tag:blogs.poz.com,2009-03-02:/simoncollery//75 2012-10-17T16:36:47Z HIV/AIDS in Africa Movable Type 4.34-en tag:blogs.poz.com,2012:/simoncollery//75.400341 2012-10-17T16:34:52Z 2012-10-17T16:36:47Z

HIV continues to be treated as if it is in some way different from other diseases, with the result that people can continue to suffer from other diseases, often easily prevented or treated, as long as they are subjected to the popular HIV interventions, that almost always target sexual behavior and now include male circumcision. But targeting HIV as if it is exceptional among diseases has, by and large, failed. If that is because HIV is not always sexually transmitted, male circumcision programs will also fail to have much long term impact on transmission rates. It's almost as if reducing HIV transmission is not really a priority of the mass male circumcision campaign and the broader HIV industry.

Simon Collery HIV continues to be treated as if it is in some way different from other diseases, with the result that people can continue to suffer from other diseases, often easily prevented or treated, as long as they are subjected to the popular HIV interventions, that almost always target sexual behavior and now include male circumcision. But targeting HIV as if it is exceptional among diseases has, by and large, failed. If that is because HIV is not always sexually transmitted, male circumcision programs will also fail to have much long term impact on transmission rates. It's almost as if reducing HIV transmission is not really a priority of the mass male circumcision campaign and the broader HIV industry. tag:blogs.poz.com,2012:/simoncollery//75.400340 2012-10-16T17:35:50Z 2012-10-16T17:37:00Z

Voluntary Medical Male Circumcision (VMMC) is being sold to Luos as a viable way of reducing sexual transmission of HIV, though they are being told that almost all transmission is sexual. If HIV transmission is almost always sexual, it needs to be shown why it is so high among some groups and not others, and what kind of sexual behavior, exactly, is involved. Otherwise, the industry may have to carry out some much needed research into non-sexual transmission, at least to rule it out, rather than to continue dogmatically denying it exists, without any evidence whatsoever.

Simon Collery Voluntary Medical Male Circumcision (VMMC) is being sold to Luos as a viable way of reducing sexual transmission of HIV, though they are being told that almost all transmission is sexual. If HIV transmission is almost always sexual, it needs to be shown why it is so high among some groups and not others, and what kind of sexual behavior, exactly, is involved. Otherwise, the industry may have to carry out some much needed research into non-sexual transmission, at least to rule it out, rather than to continue dogmatically denying it exists, without any evidence whatsoever. tag:blogs.poz.com,2012:/simoncollery//75.400336 2012-10-15T14:59:56Z 2012-10-15T15:01:54Z

Various elements of the mass male circumcision party line are repeated with almost religious fervor by most people when you ask them about their views on HIV and circumcision. Even Luos repeat the various posited explanations of exceptionally high HIV prevalence in their own tribe, though these explanations are both insulting and unsupported by evidence. Many object that HIV prevalence can also be high in circumcising populations but, despite being given no adequate response to this, an alarming number seem to have given their consent (arguably 'informed' consent) for their teenage boys to be circumcised. It seems that in the HIV industry there is no right and wrong, only funded and unfunded.

Simon Collery Various elements of the mass male circumcision party line are repeated with almost religious fervor by most people when you ask them about their views on HIV and circumcision. Even Luos repeat the various posited explanations of exceptionally high HIV prevalence in their own tribe, though these explanations are both insulting and unsupported by evidence. Many object that HIV prevalence can also be high in circumcising populations but, despite being given no adequate response to this, an alarming number seem to have given their consent (arguably 'informed' consent) for their teenage boys to be circumcised. It seems that in the HIV industry there is no right and wrong, only funded and unfunded. tag:blogs.poz.com,2012:/simoncollery//75.400334 2012-10-13T16:08:19Z 2012-10-13T16:10:09Z

We have not shown that HIV is always or almost always transmitted sexually, so we can not go from HIV infection to inferring levels of unsafe sex; nor can we go from evidence of unsafe sex to predict that HIV prevalence is high or that it will become high in the near future. We must know that by now, but we still keep on doing it. IRIN is famous for it and if they really want to do research to 'improve' their services, they should have a look back through their own disgraceful record when it comes to honest research and analysis.

Simon Collery We have not shown that HIV is always or almost always transmitted sexually, so we can not go from HIV infection to inferring levels of unsafe sex; nor can we go from evidence of unsafe sex to predict that HIV prevalence is high or that it will become high in the near future. We must know that by now, but we still keep on doing it. IRIN is famous for it and if they really want to do research to 'improve' their services, they should have a look back through their own disgraceful record when it comes to honest research and analysis. tag:blogs.poz.com,2012:/simoncollery//75.400330 2012-10-12T13:33:36Z 2012-10-12T13:35:04Z

Several of those involved in pushing VMMC have no illusions: it's about money. Some of them admit that they don't believe it is a useful public health intervention. One didn't admit that, but he did say they are still collecting the data and it's looking better and better as time goes by. Meanwhile, all uncircumcised Luo men (and boys and infants) and their sexual partners have become so many million guinea pigs in this big experiment. Religious leaders have come to see HIV as a way of attracting followers, so they are not complaining. Long held cultural prejudices about circumcision making a boy into a man have greatly assisted the program. So the time-honored combination of money, religion and political power is being used to misinform people whom they claim to be supporting, leading and informing.

