AFRICA: Dangerous myths and speculation perculate in the press

American parents have for years carried on circumcising their infant boys after the major medical organizations had come out against the routine practice in an ambiguous sort of way. In other words, the medical groups punted. Leave it to the parents, albeit with guidance, knowing the guidance would be heavily pro-circumcision, due to culture, or largely absent, due to prudish attitudes.

Justifications, to borrow a phrase from Hugh Young’s writings, are “hydra-headed.” When medical justifications don’t work anymore, make it personal, such as the ever ready “to look like daddy.” When the rights of the child discredited that reason, the reason became “it’s in the Bible,” because in the United States, religion trumps just about everything. Or for whom the religious argument didn’t appeal, to reduce the risk for urinary tract infections, or cervical cancer in women, or penis cancer in men, or phantom phimosis, and the list goes on … . personal preference of the parents being the true driver of the practice.

The case for circumcision has been termed “complicated and conflicting.” And hence, the reasons ebb and flow according to the interests of the proponent due to the fact that there are so many studies, showing just about whatever the researcher wishes to prove. And contrary studies, showing the opposite.

In law, it is said there is an expert for every opinion. One just has to find him. Or her. And of course, to pony up the cash to hire him. Or her. And hence, it is rapidly becoming so in medicine and science. Circumcision is not unique in this respect.

So for your pleasure and perusal for today we have this little article, next page. The media reports reproduced on circumstitions.com are interlineated with comments. This is a valuable way to critique a report. So, let’s do that and see where the inaccuracies lie.

A snip that helps, but won’t stop Aids [And so what will? Why, condoms and education, of course.]

CIRCUMCISED men shouldn’t consider themselves immune to HIV, according to Aids activists and health professionals on campus.

The Wits chapter of the Treatment Action Campaign (TAC) has responded with caution to current evidence that circumcised men have a lower risk of contracting the HIV virus.

The TAC’s anxiety is that this may be interpreted as licence to engage in unprotected sex and irresponsible sexual behaviour. [Common fear in skeptics, and not improbable.]

The conclusive evidence emerged last year after clinical trials in Uganda and Kenya. [Far from it, the evidence was not conclusive and the studies were never finished. A correlation maybe. But little more.]

It confirmed a 2005 South African study in Orange Farm that circumcised men were 50 to 60% less likely to contract the HIV virus. [Not mentioned is that the studies’ results favoring circumcision become less and less, the better the study is designed. Hence, 70% protective effect went to 50% in the latter studies.] The tests also showed that transmission to women was significantly reduced. [Simply incorrect. This is repetition of other inaccurate reporting. The studies did not test any hypothesis viz. male to female transmission.]

Phyllis Phukubuye, the TAC campus spokesperson, said circumcision was only one of the many complex HIV/Aids interventions. It could not be the primary prevention tool. [Commendable candor, as far as it goes.]

“We hope that this evidence will not result in the false belief that safe-sex practices are no longer required, thus worsening the incidence of HIV infection,” she said. [But it probably will.]

This sentiment is shared by journalism student Phakamisa Ndzamela. “I know a lot of circumcised people who got infected. I definitely wouldn’t take the risk of foolish behaviour,” he said. [The obvious, borne out in the real world.]

Ndzamela, who was circumcised at 18 according to Hlube tradition, said the empirical evidence could in itself be quite dangerous. [Gratifying that some people have critically examined the implications.]

“It may be interpreted as: ‘You won’t get Aids if you’re circumcised’, when what it is really saying is that the risks are probably just lower.

“This is where the media have a great responsibility to educate and inform people correctly,” he said. [And yet, we have seen precious little responsible media reporting. And this is a widespread problem very much in evidence on a wide range of issues, these circumcision studies being only one.]

Sister Yvonne Mathimba of Campus Health said she had received many queries after the trial results went public.

“Mainly male students asked: ‘If I go for circumcision does this mean I will never contract sexually transmitted infections and HIV?’ [And what of those who aren’t asking? What might they believe? And more importantly, how might they be acting on their (false?) beliefs?]

“A lot more education needs to be put in place, especially for men. Men do not talk about reproductive health.” [Sensible statement.]

If a Witsie asks Campus Health for Aids counselling, they won’t be told about this intervention unless they specifically ask.

Mathimba said this was, in part, due to the ongoing nature of the study, which still had to be extrapolated and applied in other settings. There was also controversy around male circumcision. “Some argue it is mutilation,” she said.

“The research is also still in process. Stats in rural areas, where men are circumcised, show no reduction in incidence of HIV.” [This is a surprising admission and level of knowledge. But perhaps it shouldn’t surprise us because the people speaking in this piece are there, unlike many of the researchers, who merely collected the data and did the analysis far from the location and context.]

But Dr Neil Martinson, of the Wits Health Consortium, said this was the best we had for the time being and action was needed. [Therefore, since we are desperate, we’ll experiment on a large number of people? That’s a level of panic that we haven’t seen before in this epidemic. And it should frighten as much as the disease itself.]

“Current campaigns like ‘Love Life’ are not making a big enough impact on the pandemic. Twenty-five percent of young women are still HIV positive and that stat is not coming down.” [And male circumcision does not address the level of infection in women. So why the rush to circumcise men? The Stallings study would seem to indicate that women should be circumcised if they are most at risk. But of course, that is absurd. And the other recent study, as yet unpublished, that indicates female partners of circumcised men are at higher risk should scare the bejeezus out of those concerned with HIV and women.]

Mathimba did stress that if a student asked about circumcision at Campus Health “it would create an opportunity to talk about overall sexual health”. In this light, she would also personally recommend it. [Apart from making no sense, what does this mean? If circumcising men gets them to wear condoms more often, then it has value? Why not just speak to them about condoms and let them keep their foreskins?]

Apart from protection against HIV/Aids, circumcision can also protect against other sexually transmitted diseases. [Incorrect again. The evidence has never been anything other than inconclusive on this score.] This is because the protective effect of circumcision is provided by the removal of the thin sensitive inner lining of the foreskin, which is more vulnerable to disease than the vaginal lining. [Assertion without evidence and contrary to a recent study.] Its efficacy is largely dependent on a safe hygienic surgical procedure. [A non sequitor statement.]

But both Martinson and Mathimba said public hospitals did not perform circumcisions without a valid medical reason. So a man choosing this as an intervention would have to pay a private doctor.

Some Eastern Cape students discovered this when they approached Campus Health to ask about having the operation done in a hospital before taking part in the important cultural coming-of-age ritual.

This is where Aids clinics like Zuzimpilo in the Johannesburg CBD come in.

The clinic was established to bridge the gap between the private and public health sectors.It has recently started a training programme for doctors to perform circumcisions.

Martinson, who also heads Zuzimpilo, said there would not be a marked impact on new infections until there was a marked increase in circumcisions. [This is a kind of conundrum, if true. It hints at forced circumcisions to come.]

“That would require a sensitive marketing campaign targeted at young men and possibly their mothers, selling the idea that male circumcision may be a life-saving procedure, especially when the circumcision is performed prior to sexual debut.” [And it all comes down to a sales job. The urge to exaggerate and even lie to convince people will be overwhelming.]

Reference

Ismaila, Farhana. A snip that helps, but won’t stop Aids. Vuvuzela Online. March 22, 2007.

http://www.vuvuzelaonline.com/index.php?option=com_content&task=view&id=831&Itemid=51

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