AFRICA: Botwsana to Implement Controversial Infant Circumcision Devices

Circumcisionist Ambitions Realised
As if calling circumcision an HIV prevention method, and implementing "mass circumcision campaigns" in the so-called name of HIV prevention weren't controversial enough, Botswana is one of those countries whose medical authorities have been convinced to take it a step further, and start campaigns to circumcise newborn boys. Perhaps they see this as the next step, seeing as adult men aren't falling for the propaganda, and some countries, such as Japan, have begun to stop funding adult male circumcision programs?

It should be no surprise that babies are finally being targeted for circumcision under the pretext of HIV prevention. The justification of male infant circumcision is what circumcision "researchers" have been aiming for all along. Circumcision is not this medical "solution" that "researchers" supposedly "discovered" merely 30 years ago; the fight to justify male infant circumcision has been raging on since Greco-Roman rule.

Circumcision, particularly male infant circumcision, is a cherished tradition in Judaism, and it's a money-maker for American physicians. The goal isn't to stop HIV in Africa; the goal is, and has always been, to justify male infant circumcision in the US, and elsewhere. Circumcision "researchers" want for medical organizations, such as the AAP, to point to Africa and say "Male infant circumcision prevents HIV in Africa, therefore we recommend infant circumcision for American babies." Is it any wonder that much of the funding for "mass medical male circumcision," or any similar variant, happens to be American money?

Implementation of Controversial Infant Circumcision Devices
Circumcising male infants should be controversial enough, as amputative surgery in healthy, non-consenting minors is unethical. There goes the "voluntary" part of the so-called "Voluntary Medical Male Circumcision" slogan...

The plot should thicken when, not only are baby boys being circumcised, but they're being circumcised with controversial devices.

According to StarAfrica, the Botswana Ministry of Health has adopted the Mogen clamp and AccuCirc device, to be administered to healthy, non-consenting, non-sexually-active children. National coordinator Conrad Ntsuape told state-run Radio Botswana that the two devices were the best that Botswana opted for.

The following passage is disconcerting:

"Ntsuape noted that the entire procedure would be bloodless, requiring no anaesthesia, suturing or a sterile setting."

It sounds very similar to the lines of a certain Neil Pollock.

Of course there is no such thing as a "bloodless" circumcision, requiring no anaesthesia, nor a sterile setting. Even the latest AAP statement features a lengthy passage on adequate pain management for infants undergoing circumcision. A sterile setting is necessary to avoid infections, such as those with MRSA.

Let's continue further:

"Ntsuape said the decision to adopt the two devices followed a lengthy consultation process that focused on acceptability of infant male circumcision as part of HIV prevention and male reproductive health efforts that was conducted by Botswana and the United States through Harvard Institute in 2008."

Instead of the acceptability of male infant circumcision, shouldn't it have focused on other things? Like, for example, whether or not male infant circumcision is effective in reducing HIV? (There are no studies that exist on this subject, and world data shows that it does not.) Shouldn't there have been an actual evaluation of the risks involved, especially given the devices being considered?

"Ntsuape said the results of the survey indicated that 96 per cent of mothers in Botswana accepted early infant circumcision while the remaining four per cent were undecided or not interested."

Before considering what mothers have to say in a survey after being told that circumcision would prevent HIV in their sons, where is the proof that infant circumcision reduces HIV transmission? Were the risks of circumcision discussed with these mothers? Were the risks of each device disclosed to these mothers? Was the fact that circumcision cannot prevent HIV transmission, and therefore even circumcised men have to wear condoms discussed with the mothers?


What Botswana Circumcision Advocates May Not Tell Parents

The Mogen device being marketed here has a terrible track record for circumcision mishaps, including glans amputations. So infamous is the Mogen clamp for circumcision mishaps that numerous million-dollar lawsuits put the company out of business.

Common Mogen Problem: The circumciser is blind to the condition of the child's glans. Some or all of the glans is pulled up along with the foreskin, resulting in partial or full glans amputations.

What mothers have to say about circumcision has no bearing on the fact that there is no scientific evidence that circumcising newborns will prevent HIV transmission, but would the women in this survey answer the same, if they were given this information?

The AccuCirc device is a recent invention that doesn't have much of a history, not that it needs any, as we know its intended purpose of cutting off part of a healthy child's penis.

