Discovery, Male circumcision in the US, Africa and PEPFAR
(Taken from a blogging flurry on myspace...)
Don't worry. Seriously, I am not going to be a five-a-day blogger.
I spoke in my last post about how,
well,
I gotta a lotta shit to figure out.
Among the job hunts, school hunts, and get-the-fiancee here from Africa investigation,
are some other fun things that a little more internet time than the normal human should have are enabling me to investigate.
Such as: What are the perspectives and multiple truths for the economic changes that come about in the movement towards East African Unification? This for a dreamy project to promote EA artists...
How about things I should know for a baby... Will I need to address the cicumcision issue?
Vaccinations?
Well, one thing at a time.
From my piddly understanding of circumcision in the States, it was rooted in the religious, mostly Jewish efforts to decrease sexual drive, and although in the mid 19th century is was deemed an unecessary medical procedure, it was not until the end of the 20th century that the procedure changed from being standard to optional. All the information seemed to show that it was psycologically harmful, men lost penile sensitivity (and therefore had higher resistance to using condoms!), and there were no signs that circumcision was prophylaxis for any disease.
While I was in Tanzania, being a community AIDS educator, loads of research was coming out on how male circumcision reduced HIV tansmission. This made me a little sad, but the research was overwhelming! Circumsized men showed a 50% (av. as low as 10% high up to 88%) reduction in HIV infection. Hmm. Occasionaly one of these reports would venture as to why this is, citing more sensitive and therefore penetrable mucous membranes, which, post erection, could enclose viral infected fluids within the folds, as opposed to the cut and 'cleaner' penis. Basiclly, they described the same biological reasons that a vagina is more prone to HIV. The medical community does not want men with genitals that are as sensitive as vaginas.
Already in Tanzania, a country that is 50/50 Muslim/Christian for, with a smattering of Hinduism, traditional believes etc, circumcision is a common practice. All my friends babies were taken to be circumsized, with no more explaination than an American would have: for hygiene. Cha!
I wondered why this is, but I have no new answers. It is a procedure that becomes an accepted norm, and a mother does not want to feel neglegent. Still, I typed some things in, and a new tidbit popped up. PEPFAR is now funding safe medical procedures for adult male circumcision.
A little background:
The money that funded my particular position in the Peace Corps came from the Presidents Emergency Plan for AIDS Relief, which was announced to be a 15 billion dollar project to deliver HIV/AIDS prevention education and relief. Since the Plan coincided considerably with the announcement of the war on Iraq, the financing comparisons in the following paragraph is a bit interesting. In January 2003, in his State of the Union Address, Bush proposed an unprecedented amount of money for the war on AIDS:$15 billion over the following five years, for prevention education, treatment, and support for people living with the virus, orphans and vulnerable children. The next topic in the address was how we are winning the global war on terror. Ahem! Bullshit.
That March Bush said, "My fellow citizens, at this hour, American and coalition forces are in the early stages of military operations to disarm Iraq, to free its people and to defend the world from grave danger." The war on terror had already vowed to stay the course until terrorism was a thing of the past.
The same amount of money spent in three years on the war on AIDS was spent in three weeks warring in Iraq. Ok, just a sad fact that hopefully makes one ask oneself, 'What exactly are we trying to do here? Make the world safer for our children? Hopefully we can all see that furthering war does not do this.
PEPFAR has been criticized for being too idealogical. Bush is no stranger to this criticism. His Abstinence Only programs in Texan schools prove to result in a reported higher incidence in teenage sex. So 33% of PEPFAR funding goes to abstinance only campaigns, and all funding is withheld from organizations who advocate for the safety and health of sex workers. Many of these orgs may have formerly depended on US funding.
Stick with me, I get conservative for a bit, and I do go back to the topic of male circumcision.
