same for the Christians that were varied from Catholics to orthodox. Heretics they were called. And back to the Philippines, the practice of circumcision continued and the locals justified it as being a Christian thing (Jesus was of course Jewish). The feast of the circumcision was celebrated I believe in the 1st or 3rd of January. Not all Filipinos practice it, but it is undoubtedly done to the majority of males usually about the time of puberty, but again many are doing it to infants presently. The Chinese or Spanish ancestry doesn’t usually circumcise, but the people of local ancestry or mixed background mostly do circumcise.

Among other groups in ASIA and the wider MIDDLE EAST plus the Islamic areas, the - Afghanistan, Bahrain, Bangladesh, Indonesia (largest Muslim nation),Malaysia, Iran, Iraq, Jordan, Kuwait, Oman, Pakistan, (Hindu minority about 10%-donnot circumcise), Qatar, Saudi Arabia, Syria, Turkey, UAE, Yemen (N+S), Tonga and Samoa circumcision is practiced. It is not far fetched to note that most ASIAN/MIDDLE EASTERN countries, almost only those with Islamic religious background have literature showing circumcision being practiced. Other groups like the Koreans and Japanese- one of those with very few/smallest percentages of population that can be classified as circumcised, Indians-non Muslims, Buddhists areas such as Myanmar, Tibetans, and Hindu areas are not known to be pro-circumcision.


In the Americas- circumcision is mostly influenced by religion/region except in a few cases for example the NATIVE INDIANS and amongst NATIVES IN SOUTH AMERICA where circumcision can be traced back into a form of old tradition/customs.


In Australia-the NATIVES-THE ABORIGIN NATIVES have literature pointing to their circumcision as a tradition. But amongst the other societies, the practices is purely either religious or due to other forms of influence.

****PS/NB: This post still needs more information especially circumcision as a form of rite of passage amongst African’s many customs. Suggestions/additional info are welcome.


Circumcision could have been a function of a -check-balance to reduce a young man's potential to father a child with an older man's wife. Sperm competition theory predicts that males will ways evolve to ensure that their sperm, and not another male's, fertilizes a female's eggs. Genital mutilation, in this view, could be just another way of sperm war.

In some forms of mutilation, the handicap to sperm competition is obvious. There is sub incision, for example, where cuts are made to the base of the penis. This causes sperm to be ejaculated from the base rather than the end, and is performed in several Aboriginal Australian societies among others. In some African and Micronesian cultures, young men have one of their testicles manipulated. Male genital mutilation makes it less likely that a male will manage to father a child with another man's wife if that’s the desired outcome in those societies who practiced it.

Home advantage

Circumcision is one of the less painful forms of mutilation, but it is also less effective at reducing sperm competition. Some reports suggests, however, that the lack of a foreskin could make insertion or ejaculation slower, meaning brief, illicit sex is less likely to come to fruition and lead to a pregnancy. Younger men, willingly submit to having their reproductive ability reduced because they benefit socially from the older men, by forming alliances, and by gaining access to weapons and other societal lore.

The older men have also gone through the ritual, and seen their own reproductive effectiveness reduced. But if a man with, say, four wives wants to ensure that any children his wives produce are his, there is pressure to make sure other men can't successfully impregnate them. The husband's own reproductive ability is impaired, but continuous and repeated access to his wives makes up for it, while any genital mutilation is a greater handicap to an interloper trying to sneak brief occasional sex with his wives.

Price of alliance

An older-married man must form alliances, or associates with younger or unmarried men at some point, and it would be better to associate with and invest preferentially in those who are least likely to threaten his paternity, especially in societies where cuckoldry is rife.

Men who demand genital mutilations as part of the price for alliance and investment would be less vulnerable to exploitation of such relationships and loss of paternity to peers. If the sperm competition theory were to be correct, then male genital mutilation should be more common in societies where men tend to have multiple wives, especially those in which the wives live apart from the husband.
The mutilation would also probably be carried out in a public setting, witnessed mostly by other men, and performed by a non-relative. Men who refused would face social sanctions. Most highly polygamous societies practice some form of male genital mutilation and in societies in which wives live in separate households that increases as compared to those of the monogamous societies. It might also be the case that selection works at a group level, so that societies that enforce mutilation are more stable because of less conflict over paternity. Either way there is no scientific evidence to suggest that circumcision prolongs sex or prevents premature ejaculation.

****CIRCUMCISION-therapeutic/non-therapeutic to be CONTINUED**** more info/updates will be added to the circumcision as a part of tradition topic… as I get more info either from you readers or jAnaM.

Saturday, September 13, 2008


Circumcision and other religious groups:

Hinduism- In Hinduism not being circumcised is part of the Hindu religious identity.

Buddhism-Buddhism consistently emphasizes compassion and asks followers to practice harmlessness and to avoid extremes of asceticism or self mortification. Buddhism teaches that-an opportunity to become a Buddha is open to every living being that chooses to follow the eight-fold path to enlightenment that forms the important Buddhism symbol- the eight-spoke wheel or chakra which denotes the Eight-fold path to a virtuous life as taught by Buddha. Among other symbols which are significant in Buddhism are the lotus flower, stupa, mandalas and certain physical characteristics of the Buddha. These symbols may be an iconic or centered around the physical image of Buddha.

Therefore it seems clear that, circumcision in other religions is not that popular, as the golden rule suggests.

The Golden Rule in Six Religions:

No one of you is a believer until he loves for his brother what he loves for himself.

Regarding your neighbor’s gain as your own gain, and regard your neighbour's loss as your own loss.

All things whatsoever you would that men should do unto you, do ye even so unto them, for this is the law and the prophets.

That is the sum of duty; do naught to others which if done to thee, would cause thee pain.

Is there any one maxim which ought to be acted upon throughout one's life? Surely the maxim of loving-kindness is such. Do not unto others what you would not they should do unto you.

Hurt not others with that which pains you.

*****TO BE CONTINUED****** "Male circumcision as a tradition/or cultural practice".

Friday, September 12, 2008



For the sake of this topic/post, only Male circumcision as a traditional, cultural, religious, therapeutic or for non-therapeutic reasons is going to be considered.

Circumcision and religion:

A. Circumcision and Islam- Muslims are currently the largest single religious group practicing widespread circumcision as a rite/ritual. Although not mandated by the Qur’an, it serves to introduce males into the Islamic faith, and works as a sign of belonging to the wider Islamic community also viewed as an act of faith and compliance.

The Qur'an itself doesn't mention circumcision. In the time of Muhammad, circumcision was carried by many tribal Arabs, as well as by Jews for religious reasons. Muhammad himself was circumcised, and circumcised his sons. Many of his early disciples were circumcised to symbolize their inclusion within the emerging Islamic community. These facts are mentioned several times in the Hadith. Some Hadith group circumcision with the fitrah (acts considered to be of a refined person. Other such acts include: clipping or shaving pubic hair, cutting nails, cleaning teeth, plucking or shaving the hair under the armpits and clipping (or shaving) the moustache.

Despite its absence from the Qur’an, it has been a religious norm from the beginning of Islam. It is also considered hygienically clean.
Amongst Ulema, there are differing opinions about the compulsions of circumcision in Islamic law. The majority of Islamic legal opinion is that circumcision is obligatory. Imam Abu Hanifah, founder of the Hanafi School of Islamic jurisprudence, and Imam Malik maintain that circumcision is a Sunnah Mu'akkadah — not obligatory but highly recommended. Some scholars, including Imam Shafa’I and Ahmad ibn Hanbal see it as binding on all Muslims.

Time for circumcision

Islamic sources don’t fix a particular time for circumcision. It depends on family, region and country. A majority of Ulema however take the view that parents should get their child circumcised before the age of ten. The preferred age is usually seven although some Muslims are circumcised as early as on the seventh day after birth and as late as at the commencement of puberty. According to some Hadith (Abdullah Ibn Jabir and Aisha), Muhammad circumcised his children on the seventh day after their birth. This opinion is popular amongst the Hadith and Islamic jurists.


