A number of readers have emailed me with a tip that Marie Stopes International (MSI), a UK-based family planning NGO, has put up a website promoting circumcision in Africa (complete with a circumcisons completed counter dubbed the "MCometer"). From the looks of it, it appears MSI is planning to be a big player in the field of male circumcision. I've been mulling over my reaction to this new front of propaganda in light of the previous post about the 20% of all HIV cases in Africa being caused by medical staff failing to use proper medical protocols.
My sense is that if male circumcision were left to the African health systems in place now, it would be a disaster. The circumcision lobby may be interested in circumcision first and HIV second, but I doubt they would promote a policy that will inevitably provide metrics that circumcision harms more than it helps -- and significantly so.
MSI's efforts on this issue provide some evidence that this is a battle over funding for direct involvement in an environment where funding has long had a tendency to disappear down some despot's bottomless well of graft. Whatever the intentions of African governments in implementing HIV/AIDS policy with foreign dollars, they have competition, and said competition is the NGO with "expertise" to impart or implement.
While the locals can provide culturally sensitive approaches to behavior change, the foreigners' pursuit of the honey pot only extends to providing the procedure itself, or significant ongoing support. After all, these societies would appear to be already culturally disposed to embrace the magical thinking that surrounds circumcision, and circumcision itself.
The video that MSI has produced embraces this magical thinking by acknowledging that Malawi is a country with high rates of HIV in circumcising districts, but fails to acknowledge that in fact circumcised men have not just high rates, but higher rates of HIV than intact men in that country. Moreover, an unsupported statement that variables other than circumcision make this so, and therefore this difference should be ignored, seeks to gloss over a problem of logic for the circumcision lobby generally.
The video also makes the giant leap that three studies that have produced consistent conclusions makes the science sound. Of course, three flawed studies (not double blind with insufficient follow up, and with vast selection and researcher bias) do no such thing, and certainly do not make the recommendations stemming therefrom unassailable.
The video seeks to appeal to those concerned with the impact on women by making the absurd claim that circumcised men will create a bulwark against HIV in a society where women do not have the negotiating power to insist on condom use. Somehow, men will have less HIV from the already infected store of women and therefore make condoms, what? Less necessary? No mention is made that one study has hinted at a much greater risk to women from circumcised men (See Wawer et al. [pdf]).
MSI then goes on with the script that circumcision presents a unique teaching moment to impart safer sex messages. It isn't clear what is more uniquely teachable about the context where removal of healthy, erogenous tissue from a man is the final step. Perhaps it's Pavlovian in nature? Extreme pain will be associated with the lesson to always wear a condom?
Of course, the arguments for circumcision are also arguments against circumcision. The young men and boys they use in the video are comfortable with the contradictions and probably prefer to accept the script they have been taught. Hence, they dutifully repeat in direct contradiction to the reasons given for parting with a sizable piece of their penis the mantra that one must still use condoms and respect women. For good measure, the de minimis impact of circumcision on cervical cancer and STD rates is blown up into a supporting reason to go for the cut, equivocal evidence notwithstanding.
And then we come to the part where foreigners or foreign trained personnel become indispensable. The video states circumcision is simple and minor, no big deal really, unless it is left in the wrong hands, "traditional healers, for example." It is also quick, easy, with no or few side effects, and what? It's cheap, too! And so, here we arrive at our final destination: a veiled plea for money.
MSI concludes the video with a woman stating that Malawi is "tired of HIV" over a scene of coffin makers laboring away to make, one is given to think, yet another coffin for yet another dead Malawian, presumably freshly deceased from AIDS. The woman concludes by stating that if we just inform the public how circumcision works (which nobody in the real world seems to be able to explain) and how good it is and how much it prevents HIV, "everybody will want to be circumcised."
Clearly, this video is made for an audience in the developed world, most probably for funders and decision makers in the HIV/AIDS industry. Hence, it is not produced in any of the local Malawi languages (at least yet). It seeks to address almost every issue that we in the intactivist community have argued in opposition. And finally, it uses a storytelling style that is sympathetic and benign, i.e. teenage testimonials, wide shots of vulnerable-looking children riding bicycles down dusty roads, and acoustic guitar.
MSI must understand the controversy surrounding this issue and the rapid reaction force deployable against them because they have disabled the comments on YouTube.com. However, you can comment here. Please do so.