I have found myself defendeding the program, not because it paid my $200 a month salary, (haha) but partly becuase it did enable a PC Health program and myriad projects in multiple villages that otherwise wouldn't have been there. It is true that Condom distribution was bundled up into a fringe percentage of funding, that mainly was focused on high risk groups. It is true that in Africa, a married woman is in a high risk group. EVERYONE is considered at risk of the epidemic, and yes, getting married increases that risk for a woman. But talking to them about using condoms seemed like an embaressing approach to solving the problem. They would smile and nod at me and tell me they heard all about the condoms, but if they suggested to their husbands to use them, they would be beat. Plain and simple. Rape does not exist in marriage, and neither, therefore, does a woman's right to her own body exist. So I didn't waste energy lamenting the fact that I couldn't get more money to send them all home with a year supply of rubbers, (which I am sure I could have weezled.) I felt it was more important to put on facilitated discussion forums where women could gripe amongst eachother, learn about their rights, feel empowered and invite their husbands to be a part of the converstation about family health, marital relations, and equality. Men were notoriously absent, but the women continued to be active and visit neighborhing households to make sure their sisters' households were being taken care of properly. Great! The HIV/AIDS situation is complex issue. The US offered up huge money. There are many groups working on AIDS, using different approaches. All of them are necessary. Now, like myself, many good orgs rely on the PEPFAR money for their projects. Meaning they need to follow the ideologies. Personally, I do not subscribe to the discrimination of sex workers, nor ignoring data on the importance of condoms, and I never witnessed a shortage of condoms. I saw my anti-HIV programs as needing a more holistic approach. Everyone has heard ABC until they get blurry eyed. It is like an American hearing that more exercise leads to weight loss. We are not ignorant. But we are fat. More and more so. Most people have a general idea on how HIV is spread, though it is still convuluted with a lot of rumors like it is spread through infected condoms as a western ploy to polish off Africa, and that if you are infected, sex with a virgin will cure it. Repeating the same old mantra, AB, AB, AB, AB (c-shhhh) is simply boring for all and what we need is behavior change. In order to change behavior, we need to build life skills. That is what most of Peace Corps funding went to. And life skills ed. isn't just about teaching elementary kids abstract concepts like self esteem and how to make goals, but it is to help build their esteem and give them a future by establishing income generation projects, gardens, extra-curricular school activities. This builds hope and self reliance, increases health and community. All of these things are core to the efforts. Good old fashioned Peace Corps development, as it has been since the 60's.
So often in the village, where there is no infrastructure, to support anti-HIV efforts, you find that solving one specific problem creates a whole set of new ones. If you bring testing, then you must now worry about counseling and support for those who have recieved answers, then getting them to town to recieve treatment and CD4 tests if necessary. There are constant weak links in what funding will do. It would fund education on stigma and abstinance, but not testing itself. It would not fund transportation to HIV+ groups to get to town for treatment, but it will fund educational seminars to teach those groups all about the services are offered in town, services that, too bad, they can't access. It would fund education on ways to prevent transmission, but not condoms. Well, as I long as I know that large amounts of funding are being used to create a vaginal microbicide gel that can be easily accessable to women, fine. But this is not the case. In fact, funding for that research has declined. Funding for health and reproductive services has declined. The latter because these services do not descriminate. They do not descriminate, therefore they are descriminated against by PEPFAR, who will not fund them unless they sign an oath that states they will not support sex workers. Guess what? In Tanzania, sex is one of the most popular and prosperous means of income for a girl. Period. In Tanzania, there is a phenomonal amount of young people on the streets. And they best way to make money? Sex. But lets stick to absitnance only.
Now, what my research on the history of male circumcision found out is bringing me back to my former work with nauseated interest: PEPFAR is listening to all the research that shows that male circumcision can prevent female to male transmission. They are now funding safe medical procedures to circumsize men.
What I ask must know, what are YOUR reactions to this issue?
Mine? We are now paying for a procedure that widens the gap between male and female susceptability. Men are now told that they are safer having unprotected sex with infected women (sex workers. It takes two to tango. So no we don't support sex workers, but ensure men are protected from their interactions with them.) Yes, that is exactly what the men will hear. We don't want their penises to be biologically vulnerable like a vagina. Now, how does this new funding fit within the abstinance, be-faithful funding ideology? It doesn't, and therefore, its presence is another powerful slap from the war hungry boys club.
This widens the gap, culturally and biologically, and it is confusing. Seems we are telling guys to just follow the advice of ex debuty president of South Africa, Mr. Zuma and feel free to have sex with HIV positive women, because you can always wash off with soap and water!
Yes, he said this after being charged with raping a woman who was HIV positive!
And while we are talking about THAT, what might the implications be on a renewed PROMOTION for circumcision? Is that going to affect the efforts to combate female genital mutilation? The way the confusing world works, and strange facts are translated into stranger acts (ie, the war on terror) I could imagine pro-circumcision being mistakenly interpreted to be a reason to support clitorectomies.
Anyway, to sum up, I never have seen a reason to do a circumcision on a boy, and therefore, if I have one, he will not be put through that trauma, but instead, hopefully lead a life of fulfilling and responsible sex and masturbation!
I also wondered why my Christian friends in Africa all were doing circumcision, and how Tino might respond to all of this. As the popularity of circumcision seems to be on a downturn in the States, is just the opposite in Africa.
And we talk of appropriate expenditures, and gender equality in development, I feel that this new area of PEPFAR is another glaring and embaressing example, like conservative Christians supporting war, that we are positioned along the axis of evil.
In my book.
In my blog.