Islamic circumcision does not have a strictly mandated procedure, or form of circumcision. These tend to change across cultures, families, and time. In some Islamic countries circumcision is performed after Muslim boys have learnt to recite the whole Qur'an from start to finish. In Malaysia and other regions, the boy usually undergoes the operation between the ages of ten and twelve, and is thus a puberty rite, serving to introduce him into the new status of adulthood. The procedure is sometimes semi-public, accompanied with music, special foods, and much festivity. Traditional circumcisions however are steadily becoming rarer throughout the Islamic world, with many Muslim families preferring to have their sons done at birth or if they are done older it is normally done by a doctor under local anesthetic. Circumcisions are usually carried out in a clinic or hospital. The circumciser is not required to be a Muslim. The general ‘style’ of circumcision is the traditional stretch and cut which is typically reasonably tight but leaves a lot of the inner foreskin.

B. Circumcision and Christianity:

Christians, depending upon their viewpoint and denomination, either consider the Holy Bible to be an authority, or the sole authority for faith and practice.

Consequently, Christian parents may seek guidance from the Bible in reference to circumcision. Christian parents may wish to test circumcision by the scriptural guidance on parenting although there are also references to the falseness of those who advocate circumcision as a recurrent theme in the New Testament. For example, the Apostle Paul says circumcision is a false teaching (Gal. 2:4). To guide Christian parents who encounter false teachings, the text therefore contains references to false prophets, apostles and brothers.

Scriptures about circumcision

The gospels

Luke 1:59-60 Circumcision of John the Baptist.
On the eighth day they came to circumcise the child, and they were going to name him after his father Zechariah, but his mother spoke up and said "No! He is to be called John."
Luke 2:21-39. the Circumcision of Jesus.
On the eighth day, when it was time to circumcise him, he was named Jesus, the name the angel had given him before he had been conceived.
John 7:21-24 Jesus teaches at the feast.
Jesus said to them, "I did one miracle, and you are all astonished. Yet because Moses gave you circumcision (though actually it did not come from Moses but from the patriarchs), you circumcise a child on the Sabbath. Now if a child can be circumcised on the Sabbath so that the law of Moses may not be broken, why are you angry with me for healing the whole man on the Sabbath? Stop judging by mere appearances and make a right judgment."

Acts of the Apostles

Acts 15:1-21 the Council at Jerusalem:
Some men came down from Judea to Antioch and were teaching the brothers: Unless you are circumcised according to the custom taught by Moses, you cannot be saved. This brought Paul and Barnabas into sharp dispute and debate with them. So Paul and Barnabas were appointed along with some other believers to go up to Jerusalem to see the apostles and elders about this question. The church sent them on their way, and as they traveled through Phoenicia and Samaria, they told how the Gentiles had been converted. This news made all the brothers very glad. When they came to Jerusalem, they were welcomed by the church and the apostles and elders, to whom they had reported every thing God, had done through them.
Then some of the believers who belonged to the party of the Pharisees stood up and said, "The Gentiles must be circumcised and required to obey the Law of Moses."
The apostles and elders met to consider this question. After much discussion, Peter got up and addressed them: "Brothers, you know that some time ago God made choice among you that the Gentiles might hear from my lips the message of the gospel and believe. God, who knows the heart, showed that he accepted them by giving the Holy Spirit to them, just as he did to us. He made no distinction between us and them, for he purified their hearts by faith. Now then, why do you try to test God by putting on the necks of the disciples a yoke that neither we nor our fathers have been able to bear? No! We believe it is through the grace of our Lord Jesus that we are saved, just as they are."
The whole assembly became silent as they listened to Barnabas and Paul telling them about the miraculous signs and wonders God had done among the Gentiles through them. When they had finished, James spoke up: "Brothers, listen to me. Simon has described to us how God at first showed his concern by taking from the Gentiles a people for himself. The words of the prophets are in agreement with this, as it is written:
`After this I will return
and rebuild David's fallen tent.
Its ruins I will rebuild,
and I will restore it,
that the remnant of men may seek the Lord,
and all Gentiles who bear my name,
says the Lord, who does these things'
that have been known for ages.
It is my judgment, therefore that we should not make it difficult for the Gentiles who are turning to God. Instead we should write to them, telling them to abstain from food polluted by idols, from sexual immorality, from the meat of strangled animals and from blood. For Moses has been preached in every city from the earliest times and is read in the synagogues on every Sabbath."
Acts 15:22-35 the Council's Letter to Gentile Believers
Then the apostles and elders, with the whole church, decided to choose some of their own men and send them to Antioch with Paul and Barnabas. They chose Judas (called Barnabus) and Silas, two men who were leaders among the brothers. With them they sent the following letter:
The apostles and elders, your brothers,
To the Gentile believers in Antioch, Syria and Cilicia:
We have heard that some went out from us without our authorization and disturbed you, troubling you minds by what they said. So, we all agreed to choose some men and send them to you with our dear friends Barnabus and Paul -- men who have risked their lives for the name of our Lord Jesus Christ. Therefore we are sending Judas and Silas to confirm by word of mouth what we are writing. It seemed good to the Holy Spirit and to us not to burden you with anything beyond the following requirements: You are to abstain from food sacrificed to idols, from blood, from the meat of strangled animals and from sexual immorality. You will do well to avoid these things. Thus, Circumcision is not required.

The men were sent off and went down to Antioch, where they gathered the church together and delivered the letter. The people read it and were glad for its encouraging message. Judas and Silas, who themselves were prophets, said much to encourage and strengthen their brothers. After spending some time with them, they were sent off by the brothers with the blessing of peace to return to those who had sent them. But Paul and Barnabas remained in Antioch, where they and many others preached the word of the Lord.
Acts 21:17-25 Paul's Arrival at Jerusalem
When we arrived at Jerusalem, the brothers received us warmly. The next day Paul and the rest of us went to see James, and all the elders were present. Paul greeted them and reported in detail what God had done among the Gentiles through his ministry.
When they heard this, they praised God. Then they said to Paul: "You see, brother, how many thousands of Jews have believed, and all of them are zealous for the law. They have been informed that you teach all the Jews who live among the Gentiles to turn away from Moses, telling them not to circumcise their children or live according to their customs. What shall we do? They will certainly hear that you have come, so do what we tell you. There are four men with us who have made a vow. Take these men, join in their purification rites and pay their expenses so they can have their heads shaved. Then everyone will know there is no truth in these reports about you, but you yourself are living in obedience to the law. As for the Gentile believers, we have written to them our decision that they should abstain from food sacrificed to idols, from blood, and from the meat of strangled animals and from sexual immorality."

The general letters

Galatians 2:1-5 Paul Accepted by Apostles:
Fourteen years later I went up to Jerusalem, this time with Barnabas. I took Titus along also. I went in response to a revelation and set before them the Gospel I preach among the Gentiles. But I did this privately to those who seemed to be leaders; for fear that I was running or had run my race in vain. Yet not even Titus, who was with me was required to be circumcised, even though he was a Greek. This matter arose because some false brothers had infiltrated our ranks to spy on the freedom we have in Christ Jesus and to make us slaves. We did not give in to them for a moment so that the truth of the gospel might remain in you.

Galatians 5:1-12 Freedom in Christ:
It is for freedom that Christ has set us free. Stand firm and do not let yourselves be burdened again by the yoke of slavery.
Mark my words! I, Paul tell you that if you let yourself be circumcised, Christ will be of no value to you at all. Again I declare to every man who lets himself be circumcised that he is obligated to obey the whole law. You who are trying to be justified by law have been alienated from Christ; you have fallen away from grace. But by faith we eagerly await through the Spirit the righteousness for which we hope. For in Christ Jesus neither circumcision nor non-circumcision has any value. The only thing that counts is faith expressing itself through love.
You were running a good race. Who cut in on you and kept you from obeying the truth? That kind of persuasion does not come from the one who calls you. "A little yeast works through the whole batch of dough." I am confident in the Lord that you will take no other view. The one who is throwing you into confusion will pay the penalty, whoever he may be. Brothers, if I am still preaching circumcision, why am I still being persecuted? In that case the offense of the cross has been abolished. As for those agitators, I wish they would go the whole way and emasculate them!

