Sunday, October 31, 2010

(STICKY) Zambia targets 2.5m males for circumcision

COMMENT - This is a massive violation of medical ethics. Targeting 2.5 million man cannot be done without coercion. Also, it is a direct violation of the Hippocratic oath - First Do No Harm. This is the use of surgery on individual patients for the sake of public health. Moreover, the data on which national prevalence rates in Zambia and Africa are based, are cooked. Let us see them do a Western Blot confirmation test for every positive single ELISA on all Demographic and Health Surveys, which will massively drop the national prevalence levels of HIV. They will not do that. Why, because it is 'too expensive', they say. In fact it would cost an additional $75,000 per survey (if they had 10,000 ELISA tests, and 1,000 were positive, and one WB test was the retail price of $75,-). They REFUSE to do that, because it would puncture the entire 'HIV in Africa' bubble, that has proven such a big money spinner so far. And now just Zambia alone has received $275 million to start circumcising 2.5 million men? How many billions is that for Africa as a whole? Shame on these so-called doctors for selling out their own people. Of course, "World AID$ Day" is coming up December 1st, so expect more alarmist ginning up of fear and urgency about HIV/AIDS. But this is a massive crime they are planning. What is next - mass sterilisation, because there are 'too many people' in Africa?

To see how the books on HIV in Africa are cooked (though no discussion about the use of a highly sensitive (lots of false positives) single ELISA in both ANC and DHS surveys, read this article in the Washington Post:

How AIDS In Africa Was Overstated
Reliance on Data From Urban Prenatal Clinics Skewed Early Projections
By Craig Timberg
Washington Post Foreign Service
Thursday, April 6, 2006

Estimates on HIV called too high

New data cut rates for many nations
By John Donnelly, Globe Staff | June 20, 2004

UPDATE (Nov 3rd, 2010)

It appears that the scientific evidence showing efficacy of circumcision in HIV prevention have been doctored. Of these three studies, 2 were prematurely ended, which opens the door to documenting bias (the authors carry out the trials until the desired results are reached, and then terminate the trials).

There are three large randomised controlled trials of male circumcision to reduce female to male HIV transmission: One from South Africa (2006):

* Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial
* (Kenya, 2007) Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial.
* (Uganda, 2007) Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial.

Zambia targets 2.5m males for circumcision
By Mwala Kalaluka and Eddie Mwanaleza
Sun 31 Oct. 2010, 04:00 CAT

ZAMBIA launched its 2010-2020 National Male Circumcision (MC) Strategy and Implementation in Kafue last Friday but questions still linger as to how many rivers proponents have to cross before they hit the anticipated 2.5 million circumcised male target figure by 2020.

A figure of 2.5 million against a concept or practice that is fraught with a myriad of traditional and medical stereotypes classifies the male circumcision target figure over the next decade an ambitious but critical one.

[He wouldn't know 'critical' from a hole in the ground. This is just the latest fad coming out of the multi-billion dollar AID$ industry. MrK]

It has been a long time coming.

About two days before the country launched its National Male Circumcision Strategy and Implementation Plan 2010-2020 and barely weeks after the MC (Man who Cares) advertising buzz hit the television screens and decorated the airwaves, a sizeable number of media practitioners convoked at Society for Family Health (SFH) head office in Lusaka, to help in the demystification of male circumcision.

Indeed, it is no longer an issue for heightened debates that the World Health Organisation (WHO) has identified that male circumcision has 68 per cent HIV prevention strength

[Garbage. - MrK]

but proponents of this prevention strategy have another battle to dismantle, which is the mystical and incomprehensible notions contained within the 32 per cent remnant risk of contracting HIV.

Opening the Press Orientation Workshop on male circumcision, Ministry of Health spokesperson Dr Kamoto Mbewe was nonetheless blunt about the role that media workers could play in demystifying the male circumcision strategy.

“Press, you are our mouthpiece, so you need to be well-educated to give information to the public to allay the misconceptions and the myth because even up to now there are still some myths and some misconceptions,” said Dr Mbewe.

Another Ministry of Health official, Dr Jonas Mwale, said the 10-year National Male Circumcision Strategy and Implementation Plan 2010-2020 was a formula through which the ministry would provide leadership in the male circumcision prevention strategy.

“The last six months of last year were basically dedicated to put systems in place at the Ministry of Health,” Dr Mwale said. “2010 was included as the first year for focused implementation…As a country we realised that we already have existing policies, which will adequately cover for us in the implementation.”

Dr Mwale said the percentage of circumcised men in the country was currently at around 17 and that the figure needed to be taken to about 50 in the next 10 years.
“The percentage of men that need to be circumcised is critical,” he said. “In Zambia, we are starting at a very modest rate of 50 per cent. Most of the neighbouring countries are commencing from 80 per cent.”