I hate discussing the better or worse of two evils, and discussing what is the "better" male infant circumcision method is no different than discussing which is the "better" female infant circumcision method. There simply isn't a "right" way to mutilate a perfectly healthy, non-consenting child. However, there is a good critique on why the AccuCirc is particularly terrible here.

Conflict of Interest

David R. Tomlinson

"Chief Expert on Circumcision," WHO

Inventor of AccuCirc

The citizens of Botswana may be interested to know that the inventor of the AccuCirc device also happens to be "chief expert on circumcision" at the World Health Organization. He develops, implements and evaluates male circumcision training programs in Africa, and he wrote the WHO's manual for male infant circumcision. (Reference here.) Is it any wonder that the AccuCirc device is included in many African "surveys?"

To Close
Adopting a device known to cause problems is not very wise, not to mention circumcising healthy, non-consenting newborns who are at zero risk for HIV transmission is ethically repugnant no matter what methods employed. Botswana is complicit in implementing what is effectively male infant genital mutilation, under the deceptive guise of HIV prevention.

Related Posts:

Circumcision Botches and the Elephant in the Room

The Ghost of Mogen

CINCINNATI: Intactivists Protest Circumcision "Experiment" at Good Samaritan Hospital

PEPFAR To Blow Millions on PrePex

PrePex had been running paid ads on high-end news outlets bidding for the WHO approval that would allow them to cash in on the African HIV/circumcision pie. They had a video on BBC, and ran dedicated articles on the Washington Post and the New York Times, as well as others.

Well, it looks like PrePex entrepreneurs have finally gotten their wish. According to the New York Times, the WHO has finally given their approval for the PrePex device, and PEPFAR leader Eric Goosby has already pledged to buy PrePex devices to circumcise as much as 20 million boys and men in Africa by 2015, under the ostensible pretense of "reducing HIV."

Grinning like a french poodle

In the New York Times, PrePex CEO Tzameret Fuerst said that the estimated price for each PrePex device would be an estimated $15 to $20 range. If PEPFAR pays for 20 million devices, that's a minimum of $300,000,000 a maximum of $400,000,000 American tax dollars that the program would spend on a dubious practice with speculative benefits, a waste of money considering that there are cheaper, less invasive, more effective ways of preventing HIV transmission.

No Demonstrable Scientific Proof Circumcision Prevents HIV
The sound bite that "circumcision reduces HIV 60%" is repeated over and over like a mantra, the WHO has given their blessing, and interested programs and manufacturers are promising to circumcise millions for foreign aid, but there is actually no scientifically demonstrable proof that circumcision does anything to prevent HIV transmission.

Close scrutiny of the so-called "research," however, reveals that there is actually no demonstrable scientific proof that circumcision does anything to prevent, or even "reduce the risk" of HIV at all, let alone by "60%." Circumcision promoters brush past this fact by distracting their listeners with the less-than impressive "60%" figure, and by mentioning how many men are "lining up to get circumcised." They need the money now, now, now.

There have been recent attempts to posit yet another hypothesis that attempts to explain "how circumcision prevents HIV," but they miss the mark, instead arriving at irrelevant conclusions, and not coming anywhere closer to furnishing the causal link for the so-called "effect" the much talked about "studies" were supposed to measure in the first place. Without a causal link, the "studies" are nothing more than statistics embellished with correlation hypothesis, and the efforts to circumcise millions in Africa are myth-based, not evidence-based.

African Men Not Buying into Circumcision for HIV Prevention
Despite the hyped up "mass circumcision" programs in Africa, it's been report after report of programs failing to meet their quota of circumcising boys and men in the past year.

Though they tried and tried, the much hyped Soka Unkobe program failed in Swaziland, where approximately 34,000 out of the expected 200,000 men (about 17%) were circumcised. Rather than abandon the strategy to mutilate the genitals of the men of Swaziland, American organizers are trying to figure out "what went wrong."Apparently, they feel they feel getting men to agree to have part of their penis cut off is simply a matter of "sending the right message." There is something wrong with an HIV prevention program that measures its progress by how many men they've circumcised, and not by how many they've educated about condoms and safe sex.

Three years into the 5 year program, only 80,000 of 1.2 million targeted men (about 6.7%) have been circumcised in Zimbabwe, and here too circumcision promoters are scratching their heads. Why aren't the men biting?