Galatians 6:12-15 Not Circumcision but a New Creation:
Those who want to make a good impression outwardly are trying to compel you to be circumcised. The only reason they do this is to avoid being persecuted for the cross of Christ. Not even those who are circumcised obey the law, yet they want you to be circumcised that they may boast about your flesh. May I never boast except in the cross of our Lord Jesus Christ, through which the world has been crucified through to me, and I to the world. Neither circumcision nor non-circumcision counts for anything; what counts is a new creation. Peace and mercy to all who follow this rule, even to the Israel of God.

I Corinthians 7:17-20 Marriage:
Nevertheless, each one of you should retain the place in life that the Lord has assigned to him and to which God has called him. This is the rule I lay down in all the churches. Was a man already circumcised when he was called? He should not be uncircumcised. Was a man uncircumcised when he was called? He should not be circumcised. Circumcision is nothing and non-circumcision is nothing. Keeping God's commandments is what counts. Each of you should remain in the situation which he was in when God called him.

Romans 2:25-28 the Jews and the Law:
Circumcision has value if you observe the law, but if you break the law you become as though you had not been circumcised. If those who are not circumcised keep the law's requirements, will they not be regarded as though they had been circumcised? The one who is not circumcised physically and yet obeys the law will condemn you who, even though you have the written code and circumcision are a lawbreaker.
A man is not a Jew if he is only one outwardly nor is circumcision merely outward and physical. No, a man is a Jew if he is one inwardly; and circumcision is circumcision of the heart, by the Spirit, not by the written code. Such a man's praise is not from men, but from God.

Romans 3:28-31 Righteousness through Faith:
Is God the God of Jews only? Is he not the God of Gentiles too, since there is only one God, who will justify the circumcised by faith and the uncircumcised through that same faith? Do we, then, nullify the law by this faith? Not at all! Rather, we uphold the law.

Romans 4:9-12:
Is this blessedness only for the circumcised, or also for the uncircumcised? We have been saying that Abraham's faith was credited to him as righteousness. Under what circumstances was it credited? Was it after he was circumcised, or before? It was not afterward but before. And he received the sign of circumcision, a seal of the righteousness that he had by faith while he was still uncircumcised. So then, he is the father of all who believe but have not been circumcised but who also walk in the footsteps of faith that our father Abraham had before he was circumcised.

Ephesians 2:11-13 One in Christ:
Therefore, remember that formerly you who are Gentiles by birth and called "uncircumcised" by those who call themselves "the circumcision" (that done in the body by the hands of men) - remember that at that time you were separate from Christ, excluded from citizenship in Israel and foreigners to the covenants of the promise, with hope and without God in the world. But now in Christ Jesus you who one was far away have been brought near through the blood of Christ.

Philippians 3:1-11 No Confidence in the Flesh:
Finally, my brothers, rejoice in the Lord! It is no trouble to write the same things to you again, and it is a safeguard for you.
Watch out for those dogs, those men who do evil, those mutilators of the flesh. For it is we who are of the circumcision, we who worship by the Spirit of God, who glory in Christ Jesus, and who put no confidence in the flesh - though I myself have reasons for such confidence.
If anyone else thinks he has confidence in the flesh, I have more: circumcised on the eighth day, of the people of Israel, of the tribe of Benjamin, a Hebrew of Hebrews; in regard to the law, a Pharisee; as for zeal, persecuting the church; as for legalistic righteousness, faultless.
But whatever was to my profit I now consider loss for the sake of Christ. What is more, I consider everything a loss compared to the surpassing greatness of knowing Christ Jesus my Lord, for whose sake I have lost all things. I consider them rubbish that I may gain Christ and be found in him, not having a righteousness that comes from the law, but that which is found through faith in Christ - the righteousness that comes from God and is by faith. I want to know Christ and the power of his resurrection and the fellowship of sharing in those sufferings, becoming like him in death, and so somehow to attain to the resurrection from the dead.

The pastoral letters:
Titus 1:10-16
For there are many rebellious people, mere talkers and deceivers, especially those of the circumcision group. They must be silenced, because they are ruining whole households by teaching thing they ought not to teach - and that for the sake of dishonest gain. Even one of their own prophets has said, "Cretans are always liars, evil brutes, and lazy gluttons." This testimony is true. Therefore rebuke them sharply, so that they will be strong in the faith and will pay no attention to Jewish myths or to the commands of those who reject the truth. To the pure all things are pure, but to those who are corrupted and do not believe, nothing is pure. In fact, both their minds and consciences are corrupted. They claim to know God, but by their actions they deny him. They are detestable, disobedient and unfit for doing anything good.

Circumcision is mentioned frequently in the bible. However, the Bible means different things to different religious groups. For example;
1.For Jews, the Bible consists of the 24 books in Hebrew (and some Biblical Aramaic) that are known as the Tanakh.
2.For Protestant Christians, the Bible consists of the 39 books of the Old Testament (following Jerome's Veritas Hebraica) plus the 27 books of the New Testament.
3.For Catholic and most Orthodox Christians, the Bible includes several other books known as the deuterocanonical books, the list being slightly different for each group. In addition, some Orthodox Christians have additional New Testament books, such as the Ethiopian Orthodox and Armenian orthodox, or less, such as the Syrian Orthodox Church.

Either way circumcision appears to be a purely elective procedure depending on geographical region and cultural influences. Today, most Christian denominations are neutral about biblical male circumcision, neither requiring it nor forbidding it. The first Christian Church Council in Jerusalem, held in approximately 50 AD, decreed that circumcision was not a requirement for Gentile converts. According to the Columbia Encyclopedia- The decision that Christians need not practice circumcision is recorded in Acts 15; there was never, however, a prohibition of circumcision, and it is practiced by Coptic Christians.

C. Circumcision and Jewish teachings:

There are references in the Hebrew Bible to the obligation for circumcision among Jews.
For example, Leviticus 12:3 says-On the eighth day a boy is to be circumcised.
And the uncircumcised are to be cut off from the Jewish people - Genesis 17:14:
Any uncircumcised male, who has not been circumcised in the flesh, will be cut off from his people; he has broken my covenant.

According to the Jewish Encyclopedia article on circumcision of proselytes:
The issue between the Zealot and Liberal parties regarding the circumcision of proselytes remained an open one in 1st and 2nd centuries; some have asserting that the bath, or baptismal rite, rendered a person a full proselyte without circumcision, as Israel, when receiving the Law, required no initiation other than the purificative bath; while R. Eliezer makes circumcision a condition for the admission of a proselyte, and declares the baptismal rite to be of no consequence. A similar controversy between the Shammaites and the Hillelites is given regarding a proselyte born circumcised: the former demanding the spilling of a drop of blood of the covenant; the latter declaring it to be unnecessary. The rigorous Shammaite view, voiced in the Book of Jubilees, prevailed in the time of King John Hyrcanus, who forced the Abrahamic rite upon the Idumeans, and in that of King Aristobulus, who made the Itureans undergo, Septuagint, the Persians who, from fear of the Jews after Haman's defeat, "became Jews," and were circumcised.

Nonetheless, disputes over the Mosaic Law soon broke out and generated intense controversy in Early Christianity. This is particularly notable in the mid-1st century, when the circumcision controversy came to the fore. Alister McGrath, a proponent of Paleo-orthodoxy, claimed that many of the Jewish Christians were fully faithful religious Jews, only differing in their acceptance of Jesus as the Messiah. As such, they believed that circumcision and other requirements of the Mosaic Law were required for salvation, if one equates fully faithful religious Jews with Legalism theology, for a counterview, see Covenantal nomism. See also Judaism and Christianity. Those in the Christian community, who insisted that biblical law, including laws on circumcision, continued to apply to Christians were pejoratively labeled Judaizers by their opponents and criticized as being elitist and legalistic, besides others claimed sin.

Circumcision and other religious groups.... *****TO BE CONTINUED******

Monday, September 8, 2008



But first, let’s define what circumcision is before diving into the main issues.


