Were we fooled?
Friday, 13 July 2012 19:35
Shamiso Yikoniko and Lincoln Towindo
Dozens of billboards emblazoned with the message “Circumcision — one of the top defenders against HIV and Aids” are now a common sight on major roads in Harare. Such loud advertisements, alongside an aggressive campaign in newspapers and on air, form part of a multi-million-dollar campaign aimed at encouraging sexually active men to get circumcised as a way of reducing the risk of contracting HIV.
Recently, Members of the House of Assembly and leading celebrities were roped into the campaign to try and encourage more men within the 15 and 49 age group to get circumcised.
Male circumcision is a surgical procedure for the complete removal of the foreskin of the male reproductive organ.
According to medical experts, the benefits of male circumcision include the reduction, by 60 percent, of the possibility of contracting HIV, the reduced chance of having sexually transmitted diseases, penile and cervical cancer and urinary tract infections in infants.
For some with a more discerning eye, the recent aggressive male circumcision campaign is an attempt to create a semblance of credibility for a programme which was initially suffering from mass apathy amid concerns over its safety and assumed effectiveness in fighting HIV and Aids.
Millions of dollars worth of donor funds were pumped into organisations such as Population Services International Zimbabwe (PSI), which is spearheading the campaign alongside the Government, to try and convince men to undergo circumcision.
Zimbabweans, keen to “reduce” their chances of contracting HIV by 60 percent, have embraced the idea with about 70 000 young men going under the blade in just under three years at a rate of over 10 circumcisions an hour, up from the initial rate of three an hour.
However, amid the swelling enthusiasm, Zimbabweans recently woke up to shocking revelations that the much-hyped “miracle solution” to the HIV and Aids pandemic might turn out, after all, to be pie in the sky.
According to the latest Zimbabwe Health Demographic Survey 2010-2011, the HIV prevalence rate among circumcised males between the ages of 15 and 49 in Zimbabwe is higher than that of uncircumcised males.
The prevalence rate among the circumcised is 14 percent while that of the uncircumcised is 12 percent.
In 2007, the World Health Organisation recommended male circumcision as an HIV preventive measure based on three sub-Saharan African randomised clinical trials into female-to-male sexual transmission.
In light of the latest research outcomes pointing to higher HIV and Aids prevalence among circumcised young men compared to their uncircumcised peers, many
Zimbabweans are understandably in shock after they were made to believe that it was supposed to work the other way round.
Observers have been quick to express apprehension over how promotion of circumcision has taken apparent precedence over other tried and tested methods such as abstinence and condom use, which have apparently taken a back seat.
They noted that the “Top Defender” adverts along with the others being flighted by PSI and its partners are promoting sexual bravado while subtly giving the impression of an “invisible condom” among those who would have been circumcised.
To many people, the advertisement and circumcision campaigns lack the finer details of what the procedure entails.
Mrs Patience Kunaka, inter-personal communication manager at PSI, however, insists that male circumcision reduces the risk of contracting HIV.
“The programme is effective. There is no need to panic. The whole issue is being blown out of proportion,” she said.
On the advertisement messages, Mrs Kunaka said the Government, through the Ministry of Health and Child Welfare, had the final say on the campaign materials.
“This is a programme that we are working on in partnership with the Government and we work hand in glove in terms of coming up with the proper message,” she said.
“However, at the end of the day they get to decide what is eventually communicated to the public.”
While the debate on the effectiveness of male circumcision rages on, Zimbabwe has over the past two decades managed to halve its HIV prevalence rate largely due to the promotion of abstinence and condom use. The question now on many people’s minds is whether there is a link between the advent of mass circumcision and the increase in HIV prevalence among circumcised youths.
However, what is clear to many is that circumcised youths have turned to sexually risky behaviour in the false belief that circumcision gives them an “invisible condom”.
Others are of the view that Africa might have been sold a ruse by the WHO in cahoots with Western researchers.
While it is becoming clear that enough may not have been done by individual African countries to ascertain the authenticity of the WHO-led research, many are now waking up to the sad reality that circumcision may not be the miracle solution that they had hoped it would be.
But could the circumcision campaign, which has been embraced so affectionately by African nations such as Uganda, Kenya, Zimbabwe and Namibia, be a distraction from the greater and more apparent challenge of eradicating the scourge?
Officially opening the 13th International Aids Conference held in Durban in 2000, former South African president Mr Thabo Mbeki said poverty was the underlying cause of reduced life expectancy, handicap, disability and starvation.
“Extreme poverty is the world’s biggest killer and the greatest cause of ill health and suffering across the globe,” he said.
While millions are dying of the disease every day, powerful lobby groups and global health campaigners have taken advantage of the desperation among developing countries eager to stave off the crippling effects of HIV and Aids.
Infinite campaigns, “new” medicinal discoveries and health innovations originating from powerful Western funders are being forced down the throats of African governments through funding-thirsty local NGO partners without much discernible benefits for most countries.
There is no doubt that the fight against HIV and Aids has turned into a multi-billion-dollar business and Zimbabweans should brace themselves for more “scientific” innovations that can help prevent the disease.
“In the fight against Aids, profiteering has trumped prevention. Aids is no longer simply a disease; it has become a multi-billion-dollar industry,” stated Sam Ruteikara, a known campaigner against HIV and Aids and, co-chair of Uganda’s National Aids-Prevention Committee.
Last year prominent HIV and Aids researchers Gregory J. Boyle and George Hill questioned, in a scathing research paper, the logic behind circumcision.
“Since male circumcision diverts resources from known preventive measures and increases risk-taking behaviours, any long-term benefit in reducing HIV transmission remains uncertain,” they concluded.
Boyle and Hill challenged the methodological, ethical and legal concerns of randomised clinical trials.
“Why were the trials carried out in countries where more intact men were HIV positive than in those where more circumcised men were HIV positive? Why were men sampled from specific ethnic groups? Why were so many participants lost to follow-up?” questioned Boyle and Hill.
These and several other questions remained unanswered prior to the recommendation of male circumcision. However, the programme was still foisted on poorer nations.
Powerful organisations such as UNAIDS, the WHO, and the Bill and Melinda Gates Foundation have been at the forefront of financing the circumcision crusade despite its apparent flaws.
According to researchers, the origination of male circumcision is not known with certainty. One school of thought proposes that it began as a religious sacrifice, as a rite of passage marking a boy’s entrance into adulthood, as a means of enhancing sexual pleasure or as an aid to hygiene where regular bathing was impractical.
Some believe that male circumcision began as a way of “purifying” individuals and society by reducing sexuality and sexual pleasure.
However, today circumcision is being practised in many countries across the globe for different reasons.
It was only recently that it was encouraged as a way of reducing the risk of contracting HIV following findings that the disease was not common in Moslem societies where infants are circumcised only a few days after birth.
But observers have called for more comprehensive Afro-centric research to be done before circumcision is adopted as the “top defender” against the disease.