[There is no evidence that circumcising men in Zimbabwe has any effect against HIV.]


Click to enlarge
In Botswana, programs are also failing to convince men to cut off part of their genitals. One program circumcised only 685 out of an intended 10,000. In another program, promoters convinced only 360 out of 2560 men (approx. 14%) to get circumcised. Here too, promoters are dumbfounded and can't find the right people to blame. It couldn't possibly have anything to do with the fact that they're trying to convince men to undergo permanently altering surgery on their genitals, could it?

In Zambia, circumcision uptake has also been low.

In Kenya, Homabay district, only 11,000 men have been circumcised out of the estimated 42,000 since September 2008 when the program was initiated. Here too, circumcision uptake has been low, so coordinators are targeting children who are neither at risk for HIV, nor putting others at risk, not to mention the ethical dilemma of forcibly cutting off part of the genitals of healthy, non-consenting individuals. (So much for "Voluntary Medical Male Circumcision.")

The WHO may have given their coveted blessing to plunder African HIV funds to PrePex, and PEPFAR leader Eric Goosby may have pledged American money to pay for their devices, but it remains to be seen whether the devices will actually ever be used, or if they'll simply remain sitting in storage compartments unused.

While a failure to implementing PREPEX would be ironically heartening insofar as it shows that African men aren't buying into the circumcision propaganda, it remains disturbing that millions of dollars that could be providing more effective aid and advances in public health are being wasted and squandered by PEPFAR.

Real World Data Fails to Correlate with "Findings"
While the "60% reduction" claim is repeated, it fails to manifest itself in the real world.

It is interesting that PEPFAR is so eager to help circumcise millions of men in Africa, while circumcision has done America no favors in terms of HIV reduction.

80% of America's male population is circumcised from birth, yet AIDS rates in some US Cities rival hotspots in Africa. In some parts of the U.S., they're actually higher than those in sub-Saharan Africa. According to a 2010 study published in the New England Journal of Medicine, rates of HIV among adults in Washington, D.C. exceed 1 in 30; rates higher than those reported in Ethiopia, Nigeria or Rwanda.

The Washington D.C. district report on HIV and AIDS reported an increase of 22% from 2006 in 2009. According to Shannon L. Hader, HIV/AIDS Administration, Washington D.C., March 15, 2009, "[Washington D.C.'s] rates are higher than West Africa... they're on par with Uganda and some parts of Kenya." (Hader once led the Federal Centers for Disease Control and Prevention's work in Zimbabwe)

According to a recent report:

"HIV/AIDS is the seventh leading cause of death in the United States among people age 15 to 24, and half of young people infected with HIV are not aware of it. An unbelievable 26 percent of all new HIV infections are among those 13 to 24."

According to HIV prevalence data in the CIA Factbook, and circumcision prevalence figures in Wikipedia, the United States, where 80% of the male population is circumcised from birth, has a higher HIV prevalence rate than 53 countries where circumcision is rare (e.g., falls below 20%).

Countries where circumcision falls below 20%, and HIV is less prevalent than the United States (By rank in HIV prevalence):
 

Colombia, Argentina, Uruguay, Cambodia, Peru, Nepal, Switzerland, Vietnam, Ecuador, France, Chile, Spain, Moldova, Mexico, Italy, India, Iceland, Costa Rica, Canada, Belarus, Austria, Paraguay, Netherlands, Ireland, Denmark, Bolivia, Bhutan, United Kingdom, Belgium, Nicaragua, Laos, Bulgaria, China, Cuba, Cyprus, Czech Republic, Finland, Georgia, Germany, Greece, Hong Kong, Hungary, Japan, Lithuania, Mongolia, New Zealand, Norway, Poland, Romania, Serbia, Slovakia, Sri Lanka, Sweden

There is a prevalence of European, South American and Asian countries. Countries where one might expect a higher HIV prevalence rate have a surprisingly low prevalence rate. One would expect a higher prevalence of HIV in these countries, but they fare better than the United States, where 80% of the men are circumcised, instead.

Before handing out millions to gold-mining circumcision device manufacturers, PEPFAR ought to address the question of why something that never prevented HIV in this country is suddenly going to start working miracles in Africa.