1) Male circumcision- is the removal of some or the entire foreskin (prepuce) from the penis- whether for traditional, cultural, religious or other therapeutic or non-therapeutic reasons.

2) Female circumcision or female genital cutting (FGC), also known as female genital mutilation (FGM), female genital mutilation/cutting (FGM/C), refers to -all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs- whether for traditional, cultural, religious or other therapeutic or non-therapeutic reasons.


Saturday, September 6, 2008



Speaking of Religion- I have been thinking and quite frankly perturbed by this- how come there are/is no real religion that has real African roots? Did Africans not have their own religion? they had music, languages etc.. etc... I strongly suspect they did or at least they had something similar. And if so, how come this vast continent, the only religions that we hear have nothing to do with the Africans as a people? They are mere importations/imitations of adventures of a few centuries or so ago. What happened to the African man/woman’s religion? I stumbled on this among other literature:

Major Religions of the World Ranked by Number of Adherents:

1. Christianity: 2.1 billion
2. Islam: 1.5 billion
3. Secular/Nonreligious/Agnostic/Atheist: 1.1 billion
4. Hinduism: 900 million
5. Chinese traditional religion: 394 million
6. Buddhism: 376 million
7. primal-indigenous: 300 million
8. African Traditional & Diasporic: 100 million
9. Sikhism: 23 million
10. Juche: 19 million
11. Spiritism: 15 million
12. Judaism: 14 million
13. Baha'i: 7 million
14. Jainism: 4.2 million
15. Shinto: 4 million
16. Cao Dai: 4 million
17. Zoroastrianism: 2.6 million
18. Tenrikyo: 2 million
19. Neo-Paganism: 1 million
20. Unitarian-Universalism: 800 thousand
21. Rastafarianism: 600 thousand
22. Scientology: 500 thousand

This list, it says; - Sizes shown are approximate estimates, and are here mainly for the purpose of ordering the groups, not providing a definitive number. This list is sociological/statistical in perspective.( USA.

I need some real answers not the hog/white wash above-pertaining to African religion. Hopefully we will find the answers before we can turn the century to the future generations. What are African parents teaching their children about their religion? Bring those answers-parents, scholars!


Islam and HIV/AIDS:

Muslim countries, previously considered protected from HIV/AIDS due to religious and cultural norms, are also facing a rapidly rising cases. Despite the evidence of an advancing epidemic, sometimes the usual response from the policy makers in Muslim regions for protection against HIV infection is a major focus on propagating abstention from illicit drug and sexual practices. Sexuality, considered a private matter, is usually a taboo topic for discussion as in many cultures.

Reducing the risks to the individual and the community associated with some often stigmatized, antisocial or illegal behaviors becomes important but sometimes elusive. The reliability of the available HIV/AIDS incidences, prevalence and mortality data for Muslims is low because many Muslim countries maybe either their strict following of the religious teachings that are less influenced by other external forces(western oriented) or they do not report their statistics/are good at under-reporting. Either way- HIV/AIDS is far more than a medical and biological problem around the world. In recent years, increasing attention is being paid to the manner in which social and cultural variables influence risk behaviors related to HIV infection transmission. Though the association of contentious ethical and moral issues with HIV risk behaviors exists in all societies, it is much more pronounced in the Muslim world. Thus understanding the role of social and cultural variables affecting HIV transmission in Muslim countries is critical for the development and implementation of successful HIV prevention programs as would in other regions.

As in this case where a Muslim missionary stationed in Gaborone, Sheikh Hategeaikimana Hassan, said that the government's ABC - Abstain, Be faithful, Condomise - model is not entirely compatible with the teachings of Islam. The 'C' is the problem."As Muslims, we encourage and emphasize abstinence until marriage," He said. Abstinence, the primary prevention message for Muslims, is viewed as an act of faith and compliance, but evidence from other parts of the world shows that not all Muslims have been able to comply all the time. A study carried out in Morocco showed that about 50 percent of Muslim women in that country who have AIDS were infected by their husbands. The implication is all too clear: the men had illicit affairs. From a common sense perspective, it would seem realistic to encourage those who find it difficult to A or B, to at least C. However, Hassan sid that as Muslims, they "don't condomise" and that compromise on that score would be tantamount to "encouraging unlawful desire". Generally, the rate of infection in Muslim communities is typically less than in other groups and that have been attributed to the Islamic way of life. Senegal, whose population is 92 percent Muslim, has one of the lowest rates of HIV infection in Africa.

The surgical operation is considered one of the five acts of cleanliness in Islam and the World Health Organization estimates that, on a global scale, 30 percent of males have been circumcised, with almost 70 percent of them being Muslims. The prime health benefit of male circumcision is that it thwarts transmission of HIV as there would be no foreskin to harbor and pass the virus to the rest of the body. While not recommending it as protection against HIV/AIDS, WHO and UNAIDS put out a statement last year that said that male circumcision significantly reduces the risk of HIV transmission. WHO has recommended that countries should implement free or low-cost male circumcision programmes if a high percentage of their population is uncircumcised, if HIV is widespread and if HIV spread is predominantly heterosexual. It says that most such nations are in southern Africa and, to a lesser extent, in eastern Africa.

Turning back the hands of time would be impossible but it is tempting to speculate on how Botswana's HIV/AIDS situation would be like if one time-travel back to the 1980s. Two American academics, Drs. Daniel Halperin of the University of California in San Francisco and Robert Bailey of the University of Illinois undertook a "what-if" study on Botswana's HIV/AIDS situation and reached a very interesting conclusion. Their findings suggested that if in 1985 all Botswana men and boys had been circumcised, HIV/AIDS might never have reached the pandemic proportions it did in subsequent years. Muslims have not established common ground on when circumcision should be done but some scholars recommend the seventh day of infancy. He said that if one converts to Islam in adult life, he should undergo the operation.


The low rate of HIV infection among Muslims is also attributable to the fact that Islam forbids intoxicants for all its adherents. Compliance is helpful in avoiding the consequences of loss of inhibition that drugs like alcohol would otherwise provoke. Across the border, in South Africa, grave concern has been expressed that Muslim groups have been conspicuously absent at many provincial and national forums on HIV/AIDS. In the Botswana case, however, Hassan said that the Muslim community has been working very closely with the government and relevant NGOs.
Personally, he has participated in one of the studies carried out by the Ministry of Health. He stresses the importance of working with these parties in an effort to find workable solutions to the HIV/AIDS scourge. "We respond to their call whenever our assistance is needed. We attend their meetings and workshops and exchange views on how we should deal with this problem," Hassan said. However, that collaboration has not extended to financial matters. He says that they have not benefited from any government money or funds disbursed by AIDS NGOs.
What the Muslim community has been doing over the years is raising its own funds. However, the assistance is limited because, as Hassan revealed, no one in the Muslim community has come forward to declare his or her HIV status. Furthermore, no statistics are available to ascertain the level of prevalence and trends of the disease in that community. "This does not mean that there are no Muslims who are not infected by this disease," Hassan states, adding that they use statistics obtained from the government and various NGOs. Last year, Johannesburg, South Africa hosted a five-day Islam and HIV/AIDS conference that was attended by over 200 delegates from different countries. According to Hassan, there were no delegates from Botswana.
He also said that the local Muslim community has literature on HIV/AIDS that it distributes not just to Muslims but to everybody else who wants to get up on the Islamic. approach to fighting HIV/AIDS. "Islam is a complete way of life, it deals with any social problem when the need arises," he said.
As in any other societies- Reasons for the spread of HIV in Muslim countries are open to speculations. Islam places a high value on chaste behavior and prohibits sexual intercourse outside of marriage. It specifically prohibits adultery, homosexuality, and the use of intoxicants. Then how can the spread of HIV/AIDS in Muslim countries be explained- A logical explanation is that in spite of Islamic teachings, some Muslims do engage in activities that lead to acquiring HIV; these risky practices include illicit drug use and/or premarital or extra marital sex. Men who engage in risky behaviors have the potential of transmitting the disease to their unsuspecting wives. Women, on the other hand, also are directly susceptible; in many Muslim countries, brothels and other forms of commercial sex trade are prevalent. The sex workers have poor social support and sometimes they are not screened properly or at all for sexually transmitted diseases including HIV, thus contributing to the spread of infection. Injection drug users IDUs also are rapidly becoming a population of increasing concern in the transmission of HIV and AIDS including Muslim countries. Sex- and drug-related behaviors of IDUs can facilitate HIV transmission even when syringes are not directly shared.

