SWAZI CIRCUMCISION - MORE FEARS

I wrote on Friday (23 May 2008) saying that Swazis are being misled into believing that circumcision helps in the fight against HIV transmission and that people should be cautious about having the operation because there is no clear concensus in the medical world that it helps.

I received a comment from 'Joe' on the subject. It is quite a long and detailed response, but it gives more valuable information on the subject. Here is his comment in full.

There seems to be a lack of critical thinking when it comes to HIV, circumcision, and Africa. It's like they've given up and are grasping at whatever half baked idea pops in their head and circumcision has always been a procedure looking for an excuse. What is being suggested is insane.


There is a very real risk that many people will miss the part that CONDOMS are STILL required. There are already stories leaking out about people overestimating the protective effects.


It is already happening, in this recent article in the Trinidad Express, we have this gem: "Aah," one subject said during trials, "I have a natural condom." Or from Rwanda, in a recent article by David Gusongoirye, Nothing can fight HIV/AIDS better than discipline, speaking of the new campaign a man was quoted as saying: "Mister, these Aids people have spoken for long about fighting the disease, but they had never come up with a practical solution as good as this one. Don't have sex, don't do this, don't do that. Eh, man, how can a young man such as I forfeit sex, eh?" And the condoms “ where is the sense in putting on a condom when you are having sex? Sex is about feeling, and so no young person likes them!" There are some circumcised man who will get HIV in part because now they believes they have a "natural condom".

In a study published on the effectiveness of condoms in preventing HIV acquisition, heterosexual couples that included an HIV-infected partner used condoms consistently in a total of about 15,000 instances of intercourse. None of the uninfected partners became infected.[1]

So if we just get down to the proverbial brass tacks the whole issue boils down to the following question: If you are circumcised can you have unprotected sex with a partner whose HIV status is positive or unknown and NOT worry about getting infected? Clearly the answer is no.

The critical point is you have only two options: A. You don't need a circumcision, but you need to always wear a condom and be choosy about your sex partners. B. You can get a circumcision but you need to always wear a condom and be choosy about your sex partners.

The primary advice just doesn't change. A recent article, The No-Brainer Syndrome, discusses this point particularly well; as does a recent, and far more rational, editorial in Future Medicine. As does this recent article in the African Journal of AIDS research.


Actually for some good reporting on the HIV, AIDS, Africa, and Circumcision mess you should visit this blog.


The Australian Federation of AIDS Organization's had two excellent publications on this issue: Their July 2007 statement and one that was distributed at at last year's International AIDS Society Conference. The second said in part: "How a man factors the known risk reduction alongside the unknown variables into his sexual decision-making is the important thing. Unless he opts to use condoms with all sexual partners whose HIV status is positive or unknown, he remains at risk of acquiring HIV (and if he does this, there is no need to be circumcised for added protection)."


That's good advice.There has been a lot of progress made in Africa over the last decade with regard to HIV.


In Rwanda, for example, the HIV/AIDS rate has fallen from 11% of the adult population in 2000 to 3% in 2007 using conventional HIV reduction strategies. There are no short cuts, no silver bullets.


The only way to deal with HIV in Africa is through safe sex, education, and pulling people out of poverty. We won't cut our way out of it and if we want to do them a favor we would buckle down and do the actual hard work that needs to be done. If condoms are not available everywhere we need to solve the distribution problem.


If they are for some reason not willing to use them this too must be fixed. It is a message that we shouldn't muddy lest we undo all the hardwork that has been done to ameliorate the epidemic over the last 20 years. And I am certain that is exactly what is going to happen.



[1] De Vincenzi, I. A Longitudinal Study of Human Immunodeficiency Virus Transmission by Heterosexual Partners, New England Journal of Medicine 331 (1994): 341-6.

See also
SWAZI MEDIA AND CIRCUMCISION MYTH