I don’t think the Western media cover the catastrophe of African Aids nearly enough. And I think the lessons learned there are also ignored. First, when Uganda actively promoted ABC–abstinence, be faithful, but if if not those, use condoms–HIV infection rates plumetted. That makes sense. Condoms are not “safer sex,” as our AIDS activists and press so often put it to, but “less safe sex,” since infections still occur when condoms are used. Abstinence or sex with a mutually monogamous uninfected partner are the only sure ways to prevent sexually transmitted AIDS. When Uganda’s president and public health sector actively pushed abstinence and monogamy, it worked. And, with far fewer people engaging in dangerous behavior, the condom aspect helped as well.
But, as I recall, much criticism was directed at this approach, CNN (not the news network) advocated as the alternative–start with “condoms” (which assumes people won’t be abstinent or monogomous), needle exchange (a different matter, not relevant here) and “negotiation,” teaching individuals how to negotiate with their partners about condom use and other decisions that impact HIV transmission. But this doesn’t work when the virus is spread widely throughout society:
According to the UNAIDS report, “There are no definite examples yet of generalized epidemics that have been turned back by prevention programs based primarily on condom promotion.” The report does however say that condom use is effective especially if used together with other prevention methods of abstinence and faithfulness.
That makes sense to me: If you expect people to not control their urges, they won’t.
Alas, the Uganda success story is fading now with a return to soaring of infection rates. From the story:
After a dramatic fall in the incidence of HIV/Aids in Uganda in the 1990s, the pandemic is spreading again in the east African country, a government report released this week showed. A little over 90 000 people contracted the HIV virus in 2008, nudging the infection rate to 6.4% from 6% four years ago, The New Vision newspaper on Thursday quoted the report that was released by the presidency on Tuesday as saying
One cause cited in the story, an increase in laxity toward the A and the B.
Now, in other news, a study has shown that circumcision helps prevent transmission of HIV to men from infected women, rebutting those advocates like Dr. Dean Edell, who castigate the practice as having no practical health value. From the story:
Circumcision may help protect men from the AIDS virus but it does not protect the wives and female partners of infected men, researchers reported on Thursday. The disappointed researchers had to stop the trial, which they had hoped would confirm early suggestions that circumcision would protect men and women alike. But, they said, circumcision is so effective in protecting men that will still likely benefit women indirectly by reducing circulation of the virus in general.
Here’s a story of the S. African government’s failure to promote circumcision, just the latest in its many abject failures to combat HIV. (This brings to mind when I keynoted a bioethics conference in Capetown with a speech against assisted suicide, in which I brought up the question of whether people with AIDS in S. Africa would be treated or killed. I was followed by the head of the South African Medical Association who powerfully denounced his government’s AIDS policies as “genocide.”)
AIDS is the health tragedy of our time. Alas, the politics of the disease–which angrily eschews anything that can be perceived as judgmentalism or moralizing–too often, as I see it, has mattered more than focusing on best methods of saving lives.
July 20th, 2009 | 7:42 pm
I worked in Africa, and each country is different….but the PC type are more interested in spreading American sexual “ethics” than in helping HIV.
Of course circumcision helps stop men from getting HIV, because you see less balanitis.
But there is no technical reason it should slow the infection rate to women…their risk factors are irritations and using local herbs (x rated details deleted).
As for abstinence: It has a long history in some tribes, and even Shaka Zulu used it for his “virgin” warriors. However, non vaginal intercourse is an alternative, some versions of which spread HIV but most do not (Again, this is X rated if you want the details)
Also missing is the problem of rape…including that of children to “cure” HIV.
But don’t miss the latest PC lament: Gays in Africa, especially those who work in the sex trade, have a higher rate of HIV, and the high rate is because society doesn’t approve of them. BBC LINK
July 20th, 2009 | 7:50 pm
[NOTE: THIS COMMENT HAS BEEN EDITED DUE TO ITS EXTREME LENGTH, BUT I WANTED THIS CIRCUMCISION OPPONENT TO HAVE A FAIR SAY:] It is ill- advised for WHO to be promoting circumcision on men to allegedly prevent HIV, especially among groups whose Christian faith does not require circumcision and who are warned against it in the New Testament. In the previous century, all sorts of medical excuses were used by U.S. physicians to promote routine circumcision in the U.S. History unfortunately is now repeating itself. WHO also promotes abortion, so Catholics should be mindful of this when seeking guidance from this group.
A Dutch study in March of 2007 casts serious doubt on the wisdom of promoting male circumcision to prevent HIV infection, not only because of the risk of increasing HIV in women, but also because circumcision removes a natural HIV-1 barrier from men. “Langerin is a natural barrier to HIV-1 transmission by Langerhans cells” (Nature
Medicine- 4 March 2007). This study states, “Langerhans cells (LCs)
specifically express Langerin . . . LCs reside in the epidermis of the skin and in most mucosal epithelia, such as the ectocervix, vagina and foreskin . . . ” Removal of the foreskin (male circumcision) removes the langerhans cells that express langerin, the natural barrier to HIV-1 transmission.
