Welcome to the RANT page, commonly known as the guestbook. But for our purposes, I think "rant" describes the intensity of people's feelings on the issues covered here.

Another purpose for this page is to give space to people who have something they wish to say, but nowhere relevant to say it. So, now comments elsewhere can remain relevant to the pages or posts in which they are placed.

Thanks.

Comments

[SunkenShip]

This whole circumcision/HIV propaganda is so sick and false that it makes me want to scream.

[partly]

I find this an odd juxtaposition.

R Craig Lefebvre starts with discussion of something interesting:

"heterosexual transmission patterns of HIV strongly suggest that the normative practice of maintaining 2 or more concurrent sexual partnerships (CSPs) over time (think of them as having minimal social distance if you like) is the core set of behaviors that fuel the HIV epidemic in some regions. In fact, the data show that these men and women typically have the same number of sexual partners over a lifetime as an American – it's concurrency, as opposed to serial monogamy, that is the distinguishing risk behavior. When these sets of CSPs overlap through one or more individuals being part of two or more networks, once HIV infection is introduced anywhere into these linked networks, it quickly spreads to members throughout all of the linked networks unless they are using condoms. There are many more nuances to the data, but the point of bringing it up here is that social networks may be the most important determinant of the spread of HIV – not individual behaviors. So do we now encourage ‘fidelity’ to regular partners and ‘abstinence’ when you are out at clubs on the weekend? Or are we looking at first changing the acceptability of these behaviors? Those, it turns out, may be the real questions we have to address next."

So far, so good. First, identify the root of the problem, then formulate an active response. How will the author's expertise in "social marketing and health communication" be applied, in practice?

He continues:

"I am now sitting at PSI where we have been working with JPIEGO on a pilot program for male circumcision in Zambia , the WHO has endorsed male circumcision as an HIV prevention strategy, and the government of Zambia has given the green light to scale up male circumcision programs in the country. Scaling up programs means creating demand for the service among sexually active men. And creating demand for male circumcision services, my head and gut tell me, will not be through some creative and expensive mass media campaigns. It is going to (should) cause us to rethink what we mean by interpersonal communications, the targets for such efforts and how to take them to scale. That’s what makes the NEJM article so much more interesting for me this week."

Apparently he's reference is related to this in conjunction with Johns Hopkins.

So, there you have it.

Problem identification: "social networks may be the most important determinant of the spread of HIV."

Response action: "creating demand for the service [circumcision] among sexually active men"

Wow.

[David]

This idea that multiple concurrent sexual relationships are the vector for the HIV epidemic would certainly limit the applicability of prophylactic circumcision to a very specific cultural setting, assuming one accepts the prophylactic effect of the procedure.

However, a cursory review of the history of the procedure shows that it exerts a fierce psychological grip on people that extends far beyond its original point of insertion. The disfigurement of circumcision soon becomes normative and the die is set.

Public policy makers are obligated to study alternative approaches before utilizing an invasive and dangerous surgical procedure. In that vein, better to focus on breaking up and disrupting the networks of multiple concurrent sexual relationships, in my opinion.

[IntactwhitemaleUSA]

I think what's been happening in the US in regards to the discussion of circumcision/HIV lately is actually quite positive. I commend Mr. Wilton for starting this excellent site; others like it are going up or expanding as the initial media frenzy on this has blown over. There's just way too much in the pro-circ camp's history that can be used as ammo against them. I don't think this is going to be nearly the slam dunk they predicted - this is the first health crisis they've tried to use to sell circ after the advent of the web.
Simply put, WHO is giving sexually active men in high HIV incidence regions a deadly mesage - "try playing the odds." Frankly, playing the odds stinks, particulary when losing the game means contracting HIV. It's been said that gambling is a tax on the stupid, and WHO's touting circ as a wonder cure for black Africa is the most racist (particularly the implication here is that the mesage of ABC is just too hard for Africans to implement) thing that body has ever come up with. There are shades reminicent here of the Arab world's exploitation of black Africa that need exploring - remind non-Muslim Africans of this and I think you'll see opposition build quickly. Already we see entries on the BBC's HYS decrying the West's use of Afica as an "animal lab" - in regards to this and several dismal experimental phama studies that have left the participants with dead or deseased loved ones and no avenue of recourse.
As an aside, I'd like to remind WHO, that glorious institution, that we're still waiting for you to eradicate smallpox - 30 years after you proclaimed "Mission accomplished!"
We have 100+ years of evidence in regards to the propaganda of the pro-circ crowd. It ALWAYS forms a simple patern 1) STD, uro-genital cancer, moral degeneracy etc. is an enormous, growing problem 2) the (always with singular logic) vector is the foreskin 3) circumcision is touted as a "public" health benefit - by getting rid of those dirty foreskins, society will have less STD, degeneracy or whatever. Just doing a quick web search today is enough to expose the thinking or lack thereof of the pro-circ crowd.
What we face though is a population with low internet penetration, and where the myriad articles written against the practice are mostly written in english. How can we contact newspapers and other media outlets in sub-saharan Africa to let them know what we know: circumcision is not even a distant third in relation to ABC in preventing HIV? WE NEED TO SPEAK TO THE PEOPLE AND THEIR LEADERS DIRECTLY, NOT LET WHO AND THE UN TAKE THEM FOR A RIDE.

[partly]

"How can we contact newspapers and other media outlets in sub-saharan Africa to let them know what we know: circumcision is not even a distant third in relation to ABC in preventing HIV? WE NEED TO SPEAK TO THE PEOPLE AND THEIR LEADERS DIRECTLY, NOT LET WHO AND THE UN TAKE THEM FOR A RIDE."

Support OLPC (One Laptop Per Child). Connecting Africans to the internet could be a powerful move against both HIV and pro-circumcision propaganda.

There is no better behavior modification mechanism than empowerment. Give Africans the tools to communicate, share ideas with every other human on the planet, and they'll figure out that the circumcisers aren't looking out for their interests.

Imagine if we ran a study, but instead of circumcision, the intervention was getting an OLPC machine. I hypothesize that the OLPC group would end up contracting HIV at a lower rate. Why?

1. Africans would be so enthralled by their first computer/internet experience (remember your first time?) that it would displace other activities , even unsafe sex.

2. Education. Africans need real information about HIV, not exclusively the propaganda pushed by the pro-circ crowd. Would Africans use their internet access to learn about HIV, form online communities, explain crucial information in culturally understandable ways? Yes, they would. The demand for accurate information is great, but the supply is too little and too narrow.

So, do we want to empower Africans, or mutilate them before they've got the education and organizational capability to effectively resist?

[IntactwhitemaleUSA]

In my opinion - Newspapers first. There are no doubt some folks in Zambia, for example, who are questioning circ's ability to stem HIV. Hearing word from America will bolster their claim.
It's funny, since this whole deal hit I've been thinking a lot about how Bailey, Halperin et.al. are into game theory. After all, they are playing the odds - circ'd men in all their studies still got HIV! So let's imagine - You are born w/o HIV in a country like the in the West, where your chances of getting HIV from a blood transfusion, organ donation, dirty needles, circumcision etc., are very low, approaching zero. What then? Well.................................
If you are totally abstinant, your chance of geting HIV is 0.
If you get tested, practice serial monogomy ~ your chance of HIV goes up infinetly. It's the same phenomena we experience when we buy a lottery ticket.
If you have protected sex with untested people, don't use protection, are the receiving partner in unprotected sex, visit prostitutes in that order more or less you can predict your chance of getting HIV.
Well Mr. Wilton, do you want to receive the Nobel prize for re-stating the obvious?