HIV/AIDS and Christianity:

Mostly the Christian religious groups-especially the western leaning religious groups (religious rights movements/evangelicals as they are called sometimes) tend to look at HIV/AIDS as the African disease-a continent a few centuries ago they flocked in to redeem it/her from darkness and from it/her-self, I guess and thus feels obliged to continue doing so (forget that little instrumental part they played in colonization in the name of redemption. This Dark Continent! How only the bad things are found but never the good things?

So here they come in the name of missionaries, Ngo’s, World Banks, IMFs, and in other big sounding names that the locals bleed to pronounce. They come with material aids in the name of investments-(read opportunists), misinterpretations, stigmatization, and disregard of local cultural practices pronouncing them as non-modern and manipulation of geopolitical agenda, data inflation-(High cases of diseases/other catastrophies ring a bell?) so that they can keep getting more funds from their countries of origin and usually they start/pretend by initial formation of support groups-
The routine activities of the support group typically begin with the singing of choruses and hymns, followed by a Word of God and the prayer. After that new members were welcomed through the exchange of hugs and motivated to live positively by any confident member who had already spent a reasonable amount of time with the group. At times, an opportunity was created for other members to testify about the greatness of God over their HIV infection.

According to this abstract- Although a large majority of South Africans (about 79% according to 2001 census) are affiliated to Christian churches
(Statistics South Africa, 2004), an epidemic fuelled by sexual behavior remains a major challenge in the fight against AIDS (Garner, 2000). In South Africa, one in
ten people aged 15 to 24 years is said to be HIV positive (Campbell, Foulis, Maimane & Sibiya, 2005). As many people presumably contract HIV outside
Wedlock, it is perceived as a double-sin (Duffy, 2005). This perception is not only based on the view that premarital HIV infection suggests premarital sex, and at
Worst promiscuity (Duffy, 2005), but more so, given the prevailing moral judgement about the ‘ungodliness’ of HIV infection (Machyo, 2002), it can be viewed as a
‘Punishment’ or curse from God (Takyi, 2003). However, there are mixed views about the relationships between ‘ungodliness’ and HIV infection, as well as sin or evil and diseases in general (Sanders, 2006; Wiley, 2003) Gilman (2000) draws connections between sexually transmitted diseases (STDs) and religious impurity or
Dirtiness. He argues that stigmatization of people suffering from STDs dates as far back as the end of the first millennium when leprosy emerged. In Europe,
Lepers were required to wear identifying clothes and to warn of their presence (Green & Ottoson, 1994). Like leprosy, and as a STD, the diagnosis of syphilis at the
end of the 19th century evoked similar moral judgment and stigma. Despite the complexities of these inextricable connections (disease, HIV infection
And sin/evil, and or dirtiness), there is no conclusive evidence that the presence of any disease, and AIDS in particular, suggests a ‘punishment’ from God or any
sort of dirtiness (Gilman, 2000).This view recalls Jesus Christ’s response in the Book of John 9: 2-3: when confronted with a question about the man born blind, and whether it was through his sins or his parents’ sins that he was blind, His response was,” Neither he nor his parents sinned. He was born blind so that the works of God might be displayed in Him” (Machyo, 2002, p. 6). Machyo further warns against the passing of premature judgment on HIV positive people, citing the unconditionality of God’s love as a guiding
principle. Fatovic-Ferencic and Durrigl (2001) have documented the non-refutation of the relationship between sin or evil and disease by medieval medical authors, further presenting evidence of Christ casting out a devil from a boy suffering from epilepsy. The relationship between HIV infection and sex further complicates attempts to connect it with sin or ‘punishment’ from God. A search for studies that connect sin/evil and HIV infection largely unsuccessful, and we only managed to gather materials that present anecdotal connections between sin/evil and disease. Limited discussion of sex among most, if not all, religious denominations, as well as a lack of commitment in the fight against this pandemic by some religious groups, in our view further Complicates existing stigma and moral judgments. Despite these multifaceted arguments, religion and spirituality remain invaluable coping resources for dealing with pain (Rippentrop, Altmaier, Chen, Found& Keffala, 2005), particularly for people living with HIV (Simoni, Martone & Kerwin, 2002; Takyi, 2003), as well as throughout life in general (Machyo, 2002; Stuckey, 2001). In a study conducted among people living with HIV/AIDS (PLWHA) in Australia, Ezzy (2000) established an increased likelihood of religiosity resulting from HIV diagnosis.



If the common goal is to end the global epidemic then it is time to look at the problem beyond a focus on the virus, as it exists within the human body, and to find ways to alter the social and economic environment that enable it to flourish. It is time for global education not only about HIV/AIDS but also about the social context of underdevelopment and poverty that engulfs many of those communities which also have the highest rate of infection. It is time for human society to work at all levels to develop ways to find lasting solutions to the right problems. Finding treatments that protect babies from infection or that add years to the lives of people living with HIV/AIDS is a brilliant first step and has saved children from infection and restored life and hope to many infected people. Such improvements must continue. However, this progress is grossly inaccessible where most needed. If, one day, a vaccine for HIV and cure for AIDS are developed, they must be available to the developing world.

Even then, will enough have been accomplished if the spread of HIV is halted, but the human suffering that provided fertile ground for the epidemic in the first place is allowed to continue until the next virus that might get the world's attention?
The Impact on the Rural Economy:
It is widely acknowledged within general development literature that the urban and rural economies are usually intrinsically interlinked and that incomes within the rural environment depend upon wages earned within the urban economic environment. Thus it is clear that the impact of HIV/AIDS on the formal, largely urban-based economies of Southern and Eastern Africa will increasingly have an impact in reducing the options and the cash flows between the two sectors.
Within Southern and Eastern African countries, HIV/AIDS has been acutely experienced in rural areas. A recent Fact Sheet prepared by the FAO (2000) clearly describes the threat to rural Africa:
•More than two-thirds of the populations of the 25 most-affected African countries live in rural areas.
•Information and health services are less available in rural areas than in cities. Rural people are therefore less likely to know how to protect themselves from HIV and, if they fall ill, less likely to get care.
•Costs of HIV/AIDS are largely borne by rural communities as HIV-infected urban dwellers of rural origin often return to their communities when they fall ill.
•HIV/AIDS disproportionately affects the economic sectors such as agriculture, transportation and mining that have large numbers of mobile or migratory workers.

As discussed earlier, the extensive labor migration between and within countries, associated with annual or more frequent visits home, has facilitated the spread of HIV/AIDS to the most remote rural. The prevalence of HIV/AIDS in rural areas is not adequately documented due to poor health infrastructure, restricted access to health facilities and inadequate surveillance. This emphasizes the fact that rural communities have fewer resources to prevent infection and to nurse ill people. Access to treatment and other services, as well as education, are often limited in such contexts.

The effects of HIV/AIDS within a rural economy may include:
•Redistribution of scarce resources with an increasing demand for expenditure on health and social services;
•A collapse of the educational system due to high morbidity and mortality rates amongst educator and learners;
•Younger and less experienced workers replacing older AIDS related casualties, causing reduction in productivity;
•Employers becoming more likely to face increased labor costs because of low productivity, absenteeism, sick leave and other benefits (attending funerals), early retirement and additional training costs.

Agricultural production is often central to the rural economy. This form of production is usefully differentiated into the commercial farming sector, where the organization and running of a farm/shamba often approximates a business, and the subsistence sector, which is characterized by a close relationship between the general activities of a household (including child rearing, supporting relationships between adult members, home maintenance and food processing) and the production of crops and of animals.

The Impact on Agricultural Production:

Agriculture is one of the most important sectors in many developing countries, providing a living or survival mechanism for up to 80 percent of a country’s population. However, while agriculture is extremely important to many African countries, not least of all for household survival, there are marked differences among countries in terms of current economic conditions and agricultural and economic potential.