Dr Mwale said males between the ages of 13 to 39 formed part of the target group in the 2.5 million Zambians that needed to be circumcised if the country was to shore up its male circumcision prevention strategy by 2020.

“We are aiming to have at least 80 per cent of male babies to be circumcised,” he said. “We will probably see a lot of clinical officers and nurses do the circumcisions because obviously there are few doctors to do the 2.5 million.”

Dr Mwale said male circumcision strategists wanted more men to access the male circumcision services, as way of encouraging behavioral change in the fight against the spread of HIV/AIDS.

However, Dr Mwale said collaboration with traditional male circumcisers would continue on the sidelines of the National Male Circumcision Strategy and Implementation.

“Our concern with traditional male circumcisers is with issues of infection prevention,” Dr Mwale said.

“We are not taking over but we are collaborating.” According to Dr Mwale, from the number of those that have been circumcised as of the present moment, it was envisaged that about 300,000 people would be circumcised annually by 2014 leading to the 2.5 million ultimate target figure.

“It is critical that we are able to meet this number but this requires trained health providers,” said Dr Mwale.

In a technical presentation, Dr Evans Chinkoyo from Jhpiego gave a realistic position on male circumcision vis-à-vis its merits and demerits.

His was a presentation worth noting because of the penile models he was using to drive his points home.

Dr Chinkoyo said not only was male circumcision a significant factor in the prevention of cervical cancer among women through the contraction of the Human Papiloma Virus (HPV), but that it also helped in personal hygiene.

He said countries with higher male circumcision figures had the lowest HIV/AIDS prevalence rates.

Going by statistics that buttressed his verbal presentation, Dr Chinkoyo fleshed out a reality that indicated that countries like Zambia, Zimbabwe and Botswana had lower male circumcision prevalence but were among those that had high HIV prevalence rates.

Countries like China, Cambodia and Vietnam had very low HIV/AIDS prevalence rates of around 2.1 per cent but the male circumcision prevalence rate was on a higher side.

[Absolute nonsense. How does he explain the "HIV prevalence" levels which are low in West Africa but high in East Africa? There is no cause and effect between circumcision and HIV infection. There is however a cooking of the books about national HIV prevalence levels in Sub-Saharan Africa. Remember that national prevalence in Sierra Leone went from 7% to 0.9%, simply because of a switch from Antenatal Clinic Surveys to the less corrupted Demographic and Health Surveys. You want to bring down national HIV prevalence levels, start including a Western Blot confirmation test for every single positive ELISA screening test, used in those surveys. HIV infection in Africa is a statistical game, but these so-called health policies have real world effects. - MrK]

But SFH executive director Dr Manasseh Phiri said in his presentation dubbed the National MC Campaign, that there was still a lot that proponents of male circumcision needed to do.

“There are countries that are close to us that have difficulties,” Dr Phiri said. “There are lessons for us to learn.”

Dr Phiri said through the MC strategy, the players wanted to find something that emphasised the medical benefits of male circumcision.

“So you will see in our campaign materials we are talking about a man who cares… rather than get into medical debates,” Dr Phiri said. “In 2010, we should not be talking about the evidence (that male circumcision can be used in the prevention of HIV/AIDS). The evidence is so clear.”

[There is no evidence. Correlation does not equate to causation. - MrK]

Dr Phiri said the MC advertorials had created a buzz and the 990 toll free number hosted at CHAMP in Lusaka had been hit by a volcano as in the number of people calling in the aftermath of the MC campaign.

Only the remaining 10 years will tell us whether the proponents of male circumcision can break the barriers of misconceptions, because certainly the myths around male circumcision still abound but they are not insurmountable.

[They will also show that all predictions made about HIV in Africa are garbage. Again. There is offensive, and it is dangerous. What's next - compulsory sterilisation for population control, because someone in Geneva decides 'there are too many Africans'? This whole 'drive' smacks of eugenics, and eternal shame on those Africans who go along with this garbage. - MrK]

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At 5:56 AM , Blogger MrK said...

“So you will see in our campaign materials we are talking about a man who cares… rather than get into medical debates,” Dr Phiri said. “In 2010, we should not be talking about the evidence (that male circumcision can be used in the prevention of HIV/AIDS). The evidence is so clear.”

But we should absolutely be talking about the evidence, when we intend to operate on 1/3 of men in Zambia.

It is absurd to think that somehow project of this scale should not be done under the closest of public scrutiny. Or perhaps dr. Phiri knows that the evidence doesn't exist.


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