PrePex CEO Tzameret Fuerst Gloats
In the following video, Tzameret Fuerst can be seen gloating about securing billions from PEPFAR, one can almost see the dollar signs in her eyes, as if she actually cared about HIV prevention. She repeats the same old circumcision/HIV propaganda, touting circumcision as a "one-time intervention with the efficacy of a vaccine." Sharp viewers may note other thinly veiled interests.

It'd be interesting to see her credentials. She holds degrees in urology, surgery and epidemiology, and can explain to us the mechanism whereby circumcision immunizes a man against HIV I'm sure.





But all is not lost; this new device makes the argument that circumcision would be "more painful, more complicated and more traumatic as an adult" a moot point, if in fact, as Tzemeret tells us, her product is "virtually painless and simple to do."


Related Posts:

CIRCUMCISION: BBC Runs Paid PrePex Ad

CIRCUMCISION: The Washington Post Folds to the PrePex Ad Campaign

NYTimes Plugs PrePex, Consorts With Known Circumfetish Organization

Where Circumcision Doesn't Prevent HIV 

Where Circumcision Doesn't Prevent HIV II

CIRCUMCISION "RESEARCH": Rehashed Findings and Misleading Headlines

 

Politically Correct Research: When Science, Morals and Political Agendas Collide

AFRICA: When Propaganda Fails, Try Bribery

In earlier posts, I point out how "mass circumcision campaign" efforts have been unsuccessful in coercing men into circumcision in some parts of Africa. So desperate are some circumcision promoters in getting their programs off the ground that they've tried turning to various propaganda approaches, without much success.

In Swaziland, for example, the Soka Uncobe ("Circumcise and Conquer" in Swazi) campaign had been so unsuccessful in convincing the men to undergo the knife since its launch*, that they've tried hiring an entire sports team to endorse the project. As if that weren't enough, organizers "re-launched" the program in July, with the endorsement of the Swazi King, which, by the way, keeps many wives and isn't even circumcised himself. To top it off, they've even tried hiring an artist to try and beautify the genital surgery, thinly veiling it in artistic expression. Millions of dollars in trying to convince men to cut off part of their penises, this despite the fact that HIV transmission was found to be more prevalent among the CIRCUMCISED in their own country. I can think of no better expression to describe the situation, than officials pissing in the mouths of Africans and calling it rain.

As Table 14.10 shows, the relationship between HIV prevalence and circumcision status is not in the expected direction. Circumcised men have a slightly higher HIV infection rate than men who are not circumcised (22 percent compared with 20 percent). (p. 256)

*Numbers vary by source: According to the Swazi Observer, Xaba reported that 28,000 out of 152,000 men had been circumcised as a result of the campaign, while Times Live reported only 3,000

In Botswana, only 14,000 of 467,000 targeted men (12%) have stepped forward since the program began last year, according to a Mmegi report in July. In the words of Principal public relations officer at the ministry of health, Temba Sibanda, that a large portion of the targeted group was not coming forth for circumcision is a "mystery." Here too, officials decided to go with the football team approach.

According to The Standard, officials in Turkana County, Kenya, are facing the same challenge in meeting their quota; since their program began in March this year, only 3,000 out of 175,000 men have come forth for the operation. Numbers were high at first, but they've since dwindled. Their approach? Bribe men sh100 ($1.07) to get circumcised. Through their paid referral program, men also get paid for each man they bring in for the operation.

Quoth Program Director Dr. Nicholas Muraguri:

"We really want this programme to succeed. That is why we are giving locals, who visit health facilities for the cut, incentives."

In other words, HIV prevention isn't good enough.

"This approach will help us to achieve our targets. The more you bring clients to the health facility for the cut, the more money you get... We are educating the community the health benefit of male cut in the prevention of HIV to encourage men to get circumcised."

...that is, if by "educating," he means "brainwashing," and by "encourage," he means "bribe."

I've asked before, and I'll ask again; have "mass circumcision campaign" organizers ever considered the possibility that some men may never agree to get circumcised? That some men treasure their bodies and would prefer an alternative? What alternatives do circumcision campaign organizers have ready for such men? Or was preferring to stay intact simply not supposed to be an option?

Much "support" is offered to men who go in for circumcisions. But is that same "support" offered to the men who would rather learn proper hygiene and the proper usage of condoms?

These are questions that these program organizers must answer. What if despite all the efforts, the men would prefer an alternative to circumcision? Do they have that scenario in mind? Do they have education packages as part of these "mass circumcision campaigns" for men who do not want to be circumcised in place? Or are they simply not going to offer these men that option?

