I'm here in New York City, rubbing shoulders with people from every imaginable corner of the world. It's an experience that makes you think about the meaning of acceptability, a concept that has a lot to do with the promotion of circumcision in Africa -- and in developed countries.
A great deal of the news one hears about HIV/AIDS is characterized by its dire tone, desperation, guilt inducing pleas for sympathy, and calls for money. Calls for circumcision over the decades have shared many of these qualities, particularly the direness, the desperation, and the guilt trips. Leave it to Robert Bailey and Daniel Halperin to add the money element.
Money is a funny thing. Price something too cheaply and it appears, seems, and may even look cheap without regard to the reality. Give it away and it often goes begging. Price it too high and desirability rather than quality suddenly becomes the issue. A high price seems to actually induce buying.
Something for free? Take it or leave it. The illusion is of abundance and that one can always come back.
Cheap? You get what you pay for. It won't last. We'll just have to replace it or do it again whatever it is.
Expensive? How can we afford it? How can we rearrange not just our finances, but our very priorities.
What does all of this have to do with the controversy over circumcision as an HIV prevention? Bailey and Halperin have called circumcision an HIV prevention as opposed to a risk-reducing measure, claimed an absurd 75% protective effect, and deflected the controversy by claiming no personal interest in the subject other than helping people. Halperin has said to me personally and elsewhere that most of his writings are about behavior change. But of course, this is subject-changing and deflection to slip his agenda passed lowered defenses. And one he will not be able to honestly make for much longer.
The economics of it are this. Claim an outsized value on something, and get people to pay dearly by buying into what is essentially a genital mutilation. The analogy is not perfect. It breaks down in developed countries when you consider that the value is claimed to be very high while the personal and financial costs are offered as inconsequential. The reality is that the value is close to nil in real world settings while the high cost is disguised.
The analogy is much better suited to Africa. Circumcisions are astronomical in cost both in actual money terms and in the over all resource loss to the medical system while providing no real prevention. It's basically a zero sum gain for prevention and a net loss for the provisioning of not just HIV testing, treatment and prevention services, but for basic medical services in maternity, vaccination, education, and other essential areas of health care. And the personal cost is rightly perceived as very high because adults are the target and circumcision is not common in the targeted areas. Hence, the promise of a discount for later generations, if only the current targeted group will only pay high now, by the introduction of infant circumcision where it has been unknown before.
So Bailey and Halperin have gone shrill in their calls for money, calling for expensive mobile circumcision services, and their alleged rightful share of the HIV pot to fund them. After all, circumcisions aren't going to perform themselves. And so, the campaigning for cash has begun.
So what can we do? A lot is the short and hopeful answer.
The interest of people of conscience should be two-fold. First, HIV prevention, education, and the integrity of any system that purports to participate in this endeavor. Second, providing these services at the lowest possible cost to the individual and society without dictating how individuals should go about their prevention strategies. And the irony is that working towards the lowest possible cost to the individual is ... you guessed it, expensive.
Therefore, I will be placing all contributions to the Tip Jar and my own personal contributions in trust, pending the formation of an entity that will provide the financial wherewithal and emotional, political, and personal moral support to do this work. We can make a difference, get the attention this cause deserves, and compete (yes, I mean literally compete) with the likes of Halperin and Bailey, who by the way have the full authority and economic support of their institutions behind them.
Finally, I would like to thank Joe Pellegrino for being our second contributor to the Tip Jar. Your contribution is more than financial. It encourages us all. Thanks.
[REVISED third paragraph.]
