the result of this massive program of male genital mutilation will be the further spread of AIDS, wide scale surgical infections and death. Feminist ideologues are leading the way on the ground.
In November of last year the World Health Organization, in conjunction with various other worldwide health organizations like UNIAID and the Presidents Emergency Plan For Aids Relief, released a document entitled, “Joint Strategic Action Framework to Accelerate the Scale-Up of Voluntary Medical Male Circumcision for HIV Prevention in Eastern and Southern Africa 2012–2016.”
This document outlines a multinational plan to circumcise tens of millions of men in Sub Saharan Africa over the next four years. The scope of the plan includes branding circumcision itself so young people will want to have it performed as well as school programs that actively “recruit” young boys to have the procedure done and to encourage them recruit others as well. In spite of repeated assurance throughout the document that human rights would be respected, it included provisions for a “sustainability phase” intended to eventually make male infant circumcision compulsory in the region.
It is intended to expend massive amounts of money from stakeholders to implement programs in targeted countries.
The topic of correlations between incidence of HIV infection and circumcision has made recent news. In a July, 2011, at an AIDS conference in Rome, the results of a controversial study called the “Orange Farm Study,” were released which purported that the procedure significantly reduced the incidence of HIV infection in the circumcised study group compared with the control group by 60% in South Africa, 53% in Kenya and 51% in Uganda. All over the world leaders of health organizations and advocates for sufferers of the disease celebrated. It is this report that gave the go ahead for the WHO’s Joint Strategic Frame Work and that is also being used to sell the plan of mass circumcision to local governments for approval.
Since the release of the study many voices in the medical community have expressed concern over the reasoning of the WHO’s program since condoms are nearly 100% effective and circumcision, even if the study is truly accurate, is much more expensive and risky considering it has only a fraction of the success rate. More importantly, the study itself has come under serious criticism by many who say it was seriously flawed.
In an extremely rare move, administrators of the study ended the trials early for “humanitarian” reasons. This has been criticized as a gross lapse of protocol. According to Dr. Daniel J Ncayiyana, editor of the South African Medical Journal, “The extended claim that circumcision confers lifelong protection seems like a stretch, and cannot be inferred from this or the other RCTs (randomized, controlled intervention trials), all of which were terminated at 24 months or less. And because the control groups were also offered circumcision at the termination of the RCT, the opportunity to continue longer-term follow-up was forever extinguished.”
From his article published in November of last year titled “The illusive promise of circumcision to prevent female-to-male HIV infection – not the way to go for South Africa” he goes on to explain other problems with the study:
“However, the three RCTs have not been without detractors. In a scathing critique, Van Howe and Storms6 point out that ‘In the South African trial, men who reported at least one episode of unprotected sex accounted for 2,498 person-years and 46 HIV infections during the trial. Among the remaining men, who accounted for 2076 person-years, 23 became infected although they either had no sexual contact or always used a condom …”
“Similarly, in the Ugandan trial, men who consistently used condoms had the same rate of infection as those who never used condoms. Finally, in the first three months of the Kenyan trial, five men became HIV-positive who reported no sexual activity in the period before the seroconversion.’ They conclude from their recalculations and statistical reasoning that ‘Conservatively for the three trials, 89 of the 205 infections (43.1%) were sexually transmitted.”
“Without knowing which infections were sexually transmitted [and which were not], it is impossible to test the hypothesis of whether circumcision reduces the rate of sexually transmitted HIV.’ Such studies, it must be said, depend on subject self-reporting, and, sexuality being a very private matter, the subjects may sometimes be inclined to be less than candid.”
He later points out in his article that concurring results were not present in the real life regional and global population of men.
Last week, in Zimbabwe’s online publication ZimEye, an article titled “Use Circumcision money to buy food and condoms,” was published in the business section pointing out further problems with the trials. Among other bulleted points it reports:
Even if the claim were true, based on the rate of infection in the studies, about 60 men had be circumcised to prevent one HIV infection. The other 59 men did not receive any benefit. However, based on another African report, men circumcised in Africa could be subject to a complication rate of 35% for a traditional circumcision or 18% for a clinical circumcision.
and
The studies were not consistent with other evidence. African national population surveys in eight countries found a higher rate of HIV infection among circumcised men compared to men who were not circumcised. There are at least 17 observational studies that have not found any benefit from male circumcision in reducing HIV transmission. Among developed countries, the United States has the highest circumcision rate and the highest rate of heterosexually transmitted HIV. Other countries have lower rates of HIV infection than the United States and do not practice circumcision.