So much for education and informed consent...

Related Link:

KENYA: Men bribed to be circumcised

When All Else Fails, Hire a Sports Team

It must be a tough job being a circumcision promoter... You're paid to convince a quota of men to have part of their penises cut off "for their own good," and for whatever "mysterious" reason, only a small fraction of the men you're expected to convince trickle in. You've tried music, you've tried, movies, you've tried coercion, you've tried harassment, you've tried taunting their masculinity, and nothing seems to work! You've got a quota that a paycheck from PEPFAR or Bill Gates depends on, the year is almost over and you've barely got a tenth of your goal. What to do? Hire a football team!

Nothing is more effective in brainwashing people, er, I mean properly educating them about HIV transmission and the full range of their options than celebrity endorsement. The celebrity isn't even required to be an actual user of the product advertised, just as long as their name and face is on it is enough. PEPFAR and Bill Gates say they'll flip the bill so it's all covered. The men should be jumping in line to have part of their penises cut off! If they don't, if all else fails, you can always re-launch your campaign and get the king to endorse it. After all, what's more influential than a king nobody really listens to?

Yes, it looks like the ministry of health in Botswana has taken the lead of Swaziland's ministry of health and they have finally gotten their own football team to endorse their very own campaign. It was very recently reported that men in Botswana were "mysteriously" not taking the circumcision bait, and that they were 88% behind in their quota. If this fails, Botswana's ministry of health's next move would be to hire a local king. (If they can find one that is influential and leads by example; the Swazi king has many wives and is not even circumcised himself!)

What I'd like to know is how many of the athletes that are endorsing this campaign actually went through with their circumcisions. It's very easy to to lie for money. Celebrities endorse products they never use all the time. The Swazi king has endorsed circumcision, but he has yet to announce his own. The story in Mmegi's latest article almost sounds believable, except for the part about the operation taking 5 minutes. Is this story even true? Or was his athlete paid to lie? It would be interesting to ask for these men to drop their pants to see if they're lying or not. There's not a doubt in my mind that some of the very organizers of these so-called "mass circumcision campaigns" would never put their money where their penises are.

Sooner or later the circumcision/HIV hoax will blow over. These so-called "studies" are going to explode into the scientific scandal of the century, and the WHO, UNAIDS, PEPFAR, Bill Gates etc., will all have to bear responsibility for bankrolling miseducation campaigns, and the genital mutilation of thousands of men and children across Africa in the name of "humanitarian aid."

BOTSWANA: Men Shunning Circumcision a "Mistery"

A few blog posts ago, I expose how the PEPFAR backed Soka Uncobe campaign is having trouble getting off the ground. Such a failure the campaign has been so far that organizers have tried boosting the campaign with a football team and endorsement from the king himself.

It looks like, however, Swaziland is not the only country where men aren't swallowing the circumcision/HIV pill. According to Mmegi, in Botswana, only 14,000 of 467,000 targeted men (12%) have stepped forward since the program began last year.

In the words of Principal public relations officer at the ministry of health Temba Sibanda, that a large portion of the targeted group is not coming forth for circumcision is a "mystery."

A "mistery?" Really? Has the ministry of health not considered that perhaps these men aren't too keen on getting part of their penises cut off? Even with perceived "benefits?"

Have "mass circumcision campaign" organizers ever considered the possibility that some men may never agree to get circumcised? That some men treasure their bodies and would prefer an alternative? What alternatives do circumcision campaign organizers have ready for such men? Or was prefering to stay intact simply not supposed to be an option?

The Soka Uncobe campaign has tried to appeal to Swazi masculinity by employing the imagery of women, and asking women to "support" men who go in for circumcisions. But does that same "support" go for the men who would rather learn proper hygiene and the proper usage of condoms?

That is a question that needs to be put to these knife-happy pro-mutilators. What if despite all the efforts, the men would prefer an alternative to circumcision? Do they have that scenario in mind? Do they have education packages as part of these "mass circumcision campaigns" for men who do not want to be circumcised in place? Or are they simply not going to offer these men that option?

The priorities of so-called humanitarian aid organizations come ever into view; what is the true end-game? Is it truly the prevention of HIV transmission? Or is it the acceptance and proliferation of a controversial surgical procedure?