Wednesday, 29 October 2014

The witchcraft potential of foreskins

TUESDAY, OCTOBER 28: SESSION BY DR SEMA SGAIER OF THE BILL AND MELINDA GATES FOUNDATION

WYCLIFFE MUGA writes: When the programme of Voluntary Medical Male Circumcision (VMMC) was first announced in Uganda (around 2007) one of its greatest critics was the Ugandan President, Yoweri Museveni. This was somewhat surprising because President Museveni had long been praised all over the world, as an African leader who had taken a place at the frontline of his country’s fight against AIDS (Uganda then having the dubious record of being one of the countries most devastatingly affected by HIV.)

On the face of it, President Museveni appeared to have a point: His argument was that this claim that male circumcision had been proved to reduce HIV transmission by 60% would be understood by most Ugandan men to be the long-dreamed-of get-out-of-jail-free card. And that on the assumption that the chances of getting infected had been drastically reduced, they would engage in wanton promiscuity which would ultimately INCREASE – rather than reduce – the incidence, and ultimately the prevalence of HIV.

And since this was at a time when it was widely anticipated within Africa, that sooner or later a ‘silver bullet’ against AIDS would be discovered in some sophisticated lab in Western Europe or North America (more or less what seems to be happening with Ebola now) this seemed to be a perfectly valid argument.

But, as it turns out, President Museveni was wrong. The VMMC programmes have been perhaps the single most important intervention against AIDS thus far, in the countries where such programmes were rolled out. Already about 6.0 million men have voluntarily submitted to circumcision and the target set is for 20 million men by 2016 or thereabouts.

And “risk-compensation studies” have since demonstrated that the men, who undergo such circumcision, are not in fact any more reckless in their sexual conduct than those who do not.

Of course – in my view, anyway, and as this is a self-selected cohort – there is the question of whether it is not the case, that such men who have already demonstrated a willingness to take steps to protect themselves and their families from the scourge of AIDS would be the very men most likely to be very careful and least reckless in their sexual conduct. And in any case, any man who is enrolled in this programme receives the most intense counselling imaginable, and all kinds of ancillary clinical services. Surely these too contribute to the drop in new HIV infections among circumcised men.

Back to the question of foreskins: With 6.0 million men circumcised over just a few years, well, that is a ton of foreskins: what do you do with them?

Of course the point here is that any medical intervention taking place within Africa – whether successful or not – will be subject to all kinds of rumours and speculations as to what the REAL objective is (e.g. “Might this be a new family planning method?” Or, “Why would anyone want to harvest so many foreskins, unless they knew that there is some kind of powerful juju which such foreskins can be used for?” Which would automatically lead to “Shouldn’t they be paying us for these valuable foreskins??”)

Just so you know: Dr Sgaier assured us that ALL the foreskins are treated as “biological waste” and are promptly incinerated.

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