In spite of these compelling objections the WHO and other super national organizations still plan to execute the initiative to circumcise nearly 28,000,000 men, boys and infants over the next five years. The list of stakeholders in the project reads like a who’s who of international political and economic powerhouses: They include:
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- Bill & Melinda Gates Foundation (BMGF);
- Centers for Disease Control and Prevention (US CDC);
- Department of Defense, U.S. Government (US DOD);
- Office of the U.S. Global AIDS Coordinator (OGAC);
- UNAIDS Secretariat Headquarters (UNAIDS/HQ);
- UNAIDS Regional Support Team for Eastern and Southern Africa (UNAIDS/RST);
- U.S. Agency for International Development (USAID);
- WHO Headquarters (WHO/HQ);
- WHO Regional Office for Africa (WHO/AFRO);
- The World Bank Global HIV/AIDS Program;
- The World Bank country-level Health Team and Task Team Leaders of World Bank Health Operations.
[/unordered_list]
In fact the plans for this initiative were formed a nearly a year before during a three day USAID sponsored meeting taking place during September of 2010 in Durban, South Africa. The South Africa AIDS Support and Technical Assistance Resources (AIDSTAR-One) Project, as the meeting was called, brought together over a hundred health professionals from 14 countries in east and southern Africa and international experts from Europe and North America.
None of them presented any medical data concerning the RCT tests nor was there any medical discussion concerning the efficacy of male circumcision for the reduction of HIV infection risk compared to that of condom usage. The vast majority of participants were not even medical doctors but rather public health officials and academics as well as a spattering of epidemiologists.
The presentations at the meeting resembled marketing plans for big sales drives more than anything else. They talked of branding, community outreach, demand creation and even “training journalists.” in one instance. The common themes throughout the reports were:
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- Communicating with women about the dangers of uncircumcised men and enlisting them in the “recruitment process.”;
- Supplying money to and engaging with local governments and tribal authorities to promote circumcision;
- Creating programs targeting adolescent boys in order to encourage them to have the procedure done;
- Setting the groundwork for compulsory circumcision of male infants;
- Secondary to all of these objectives were the distribution of and education on the importance of condom use. Nowhere is there any mention of specific strategies in this regard other than as a follow up to circumcision;
[/unordered_list]
Prominently represented in the list of presenters were two women in particular:
Kawango Agot, a PhD. in Nutrition and Kenyan native and Ayanda Nqeketo, a health official in Swaziland. Both are the program heads for the project in their respective countries. Neither are medical doctors. Both have been leaders in wooing governments with promises of millions of dollars in support the plans implementation. Both are self-proclaimed feminist ideologues who have on occasion betrayed a disturbing fixation on the topic of male circumcision.
In actuality these two women had not only been preparing their communities for the grand project that was about to come for some time, they were actually engaging in their own studies and implementing their own promotional programs in which thousands of circumcisions took place.
In 2008, Dr. Agot came under severe criticism by Kenyan blogger, Harun Lumiti in an article titled “Why is This Woman So Eager to Circumcise Her Kinsmen?” in which he quotes her as saying:
As I was reading through some academic books on HIV, I bumped into one that suggested a link with male circumcision and it made a lot of sense to me. The more I read books about the male cut, the more interested I became.
Keep in mind that Agot is not a medical doctor.
Lumiti goes on to describe a study conducted under the guidance of Agot and others not affiliated with the Orange Farm studies:
“And so one thing led to another until she bumped (?) into circumcision enthusiast Robert Bailey and secured funding for her research on the role of the penile foreskin in spreading AIDS. So determined was Agot and her zealous cohorts that their study in Kisumu was cut short because of “overwhelming evidence” to support their contention that circumcision protects against HIV infection.”
“Where was the Professor rushing to? Or were people dying at such a rate that there would be none left to cut by the time the study ended? Or was she rushing to beat some deadline for unlocking project funds? Indeed PEPFAR and other donors including the Global Fund for fight against AIDS had said they would not support male circumcision programs until the results from the study were released. Did this not influence the outcome of the study? Obviously, no funds would be released if no correlation between HIV and the cut was established.”
“And what was the overwhelming evidence at the time the study was terminated? From the uncircumcised group, 47 men tested positive for HIV while from the circumcised group the number was 22. That is about 60% less. Interpretation? Circumcision offers 60% protection against HIV infection. Such genius!”
“Next stop was the Prime Minister’s Right Honorable Office. Raila Odinga, also from the Luo community, quickly offered the stamp of political correctness to the study so as to smoothen Agot’s campaign in Luoland. Roping in the PM was a smart, though not entirely difficult feat for Agot, given Raila’s perpetually devious politics that is about to attain legendary status. Said he:”
I know circumcision will raise a lot of eyebrows. But there is evidence that it reduces infection by as much as 60 per cent.
