Sunday, October 5, 2008


Do Not Cloud the Message! - Kenyan politicians hailing from Lake Region.

There has been some excitement at international conferences around the globe on HIV/Aids like the one held in Mexico and others that, male circumcision can help prevent the spread of the pandemic.
Regrettably, some false hope is thus being indirectly cultivated that the cut is the means to keep the virus at bay.

The emerging statistics clearly call for caution. If the infection rate among circumcised men has declined from, say 7.5 to 6.5 per cent, on average, it is scant comfort, indeed. This means clearly that there is only one percent difference! As debate on whether circumcision reduces the risk of HIV infection or not rages, it is amazing how each side of the divide is getting carried away by emotions to the extent of losing sight of the available evidence.

This reminds one of the saying that "a good slogan can stop analysis for years".
It is true that there is evidence that HIV prevalence is lower among communities that practice male circumcision than among those that do not.
But there is also evidence to the contrary: that HIV prevalence is higher among communities that practice male circumcision than among those that do not.

This sounds somehow confusing, one would say. But in a nutshell, it shows that the evidence on whether male circumcision protects one against HIV infection is mixed.
Unfortunately, both the proponents and the opponents of the protective role of male circumcision have refused to soberly confront this reality, and thus think through an appropriate prevention strategy.

Since so much has been said about studies that show the protective role of male circumcision, Lets talk about the evidence that shows the contrary.
Two data sets from Malawi (the 2004 Malawi Demographic and Health Survey (MDHS) and the 2004 and 2006 Malawi Diffusion and Ideational Change Project (MDICP)) show that HIV prevalence was highest in the Southern region than in the Central or Northern regions.

Yet, a higher proportion of men from the Southern region, compared to those from the other regions, reported having been circumcised.
In contrast, individuals from the other regions were less likely to report multiple life-time sexual partners than those from the Southern region.
They were also more likely to report condom use during the 12 months preceding the survey than those from the Southern region.
At the individual level, HIV prevalence was higher among circumcised than among uncircumcised men. Among circumcised men, those who were HIV-positive were more likely to report multiple life-time sexual partners than their HIV-negative counterparts.

Similarly, among married women with circumcised husbands, HIV prevalence was higher among those whose spouses reported multiple life-time sexual partners than among their counterparts whose spouses reported one life-time sexual partner.
At a recent meeting when engaging a fellow participant on this exceptional evidence from Malawi, one of the participants got carried away and branded opposing view a circumcision-basher. Is circumcision some tender pet or victim whose feelings we ought to respect?

That one of the participants did not even stop to listen to what the opposing side had to say. Yet, the intention was to see whether, given the two sets of contrasting evidence, that there could be a way of thinking through a better way of confronting the HIV and Aids scourge.

It was surprising at to how low some scholars have sunk, to the extent of reducing the debate to "us versus them". It left one, wondering how the so-called circumcision-bashers refer to those on the other side of the divide.

In any case, HIV and Aids should concern everyone and any effort aimed at combating it is laudable.

However, aware of the two sets of contrasting evidence, the concern has always been the manner in which male circumcision is being presented to the public, as if it is the ultimate method of protection against HIV/AIDS infection.
The ultimate view should be, the promotion of male circumcision should be accompanied by riders encouraging people to use other means of protection even after the cut.

Otherwise we run the risk of creating the false impression that once a man is circumcised, he can start sleeping around without any care in this world.
Given the evidence from Malawi, one can only shudder at what this might lead to. The Malawi exception also brings into focus the issue of the position of the woman.
It suggests that we can circumcise the men alright, but as long as they remain promiscuous and do not use any protection, their women are still at risk. The question then is; how do we protect the women?

It is against this backdrop that a new way of thinking has started gaining ground within program circles, what is known in program parlance as MC-plus (Male Circumcision plus other preventive methods). Isn't this what we ought to be promoting?

The grave danger still lurks out there, and it must be made clear to all that circumcision is no panacea.
There is need to continue waving the banners of abstinence, being faithful to one's partner or using condoms, because the naked reality is that no cure for Aids has been found.

Circumcision is thoroughly unhelpful if one's partner is infected or if its taken for immunization. It's no good reason for people to dance around, clouding the message that the scourge is curable.AS OF NOW IT IS NOT!



ZIWANI said...

I am luo and circumcised.Cirumcision does not change the fact that i am by birthright luo.When the Aids warning was sounded,"discovered" by those two gentlemen who have just recieved the nobel prize luo elders then this is nothing new it is "chira". Fact is today 1 in every 4 luos has aids26% prevalence-i know cause Aids killed 4 of my close relatives. History in Nyanza has always been to respond to a crisis with 1.Denial 2. Passing the buck -read the government is to blame 3. Hiding behind culture. The next unknown epidemic is around the corner that will plague my generation. I will not blame chira.I refuse to watch as my son is killed just because a piece of worthless skin was the difference between him having a 60% chance of living a full life.

Hugh7 said...

There are lies, damned lies and statistics, and "60% protection" is one of those. The trials that claim to show "60% protection" are far too full of holes to rely on. After circumcising thousands of men and leaving thousands of others intact, a few tens got HIV - but hundreds left the trials, never to come back, and we don't know if they got HIV or not.

We do know that having several partners at once, and not using condoms are the main ways HIV is spread in sub-Saharan Africa. (The virus is most easily spread when it is new in the body, so multiple partners is just what it likes best.) Also injections from dirty needles. The Luo fishermen's custom of having "girlfriends" around the lake, who trade sex for fish, is one of the main reasons the Luo are more at risk of AIDS - NOT their foreskins.