Several years ago, I conducted an ethnographic study on people's knowledge, attitudes and beliefs towards medical research using a trial on male circumcision as a case study in a town in western Kenya.
For 9 months, I held hundreds of interviews and group discussions with the young, the old; the poor and the not-so poor; men and women. I would like to believe I really got to know people well, basically by hanging out with them as fellow human beings (many of whom I have developed close friendships with) rather than what is known in development and research as "participants". Terms, distinctions and categories disappeared and were replaced by focused bar talk. Given that our main topic of conversation was sex and western models of research, you can imagine we always had plenty to jazz about.
Six years later, CNN and Time declared male circumcision as the biggest medical breakthrough of 2007. Over 40 studies among heterosexuals in Africa, India and the U.S. have found between a two-fold and eight-fold increased risk of HIV acquisition in uncircumcised compared to circumcised men and it is now widely accepted that the majority of men who are HIV positive have been infected through the penis. The media moguls made their stand shortly after the World Health Organisation and UNAIDS publicly announced,
that male circumcision performed by well-trained medical professionals was safe and reduced the risk of acquiring HIV infection by approximately 60%. The efficacy of male circumcision in reducing female to male transmission of HIV has been proven beyond reasonable doubt. This is an important landmark in the history of HIV prevention.
The anti-circumcision lobby has a lot of issues with just how scientifically sound the evidence is given that the reality of implementing mass male circumcision is always very different from clinical controlled settings. In a recent scientific paper, co-author Travis claims that
the African studies were conducted in atypically sanitary clinics with highly skilled operators and cannot be extrapolated to the general population. The studies have been criticized for their poor science including: the men were paid to be circumcised, received free condoms and extensive education, and the studies were halted after only 21 to 24 month periods...Promoting circumcision will drain millions, possibly billions, of dollars away from more effective prevention strategies, and cause tens of thousands of infections and other surgical complications, further straining an already overwhelmed healthcare system and undermining the current ABC (abstinence, be faithful, and use condoms) campaigns by creating a false sense of immunity and increasing risk-taking behaviors. African males are already lining up to be circumcised, believing that they will no longer need to wear condoms, and this is a serious concern.
However, some African countries are convinced that male circumcision might offer part of the solution desperately needed now. In Uganda, the Ministry of Health has declared that male circumcision services will be free of charge while Rwanda has announced plans to conduct mass male circumcision and Kenya has recently followed suit. Principal Investigator for the Trial in western Kenya, Professor Bailey, is confident that this is what we have been waiting for:
If male circumcision is taken up by just 50% of men in areas of sub-Saharan Africa where it is currently little practiced, millions of new HIV infections will be averted in men and women. We cannot treat our way out of this tragic epidemic. Until we have an effective HIV vaccine, which is likely to be decade's away, circumcision is a major weapon for preventing new infections in areas where most HIV transmissions are acquired through heterosexual activity. The challenge is now to make safe, affordable circumcision services widely available to the many Africans who now are seeking them.
Inevitably, there are concerns about how young circumcised men might perceive themselves to be fully protected and the trials did not divorce themselves from the importance of counseling. It is also true that millions of dollars have been poured into the research and lots more will go in to promoting male circumcision but does not compare in any way to the amount spent on vaccine trials and the scientists behind vaccine trials are the first to admit they are no closer to finding a vaccine then when they started. However, with 4000 new daily infections in male populations in Africa alone, there is a desperate need for a practical solution that does not depend on entirely on the will of the individual nor can Africa wait any longer for a vaccine. Slowing down the rate of new infections has to be a priority in order to give cultural and behavioral based models a chance.
|
TrackBack URI for this entry
Subscribe to this comment's feed
Show/Hide comments
Show/Hide comment form
In addition to men that have been circumcised having the perception of being fully protected from acquiring HIV/AIDS, the healing time after the procedure should also be explained to them by the health practitioners. Men are more infectious in the months following surgery, so having intercourse before they are fully healed is extremely risky for women. Male circumcision also does not decrease the rate of male to female transmission