Agriculture faces major challenges including unfavorable international terms of trade, mounting population pressure on land, and environmental degradation. The additional impact of HIV/AIDS is also severe in many countries. The major impact on agriculture includes serious depletion of human resources, diversions of capital from agriculture, loss of farm/shamba and non-farm income and other psycho-social impacts that affect productivity.

The adverse effects of HIV/AIDS on the agricultural sector can, however, be largely invisible as what distinguishes the impact from that on other sectors is that it can be subtle enough so as to be undetectable. In the words, even if rural families are selling cows to pay hospital bills, one will hardly see tens of thousands of cows being auctioned at the market...Unlike famine situations, buying and selling of assets in the case of AIDS is very subtle, done within villages or even among relatives, and the volume is small Furthermore, the impact of HIV/AIDS on agriculture, both commercial and subsistence, are often difficult to distinguish from factors such as drought, civil war, and other shocks and crises.

For these reasons, the developmental effect of HIV/AIDS on agriculture continues to be absent from the policy and programmes agendas of many African countries. Many studies on HIV/AIDS that have focused on specific sectors of the economy such as agriculture have been limited to showing the wide variety of impacts and their intensity on issues such as cropping patterns, yields, nutrition, or on specific populations. They have not adequately touched on questions such as the effects of changes in prices of commodities, such as tea or cocoa, land tenure and the rights of women and children.

Impact on the Commercial Sector:

Commercial agriculture is particularly susceptible to the epidemic and is facing a severe social and economic crisis in some locations due to its impact. Morbidity and mortality due to HIV/AIDS significantly raise the industry’s direct costs (medical and funeral expenses) as well as indirectly through the loss of valuable skills and experience.
The epidemic thus adversely affects companies’ efficiency and productivity. Thus HIV/AIDS is leading to falling labor quality and supply, more frequent and longer periods of absenteeism, losses in skills and experience, resulting in shifts towards a younger, less experienced workforce and subsequent production losses. These impacts intensify existing skills shortages and increase costs of training and benefits.

At a FAO Conference on HIV/AIDS and agriculture, an example was given of the costs to this particular sector. It was argued that in Sub-Saharan Africa’s 25 worst affected countries, seven million agricultural workers have died from the epidemic since 1985 and sixteen million more may die by 2020, according to that report. Table below depicts the grim picture of the agricultural labor force decreases in the ten most heavily affected countries in the continent. Intensive agriculture will be severely impacted through the loss of this specialized labor. Areas of production such as harvesting and processing that require a high level of skill will be most severely affected.

Impact of HIV/AIDS on agricultural labor in some African countries (projected losses in percentages)

Country 2000 2020

Namibia 3.0 26.0
Botswana 6.6 23.2
Zimbabwe 9.6 22.7
Mozambique 2.3 20.0
South Africa 3.9 19.9
Kenya 3.9 16.8
Malawi 5.8 13.8
Uganda 12.8 13.7
Tanzania 5.8 12.7
C.A. Republic 6.3 12.6
Ivory Coast 5.6 11.4
Cameroon 2.9 10.7

It should also be emphasized that the impact on commercial agriculture is only one side of the story. In much of southern Africa, agriculture is not the dominant economic sector, even while access to land and its resources is important for the diverse multiple livelihood strategies of many rural denizens.

Impact on the Small-Scale and Subsistence farming Sectors:

Many studies conducted on the impact of HIV/AIDS in Africa have focused on the farm-household level - where agricultural production at the subsistence or small-scale level is often embedded within multiple-livelihood strategies and systems. Over the past two decades there have been profound transformations in these livelihood systems in Africa, set in motion by Structural Adjustment Programmes, the removal of agricultural subsidies and the dismantling of parastatal marketing boards. As a result of these and other issues, many African households have shifted to non-agricultural income sources and diversified their livelihood strategies accordingly.

However, despite the evident of diversification out of agriculture, rural production remains an important component of many rural livelihoods throughout Sub-Saharan Africa. ‘African rural dwellers ...deeply value the pursuit of self-provisioning is gaining in importance against a backdrop of food inflation and proliferating cash needs. Participation in “small-plot/shamba agriculture” is highly gendered, with women taking major responsibility for it as one aspect of a multiple livelihood strategy. Access to land-based natural resources remains a vital component of rural livelihoods particularly as a safety net. In this context, land tenure becomes increasingly important for the diverse livelihood strategies pursued by different households.

Diversification out of agriculture may be compounded by the affect of HIV/AIDS in a number of ways. These include its impact on labor, the disruption of the dynamics of traditional social security mechanisms and the forced disposal of productive assets to pay for such things as medical care and funerals. In turn, local farming skills are drained and biodiversity in crop variety diminished. Indigenous knowledge systems and technology adapted by farmers to suit the particular conditions of specific areas often die with the farmers, a dangerous trend as far as cultural practices are concerned. A large number of Sub-Saharan African countries have already experienced a shift in the allocation of labor especially by subsistence households. A study in Zimbabwe conducted by the Zimbabwe Farmers Union (some times back-but still relevant )showed that the death of a breadwinner due to AIDS will lead to a reduction in maize production in the small-scale farming sector and communal areas of 61 percent.

The loss of agricultural labor is likely to cause farmers to move to production of less labor intensive crops in a bid to ensure their survival. This often means a shift from cash to food crops or high value to low value crops. The impact of HIV/AIDS on crop production relates to a reduction in land use, a decline in crop yields and a decline in the range of crops grown, mainly with reference to subsistence agriculture. Reduction in land use occurs as a result of fewer family members being available to work in cultivated areas and due to poverty resulting in malnutrition leading to the inability of family members to perform agricultural work. This, in turn, leads to less cash income for inputs such as seeds and fertilizer. In Ethiopia, for example, labor losses reduced time spent on agriculture from 33.6 hours per week for non AIDS-affected households to between 11.6 to 16.4 hours for those affected by AIDS.

At another workshop on HIV/AIDS and land, the then FAO director in South Africa stated that the food shortages facing several Southern African countries, including Lesotho and Zimbabwe, were ‘a stark demonstration of the collective failure to recognize and act upon the deep-rooted linkages between food security and HIV/AIDS’. This reiterates the argument that the continuous interruption of labor may also impact on the type of crops grown, and hence substitution between crops may take place. This is especially true for labor intensive crops, which would likely result in the substitution for less labor intensive production and a possible decrease in the area being cultivated. Food security therefore becomes an important issue in the context of HIV/AIDS.

Food security implies that every individual in a society has a sustainable food supply of adequate quality and quantity to ensure nutritional needs are satisfied and a healthy active life be maintained. At a household level, food security refers to the ability of households to meet target levels of dietary needs of their members from their own production or through purchases.

Therefore, the impact of HIV/AIDS on agriculture directly affects food security, as it reduces:

•Food availability (through falling production, loss of family labour, land and other resources, loss of livestock assets and implements).
•Food access (through declining income for food purchases).
.The stability and quality of food supplies (through shifts to less labour intensive production).

HIV/AIDS can therefore be a cause of food insecurity and a consequence thereof. For example, during times of food insecurity, such as during drought, individuals or families can be forced to engage in survival strategies that increase their vulnerability to contracting HIV.

Natural resource management has also been directly impacted on by HIV/AIDS, which has important implications for non-agriculturally based multiple livelihood systems. Conservation and resource management are also dependent on human factors such as labor, skills, expertise and finances that have been affected by the epidemic. Therefore the reduction in the number and capacity of ‘willing, qualified, capable and productive people’ who have managed natural resources has negatively impacted on sustainable utilization of these resources. In addition, the epidemic can impact natural resource conservation and management by accelerating the rate of extraction of natural resources to meet increased and new HIV/AIDS demands.
These issues relating to labor, production, natural resource management and food security are elaborated in more detail in the following section describing household production.