To learn more about this study, see:
http://www.cirp.org/news/healthday2007-03-05/
In addition, a study in the March, 2007 issue of the “Annals of Epidemiology” found
that circumcision is “likely to spread” HIV. See: http://www.afrol.com/articles/24469
A study published on June 20, 2007 found that male circumcision is overstated as a
prevention tool against AIDS. This study found that the key to understanding the
global spread of AIDS is the size of the infected prostitute community around the
world. See:
http://www.eurekalert.org/pub_releases/2007-06/plos-mco062007.php...
Below are several articles that shed light on the circumcision/HIV issue. If circumcision truly helped prevent HIV, then circumcised
men would not need to worry about other methods of HIV prevention. The false sense of security that circumcision provides could increase the incidence of HIV. Already reports are coming out from Africa about men who think they cannot get HIV because they have been circumcised. One Reuters story reports the comments of young men in Africa undergoing circumcision. “”All I know is that when I am circumcised, it will not be as easy for me to get infected with HIV/AIDS,” said one young man, Kizeja Michael, as he lined up for the operation. People who are circumcised are not able to get AIDS,” said his friend, Peter Kibatsi. See:
http://africa.reuters.com/top/news/usnBAN338078.htm...
Men should not be misled. If the African studies had not been stopped early and long-term results had been obtained, the HIV infection rate might might very well have become statistically insignificant between the circumcised and non-circumcised groups. The number of cases in each period for each group is small, so their relative sizes are affected greatly by random variation. It appears from the data that the rate of infection is lower among the circumcised men in the first 18 months following circumcision, but that there’s little difference beyond 18 months. (And it should be noted that the circumcised men were required to refrain from sexual activity for six weeks during the healing process, and the intact men were not.)
Below are articles that point out the problems in the circumcision prevents HIV claims.
“HIV infection and circumcision: cutting through the hyperbole” THE JOURNAL OF THE ROYAL SOCIETY FOR THE
PROMOTION OF HEALTH, Volume 125, Number 6: Pages 259-265, November 2005
http://www.cirp.org/library/disease/HIV/vanhowe2005a/
The Use of Male Circumcision to Prevent HIV Infection
http://www.doctorsopposingcircumcision.org/info/HIVStatement.html
Circumcision and HIV Infection
http://www.cirp.org/library/disease/HIV/
Why Most Published Research Findings are False – John Ioannidis
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1182327
Published online 2005 August 30
Why Is HIV So Prevalent In Africa? – Michael Fumento
http://www.fumento.com/disease/aids2005.html
Position Statement on the Use of Male Circumcision to Limit HIV Infection
http://www.nocirc.org/statements/hiv2003.php
HIV-AIDS and Circumcision
http://www.circinfo.org/hiv.html
http://www.circumcisionandhiv.com/
July 21st, 2009 | 3:28 am
I’m curious about two things.
One, if circumcision drastically reduced HIV/AIDS, then why does the US (with it’s high percentage of circumcised men) have much higher HIV rates than places like Italy or Sweden (where circumcision is rare)?
Two, how on earth could someone living in Africa, where HIV is so rampant, NOT wear a condom every single time without fail? That is the only thing that will stop the spread of HIV. I understand the needs of men, but my need to have sex has never been greater than my need to stay alive. And once you have HIV in Africa, your rate of staying alive plummets!
July 21st, 2009 | 9:18 am
I worked as a physician with HIV patients on South Beach in Florida for some time. I was shocked at how dangerous were the PC attitudes of the HIV clinics. NEVER did they suggest in their pamphlets, posters, etc, even moderation in the number of partners, even for infected men and women. Instead, condoms, dental dams, etc. It was entirely expected that the target audience was wildly promiscous, and that this was “ok”.
Granted, homosexual men are generally wildly promiscuous, but how could they NOT suggest the only “safe” approach: abstinence and faithfulness? I was especially scared by the implied acceptance that infected men and women were also promiscuous, and rightly so. It was considered INSULTING to suggest to an infected man that he should abstain, in the hopes of stopping infection.
Just wear a condom. HAH! As a physician, I’ve encountered umpteen pregnancies as a result of misused or torn condoms. Condoms aren’t a panacea, they are a thin film of rubber. Makes me fume. I had to stop working for those idiots, who were so concerned for their HIV patients, but not concerned enough to actually stop the rate of infection. Infection in South Beach has increased and increased and I’m not surprised.
July 21st, 2009 | 9:33 am
[...] Secondhand Smoke: Of Uganda, AIDS, Abstinence, and Circumcision by Wesley J. Smith I don’t think the Western media cover the catastrophe of African Aids nearly enough. And I think [...]
July 21st, 2009 | 12:28 pm
[...] That, of course, is sentimental church-talk dispensed by uptight, unsophisticated God-freaks who want to run your life, even unto death. [...]
July 22nd, 2009 | 3:45 am
I am working with a medical NGO in South Africa. Over the last two years we have seen a drastic decline in international financial support for AIDS awareness, prevention and care programs. The global economic conditions could have some impact, but it would appear that funds are now going to other areas e.g. education, feeding schemes, eye surgery etc. Some international donors have even indicated that funding proposal should make NO mention of AIDS … goodness knows why!
Yet, UNAIDS estimates that 5.7 million people live with HIV in South Africa alone, of which only 410 000 HIV patients receive ARV’s. (Instead 400 million condoms are distributed annually.) In the Province of KwaZulu-Natal (where I work) 39.1% of the population of about 10 million is infected with HIV.
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