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Friday 23 May 2008

SWAZI MEDIA AND CIRCUMCISION MYTH

What is it about male circumcision that makes people in the Swazi media lose their critical faculties?

I have lost count of the number of reports that tell us that having the snip will help to control the spread of HIV AIDS.

There were two this week in the Times of Swaziland alone. The first was in the truly dreadful column, Let’s Talk About Sex, last Friday (16 May 2008) and the other was on Tuesday (20 May 2008).

Tuesday’s report was about a member of parliament who told the nation that where men were circumcised ‘the rate of HIV AIDS infections was drastically declining’.

He gave no evidence beyond saying that the Swazi government and NGOs were ‘seriously canvassing’ for men to have the operation.

Swaziland has been featured in the international media as a place where circumcision is being used in the fight against HIV infection. One report in the Globe and Mail, Canada, (27 March 2008) even told of a near ‘riot’ at one medical point because there was not enough time to treat all the men who had turned up.

The report went on to say that the Swaziland Government wanted 200,000 men in the kingdom (with a population of just fewer than one million) to have the snip.

When the story appeared on the Globe and Mail website, many readers wrote in to dismiss the idea that circumcision helps in the fight against HIV infection.

What worries me is that people in Swaziland are being misled into believing that circumcision can help, when the international medical community continues to debate whether there is any evidence that it can.

An organisation called Doctors Opposing Circumcision (DOC) has published a lengthy report in which it urges that ‘Both the public and the medical community must guard against being overwhelmed by the hyperbolic promotion of male circumcision.’

DOC reports that there is no clear evidence as to the effects of circumcision.

‘One study found that male circumcision had no protective effect for women and another study found that male circumcision increased risk for women.

‘[A different study] found more HIV infection in circumcised men.

‘[Yet another study] found no evidence that lack of circumcision is a risk factor for HIV infection.


‘A study from India found little difference between circumcised and non-circumcised men.

‘A study carried out in South Africa found that male circumcision offered only a slight protective effect.

‘A study carried out among American naval personnel found no difference in the incidence of HIV infection between non-circumcised and circumcised men.'


This leads DOC to conclude, ‘Instituting a program of male circumcision is of dubious value. It will divert resources from proven methods of epidemic control and it may generate a false sense of security in males who have been circumcised. The desensitization of the penis that frequently results from male circumcision is likely to make men less willing to use condoms. A program of male circumcision very likely may worsen the epidemic.’

The group has its own idea on why places like Swaziland may have higher rates of HIV infection than elsewhere, ‘The epidemic in Africa may have little to do with lack of circumcision and everything to do with the percentage of the female population engaged in female sex work. One study found a definite link between the number of female sex workers in the population and the level of HIV infection.’

Before jumping on the bandwagon, journalists in Swaziland should educate themselves and their readers about the truth about circumcision.

To access the report click here.

1 comment:

Anonymous said...

Richard, I think you are on to something. There seems to be a lack of critical thinking when it comes to HIV, circumcision, and Africa. It's like they've given up and are grasping at whatever half baked idea pops in their head and circumcision has always been a procedure looking for an excuse. What is being suggested is insane. There is a very real risk that many people will miss the part that CONDOMS are STILL required. There are already stories leaking out about people overestimating the protective effects.

It is already happening, in this recent article in the trinidad express, we have this gem: "Aah," one subject said during trials, "I have a natural condom." Or from Rwanda, in a recent article by David Gusongoirye, Nothing can fight HIV/AIDS better than discipline, speaking of the new campaign a man was quoted as saying: "Mister, these Aids people have spoken for long about fighting the disease, but they had never come up with a practical solution as good as this one. Don't have sex, don't do this, don't do that. Eh, man, how can a young man such as I forfeit sex, eh? And the condoms – where is the sense in putting on a condom when you are having sex? Sex is about feeling, and so no young person likes them!" There are some circumcised man who will get HIV in part because now they believes they have a "natural condom".

In a study published on the effectiveness of condoms in preventing HIV acquisition, heterosexual couples that included an HIV-infected partner used condoms consistently in a total of about 15,000 instances of intercourse. None of the uninfected partners became infected.[1] So if we just get down to the proverbial brass tacks the whole issue boils down to the following question: If you are circumcised can you have unprotected sex with a partner whose HIV status is positive or unknown and NOT worry about getting infected? Clearly the answer is no. The critical point is you have only two options:

A. You don't need a circumcision, but you need to always wear a condom and be choosy about your sex partners.

B. You can get a circumcision but you need to always wear a condom and be choosy about your sex partners.

The primary advice just doesn't change. A recent article, The No-Brainer Syndrome, discusses this point particularly well; as does a recent, and far more rational, editorial in Future Medicine. As does this recent article in the African Journal of AIDS research. Actually for some good reporting on the HIV, AIDS, Africa, and Circumcision mess you should visit this blog.

The Australian Federation of AIDS Organization's had two excellent publications on this issue: Their July 2007 statement and one that was distributed at at last year's International AIDS Society Conference. The second said in part: "How a man factors the known risk reduction alongside the unknown variables into his sexual decision-making is the important thing. Unless he opts to use condoms with all sexual partners whose HIV status is positive or unknown, he remains at risk of acquiring HIV (and if he does this, there is no need to be circumcised for added protection)." That's good advice.

There has been a lot of progress made in Africa over the last decade with regard to HIV. In Rwanda, for example, the HIV/AIDS rate has fallen from 11% of the adult population in 2000 to 3% in 2007 using conventional HIV reduction strategies. There are no short cuts, no silver bullets. The only way to deal with HIV in Africa is through safe sex, education, and pulling people out of poverty. We won't cut our way out of it and if we want to do them a favor we would buckle down and do the actual hard work that needs to be done. If condoms are not available everywhere we need to solve the distribution problem. If they are for some reason not willing to use them this too must be fixed. It is a message that we shouldn't muddy lest we undo all the hardwork that has been done to ameliorate the epidemic over the last 20 years. And I am certain that is exactly what is going to happen.

[1] De Vincenzi, I. “A Longitudinal Study of Human Immunodeficiency Virus Transmission by Heterosexual Partners,” New England Journal of Medicine 331 (1994): 341-6.