The Impact on Household Livelihood Strategies:

As demonstrated above, various “research” initiatives have shown that HIV/AIDS first affects the welfare of households through illness and death of family members, which in turn leads to the diversion of resources from savings and investments into. It is expected that the premature death of large numbers of the adult population, typically at ages when they have already started families and become economically productive, can have a radical effect on virtually every aspect of social and economic life. This is clearly indicated by an increase in the number of dependents relying on smaller numbers of productive household members and increasing numbers of children left behind to be raised by grandparents or as child-headed households or extended family members.

Once a household member develops AIDS, increased medical and other costs, such as transport to and from health services, occur simultaneously with reduced capacity to work, creating a double economic burden. The households with an AIDS sufferer frequently seek to keep up with medical costs by selling livestock and other assets including land. Members who would otherwise be able to earn or perform household and family maintenance may then be spending their time caring for the person with AIDS. An example a son with a sick mother in Zambia- reported that he spent more time looking for money to make ends meet by working in the field and doing casual jobs, and in addition having to contribute an average of three hours a day towards caring for his mother and staying up part of the night attending to her needs. Cases like that are not unique; rather they are more frequent and familiar in most families in developing countries.

This emphasizes an impact of HIV/AIDS illness and death, which often results in the re-allocation of livelihood tasks amongst household members. Reports that intensive use of child labor increases as a major strategy and it’s typically used by the afflicted household during care provision. Children may be taken out of school to fill labor and income gaps created when productive adults become ill or are caring for terminally ill household’s members or are deceased. Another example from Tanzania-and many other countries whose populations are struggling with the effects of the disease- shades light on to how the illness affects time allocation puts pressure on children to work, divert household cash and the disposal of household productive assets. HIV/AIDS is therefore an impoverishing process that leads to other problems such as malnutrition, inaccessibility to health care, increased child mortality and hence intergenerational poverty.

It is important to recognize that the impact of HIV/AIDS on rural households is not equal: the poorer- especially those with small land holdings are much less able to cope with the effects of HIV/AIDS than wealthier households who can hire casual labor and are better able to absorb shocks. The question as to who benefits from the sales of assets by farming-households attempting to cope with the long drawn-out effects of HIV/AIDS could be unclear. Number of occurrences evident could lead to significant changes in the socio-economic structures of villages, redistribution of wealth and of land. HIV/AIDS infection ultimately stretches the resources of an extended family beyond its limits as both material and non-material resources are rapidly consumed in caring for the infected.

The manner, in which HIV/AIDS can cause affected households to become socially excluded, thus diminishes their ability to cope with further crises. Similarly, extended family networks sometimes collapse, not least due to pressure of having to support orphaned children. Moreover, it has been argued that for instance in KwaZulu-Natal, South Africa, HIV/AIDS has forced a change in household composition, severely weakening and often breaking the young adult nexus between generations. This, in turn, exacerbates an already existing social crisis of care, which worsens as the epidemic progresses. It is a social context that is unlikely to withstand the weight of need that HIV/AIDS related deaths generate and many, especially children and the aged, face economic and social destitution.

It is increasingly clear that as a result of HIV/AIDS causing significant increases in morbidity and mortality in prime-age adults, increasing negative social, economic and developmental impacts will occur. As can be clearly indicated, the economic impact at the household level will be decreased, increased health-care costs, decreased productivity capacity and changing expenditure patterns. Major survival strategies developed in response to the epidemic may include the altering household composition the withdrawal of savings and the sale of assets, the receipt of assistance from other households. Following death the impact breaks out the households and cutting into the community in the form of increasing number of dependents such as orphans.

Coping Strategies - or simply surviving?

In the face of the extreme impact of HIV/AIDS, individuals and households undergo processes of experimentation and adaptation when adult illness and death impacts whilst an attempt is made to cope with immediate and long-term demographic changes. Several factors determines a household’s ability to cope including access to resources, household size and composition, access to resources of the extended family, and the ability of the community to provide support. The interaction of these factors will determine the severity of the impact of HIV/AIDS on the household.

Household Coping Strategies:

Strategies aimed at improving food security Strategies aimed at raising & supplementing income to maintain household expenditure patterns Strategies aimed at alleviating the loss of labor
•Substitute cheaper commodities (e.g. porridge instead of bread)
•Reduce consumption of the item
•Send children away to live with relatives
•Replace food item with indigenous/wild vegetables
•Income diversification
• Migrate in search of new jobs
• Loans
• Sale of assets
• Use of savings or investment • Intra-household labor re-allocation and withdrawing of children from school
• Put in extra hours
• Hire labor and draught power
• Decrease cultivated area
• Relatives come to help
• Diversify source of income

The household experience in the context of HIV/AIDS and may divert policy-makers from the enormity of the crisis. AIDS-induced morbidity and mortality has an immense impact on rural households but questions whether the observed effects should be defined as “coping strategies”. And any meaningful analysis of coping behavior must include the real and full costs of coping.

There are several reasons why the concept is of limited use and explores alternative ways of conceptualizing the impact of HIV/AIDS in more detail. Firstly one could define the concept as being essentially concerned with the analysis of success rather than failure of the household as it implies that the household is managing or persevering. This ignores evidence that households often dissolve completely with survivors joining other households. This runs contrary to a concept of strategy intended to avert the breakdown of the household unit.

Secondly, households do not act in accordance with a previously formulated plan or strategy but react to the immediacy of need, disposing of their assets when no alternatives present themselves. Decisions are not based on the importance or usefulness of the asset to the household as saving lives is deemed more important than preserving assets. More evidence is emerging that even land, the “most important agrarian asset”, may not be spared in the quest to ‘cope’ with illness. Indeed, a recent study on the impact of HIV/AIDS on female microfinance clients in Kenya and Uganda, found that there was a clear sequence of “asset liquidation” among AIDS caregivers in order to cope with the economic impact - first liquidating savings, then business income, then household assets, then productive assets and, finally, disposing of land. This last resort of disposing of land has profound consequences for people losing their economic base. People are likely to be those with fewest options and those who are most vulnerable.

Thirdly, coping strategies tend to be defined as short-term responses to entitlement failure giving the impression that it involves few additional costs thereby obscuring the true cost of coping. In Tanzania, short and long-term costs included curtailing the number and quality of meals that a household could afford which resulted in poor nutrition with obvious implications for health. Another household option was the withdrawal of children, mostly girls, from school in order to utilize their labor and save money, which, amongst other things, had ramifications for future literacy levels and the child’s participation in the modern economy. The positive gloss accorded to coping invariably ignored long-term costs that fundamentally jeopardize recovery of a household let alone sustainability.

In summary, one would argue that references to coping strategies may make sense in circumstances of drought or famine but not for the impact of HIV/AIDS, which not only changes communities and demographic patterns but also agro-ecological landscapes with long-term implications for recovery. The fact that AIDS kills the strong people and leaves behind the weak undermines the capacity of households and communities, especially in the long-term. It is therefore important to further differentiate the household according into their various possible members with an emphasis on the power relations between people forced to respond to the compounding impact of HIV/AIDS on their livelihood strategies.

Women and HIV/AIDS:

There are a number of interlocking reasons why women are more vulnerable than men to HIV/AIDS, which include female physiology, women’s lack of power to negotiate sexual relationships with male partners, especially in marriage, and the gendered nature of poverty, with poor women particularly vulnerable (Walker, 2002: 7). Inequities in gender run parallel to inequities in income and assets. Thus women are vulnerable not only to HIV/AIDS infection but also to the economic impact of HIV/AIDS. This is often a result of the gendered power relations evident in rural households, which can leave women prone to the infection of HIV. With increasing economic insecurity women become vulnerable to sexual harassment and exploitation at and beyond the workplace, and to trading in sexual activities to secure income for household needs.
As a result, women have experienced the greatest losses and burdens associated with economic and political crises and shocks with particularly severe impact from HIV/AIDS.

The epidemic exacerbates social, economic and cultural inequalities (economic need, lack of employment opportunities, poor access to education, health and information), which define women’s status in society;
•Breakdown of household regimes and attendant forms of security: Decades of changes in economic activity and gender relations have placed many women in increasingly difficult situations. HIV/AIDS has accelerated the process and made “normal” sexual relations very risky. Women whose husbands have migrated for work are afraid of the return of the men knowing that they may be HIV-infected. Although poorly documented, the range and depth of women’s responsibilities have increased during the era of HIV/AIDS. More active care giving for sick and dying relatives have been added to the existing workload. Children have been withdrawn from school, usually girl-children first, to save both on costs and to add to labor in the household.