“Apparently, in Luoland no one questions what Raila hasn’t. His approval not only helped reduce resistance to the campaign but also ensured its incorporation into the government’s public health programs. This was crucial to access further funding. And so Agot went over the moon. In her words:
In the idiom of the youths, I can say tumetoboa.
Tumetoboa is Kiswahili for “we have made it”. It is exclusively used to express the joy of crossing over to riches.
And, in a turn of events a few weeks later;
“The chairman of the Luo Council of Elders, Ker Riaga Ogallo says that he was arm-twisted to endorse the male cut among the Luo community.
“Ker Ogallo said that the whole affair had been turned into a cash cow by individuals and NGOs bent on enriching themselves. He claimed that an NGO recently bought a fleet of vehicles and hired a few staff but did not have any structures.”
“Our people are still languishing in poverty. No NGO is ready to offer practical assistance. I am shocked that when it comes to circumcision of Luo youths, an organization can import 24 new vehicles at once,” he said.
Ayanda Nqeketo, on the other hand, has had a good reception in the Swaziland press. She has also enjoyed considerable support from the government in Swaziland although King Mswati III has indicated his support in private but not given it publicly. An article was written in February of last year in Physorg.com featuring a program she had started with funds from the Bill and Melinda Gates foundation meant to be a pilot for other programs in Africa. The language within betrays the contempt “recruiters” have for male sexual health and religious sensibilities:
“One man boasts that he got circumcised because it is “nice to have sex without condoms” — drawing a furious reaction from the recruiters.
“That is NOT what he was told at the clinic!” exclaimed Mbogniseni Ndzimandze, the leader of the recruitment team.
“What am I going to do when God asks me, ‘Where is your foreskin?'” demands another man.
It is a question the recruiters are used to answering
“Why do you cut your hair?” says Mzwandile Shongwe. “God could ask you that, too.”
It is not explained where the man got the idea that getting circumcised would immune him from HIV infection or why it is necessary to compare the tip of a man’s penis with his discarded hair.
Even more alarming is the content of one of the reports that Nqeketo presented at the AIDSTAR-One meeting entitled “Mobilizing the General Population for Male Circumcision Saturation.” In the report she describes plans for a massive campaign for a media drive including branding, street theater, along with TV, radio and billboard adds.
Weighing heavily in the presentation are descriptions of programs already under way which include involving women family members in the recruitment process. A newspaper clipping pasted into the presentation features an article titled: Maidens Compose a Circumcision Song, which describes how hundreds of women symbolically cutting off the ends of reeds simulating the circumcision procedure while singing “the male youth are arrogant by not going through the circumcision process.” The participants then marched to the gates of the royal palace to place the reeds at the door of the King himself.
Perhaps most disturbing though is a newspaper clip describing the success of a “Back to School” program aimed at recruiting young adolescent boys that used the reward of a T-shirt to be awarded to any boy that convinced five others to go through with the procedure.
It is not clear how what started as a male health issue regarding HIV contraction has turned into what can only be called a feminist ideologue theme park concept. It is also not clear why these very powerful stakeholders are both listening and giving money to individuals and groups who clearly are not qualified to lead this initiative and who have come under considerable scrutiny from a wide variety of critics.
It is a well-known and proven fact that condoms as well as education concerning the spread of HIV have been extremely effective in the developed world, yet these methods are only being used as a secondary to a procedure whose benefits are at best unclear and unsubstantiated. This is not to mention that a growing number of people around the world are starting to view male circumcision as a barbaric, dangerous, cruel and medically unnecessary procedure.
Aside from the risk of illness and death through surgical infections, which are much higher in undeveloped nations, perhaps the most disturbing facet of these massive scale plans for “the cut,” is that they will have a negatively synergistic effect with rampant ignorance in that area. Africa has experienced some horrific problems, including child rape, because people superstitiously believed that sex with a virgin would cure aids.
It is not unreasonable to expect that a widespread belief that circumcision would prevent AIDS could easily foster the spread of the disease.
One thing is for sure, a lot of money, resources and political clout is sinking into an effort which has the potential to result in the deaths of millions of people.
Sources:
http://www.who.int/hiv/pub/strategic_action2012_2016/en/index.html
http://samj.org.za/index.php/samj/article/view/5384/3655
http://www.zimeye.org/?p=42943&cpage=1
http://hlumiti.instablogs.com/entry/why-is-this-woman-so-eager-to-circumcise-her-kinsmen/
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2807%2960312-2/fulltext
http://www.physorg.com/news/2011-02-swaziland-hiv-mass-circumcision.html