Thus HIV/AIDS is facilitating a further and fairly rapid differentiation along gender lines.
•Loss of livelihood: Whether women receive remittances from men working away from home, are given “allowances”, or earn income themselves, HIV/AIDS has made the availability of cash more problematic.
•Loss of assets: Although poorly documented, fairly substantial investments in medical care occur among many households affected by HIV/AIDS. These costs may be met by disinvestments in assets. Household food security is often affected in negative ways. Furthermore, in many parts of Africa, women lose all or most household assets after the death of a husband.
•Survival sex: Low incomes, disinvestments, constrained cash flow - all place economic pressures on women. Anecdotal evidence and some studies indicate that these pressures push a number of women into situations where sex is coerced in exchange for small cash or in-kind payments.

Women frequently carry a double burden of generating income outside the home and for care giving as well as maintaining family land. In this regard, women are responsible for caring for sick members of the household as well as being heavily involved in generating income and supplying food for their households through agricultural production. Further, the burden of caring for people living with HIV/AIDS and for orphans’ falls largely on women. Thus, it has been argued that the illness and death of a woman has a “particularly dramatic impact on the family” in that it threatens household food security, especially when households depend primarily on women’s labor for food production, animal tendering, crop planting and harvesting.

In rural areas, women tend to be even more disadvantaged due to reduced access to productive resources and support services. The issue of AIDS and inheritance is therefore particularly important when discussing the impact of HIV/AIDS on women. Many customary tenure systems provide little independent security of tenure to women on the death of their husband, with land often falling back to the husband’s lineage. While this may, traditionally, not have posed problems, it may create serious hardship and dislocation in the many cases of AIDS-related deaths. While this may create an opportunity for communities to tweak/ and or address the land-ownership related cases, by no means this should be an opportunity for others (parties/groups) - Read (westerners and the like, who have little knowledge or care not to understand other people’s customs) to condemn/denounce-ridicule-belittle or categorize it as inferior. In other words it should be an inside job –done by the community members as they understand their customs, thus better to address it accordingly.

The Elderly and HIV/AIDS:

As already illustrated, the HIV/AIDS epidemic has immense ramifications for the structure of households with prolonged emotional and financial responsibilities of child-raising for grandparents. Large numbers of orphans have been left in the care of their grandparents across the globe. The role of the elderly in rural development in the context of the HIV/AIDS epidemic has been neglected. The elderly play a crucial role, not just in care giving, but in ensuring the food security of millions of affected rural farm-households as they become an alternative for the family.
The reports on population projection with HIV/AIDS scenario highlights changes in sex and age structure from the perspective of elderly at the national level, particularly for countries like Botswana and South Africa, two of those that have been worst affected countries. Thus the population pyramids for these countries suggest that:

•In 20 years time a significant number of 60-69 year olds will be dead (HIV mortality peaks around 30-34 years for women and 40-44 years for men),
•The surviving younger elderly of 60 years or more will have a role as care and subsistence of older ones.
•Number of children will decline significantly over 20 years,
•Due to change in sex ratio for adults, female age group, middle age and young elderly will have a burden of care and housework and this will force changes in division of labor.
•In Botswana more rapid ageing is seen in rural areas than in urban areas. This is also reflected in South Africa as a result of younger working age people migrating from rural communities and older people often returning. In countries such as Kenya, infection rates tend to be higher in densely populated areas, which are the most productive agricultural areas. With this spread of HIV/AIDS, it can be concluded that if this is not addressed aggressively, there will be fewer young adults who will be able to carry out essential tasks.

Therefore the elderly will increasingly be required to do such tasks. Thus it’s easy to conclude that the elderly are a largely invisible resource in the context of HIV/AIDS, requiring assistance and empowerment in order to fulfill its indispensable potential in areas of crisis. Thus the rural elderly have a potential to play a pivotal role of holding together farm households, ensuring food security and survival of orphans.

A Conceptual Framework: HIV/AIDS and Land:

A man is taken ill. While nursing him, the wife can’t weed the maize and cotton fields, mulch and pare the banana trees, dry the coffee or harvest the rice. This means less food crops and less income from cash crops. Trips to town for medical treatment, hospital fees and medicines consume savings. Traditional healers are paid in livestock. The man dies. Farm tools, sometimes cattle, are sold to pay burial expenses. Mourning practices in most Africa countries forbid farming for several days. In the next season, unable to hire casual labor, the family plants a smaller area. Without pesticides, weeds and bugs multiply. Children leave school to weed and harvest. Again yields are lower. With little home-grown food and without cash to buy fish or meat, family nutrition and health suffer. If the mother becomes ill with AIDS, the cycle of asset and labor loss is repeated. Families withdraw into subsistence farming. Overall production of cash crops drops-that is a typical scenario.

The narrative captures the stark reality of the cruel impact that HIV/AIDS has on the household producing on the margins (and above) the subsistence level. Many of these experiences indicate the powerful linkages between HIV/AIDS and land. There are therefore it is clear that prolonged illness and early death alter social relations. It can therefore be assumed that such relations would include institutions governing access to and inheritance of land.

Prolonged morbidity and mortality would also contribute to the disposal of land to cater for the care, treatment and funeral costs. this is a double-edged sword as on the one side access and utilization are affected among households and individuals, and on the other hand it would affect land planning and administration at various levels. These changes, particularly as they relate to individuals and households, would have dimensions across both age and gender. Therefore, in summary, HIV-related mortality would alter the land rights or the command positions held by people of different age and gender over land. An analysis of the impact of HIV/AIDS on land is essentially an analysis of changes in social institutions in which rights to land are anchored.

Therefore the analysis needs to take cognizance of a range of social attributes that affect the dynamics of land relations:

•Cultural, legal, political and other social dimensions affecting entitlement;
•How HIV/AIDS affects land entitlement and how land entitlement affects HIV/AIDS;
•Whether lack of entitlement to land increases vulnerability to HIV/AIDS;
•How HIV/AIDS impacts on institutions involved in land administration;
•The inputs needed to secure effective use of land by HIV/AIDS affected households;
•The fact that entitlement is not static and changes across gender and age;
•The complex continuum from landed to landless;
•The fact that although access to land may not be the most effective strategy for HIV/AIDS affected households, in rural areas it is likely to remain central to their survival.

From this- it is evident that the concept of land issues is extremely broad. To further help conceptualize the impact of HIV/AIDS, these issues have been differentiated into three main areas, namely land use, land rights and land administration. The impact on these areas is usefully conceptualized through the lens of the household particularly as HIV/AIDS is depriving families and communities of their young and most productive people:

•HIV/AIDS-affected households generally have less access to labor, less capital to invest in agriculture, and are less productive due to limited financial and human resources. Thus the issue of land use becomes extremely important as a result of the epidemic’s impact on mortality, morbidity and resultant loss of skills, knowledge and the diversion of scarce resources. A range of multiple livelihood strategies, often involving land, has been affected resulting in changes as rural households fight for survival in the context of the epidemic.

•The focus on land rights considers the extent of impact on the terms and conditions in which individuals and households hold, use and transact land. This has particular resonance with women and children rights in the context of rural power relations, which are falling under increasing pressure from HIV/AIDS. Anecdotal evidence from around the globe indicates that dispossession, particularly for AIDS-widows, is increasingly becoming a problem in locations with patrilineal inheritance of land. There are, however, a number of other issues to be examined in relation to HIV/AIDS and land tenure especially in localities that are experiencing increasing land pressure, land scarcity, commercialization of agriculture, increased investment, and intensifying competition and conflicts over land.

•The impact on land administration is a related issue and is a result of epidemic affecting people involved in the institutions that are directly or indirectly involved in the administration of land. These include local level or community institutions such as traditional authorities, civil society, various levels of government, and the private sector.