Simon Collery Several of those involved in pushing VMMC have no illusions: it's about money. Some of them admit that they don't believe it is a useful public health intervention. One didn't admit that, but he did say they are still collecting the data and it's looking better and better as time goes by. Meanwhile, all uncircumcised Luo men (and boys and infants) and their sexual partners have become so many million guinea pigs in this big experiment. Religious leaders have come to see HIV as a way of attracting followers, so they are not complaining. Long held cultural prejudices about circumcision making a boy into a man have greatly assisted the program. So the time-honored combination of money, religion and political power is being used to misinform people whom they claim to be supporting, leading and informing. tag:blogs.poz.com,2012:/simoncollery//75.400326 2012-10-11T14:01:54Z 2012-10-11T17:09:47Z

If most of those being circumcised do not face high risks of being infected with HIV, they will form a low HIV prevalence group, who all happen to have been circumcised. If most of those who face high risks are currently not being circumcised, they will form a high HIV prevalence group, who all happen to be uncircumcised. And if anyone who is circumcised happens to become infected with HIV, they can be accused of engaging in 'unsafe' sexual behavior. Since most sexual behavior can be construed as unsafe in high HIV prevalenc areas, the VMMC program should continue to look like a great success.

Simon Collery If most of those being circumcised do not face high risks of being infected with HIV, they will form a low HIV prevalence group, who all happen to have been circumcised. If most of those who face high risks are currently not being circumcised, they will form a high HIV prevalence group, who all happen to be uncircumcised. And if anyone who is circumcised happens to become infected with HIV, they can be accused of engaging in 'unsafe' sexual behavior. Since most sexual behavior can be construed as unsafe in high HIV prevalenc areas, the VMMC program should continue to look like a great success. tag:blogs.poz.com,2012:/simoncollery//75.400318 2012-10-05T16:04:46Z 2012-10-05T16:19:24Z

Development priorities may well be, as some say, all about money; but there seems to be a lot of money around. However it needs to be spent on programs that improve people's lives, not ones that provide some benefit that may be more than offset in some other way. The same NGOs will have their snouts poised over the trough, it's all money to them. But there are beneficial ways of spending it and most Africans probably know what they are. Western donors clearly don't.

Simon Collery Development priorities may well be, as some say, all about money; but there seems to be a lot of money around. However it needs to be spent on programs that improve people's lives, not ones that provide some benefit that may be more than offset in some other way. The same NGOs will have their snouts poised over the trough, it's all money to them. But there are beneficial ways of spending it and most Africans probably know what they are. Western donors clearly don't. tag:blogs.poz.com,2012:/simoncollery//75.400316 2012-10-04T07:21:52Z 2012-10-04T07:23:29Z

UNAIDS tries to justify their strenuous efforts to ignore non-sexual HIV risk, especially through unsafe healthcare, by saying that it would confuse people to tell them about more than one risk, and that it may make people more cautious about attending healthcare facilities when they are sick. It is hard to imagine greater confusion that that found among people in non-circumcising populations, and even among circumcising populations.

Simon Collery UNAIDS tries to justify their strenuous efforts to ignore non-sexual HIV risk, especially through unsafe healthcare, by saying that it would confuse people to tell them about more than one risk, and that it may make people more cautious about attending healthcare facilities when they are sick. It is hard to imagine greater confusion that that found among people in non-circumcising populations, and even among circumcising populations. tag:blogs.poz.com,2012:/simoncollery//75.400312 2012-09-27T12:09:08Z 2012-09-27T12:11:01Z

Those working on the current circumcision program in Kenya are well aware that most people who are claimed would be protected by the operation have not agreed to be circumcised, and that most people who have agreed are at low risk of being infected with HIV. They just seem completely unconcerned by these matters. The reasoning seems to be that VMMC attracts a lot of funding, whereas genital hygiene does not.

Simon Collery Those working on the current circumcision program in Kenya are well aware that most people who are claimed would be protected by the operation have not agreed to be circumcised, and that most people who have agreed are at low risk of being infected with HIV. They just seem completely unconcerned by these matters. The reasoning seems to be that VMMC attracts a lot of funding, whereas genital hygiene does not. tag:blogs.poz.com,2012:/simoncollery//75.400311 2012-09-25T12:50:00Z 2012-09-25T12:52:35Z

Far from being an shining beacon to the uncircumcised populations of high HIV prevalence African countries, the male circumcision program in Kenya should serve as a horrific example of what can result from public health programs that are based on selective use of data and lies. There are billions of dollars behind this program, but the Luo people should not be participants in an experiment to which they did not give their consent, and for which the outcome was already known before the program started. Whether it is driven by cultural superiority, academic hubris, political machinations by those promoting the program, huge amounts of money or a combination of all of these, this program needs to be investigated fully before it goes any further.

Simon Collery Far from being an shining beacon to the uncircumcised populations of high HIV prevalence African countries, the male circumcision program in Kenya should serve as a horrific example of what can result from public health programs that are based on selective use of data and lies. There are billions of dollars behind this program, but the Luo people should not be participants in an experiment to which they did not give their consent, and for which the outcome was already known before the program started. Whether it is driven by cultural superiority, academic hubris, political machinations by those promoting the program, huge amounts of money or a combination of all of these, this program needs to be investigated fully before it goes any further. tag:blogs.poz.com,2012:/simoncollery//75.400307 2012-09-23T13:24:19Z 2012-09-23T13:27:11Z

Appalling living conditions, hazardos healthcare, poverty and lack of opportunity, low levels of education and multiple other factors ensure that people's lives remain blighted, with HIV being only one of many sources of the blight.

Simon Collery Appalling living conditions, hazardos healthcare, poverty and lack of opportunity, low levels of education and multiple other factors ensure that people's lives remain blighted, with HIV being only one of many sources of the blight. tag:blogs.poz.com,2012:/simoncollery//75.400306 2012-09-22T07:15:22Z 2012-09-22T07:17:31Z

HIV transmission could be entirely uninfluenced by circumcision status, and yet the results of the current circumcision program in Kenya could be used to make it look extremely effective. A match made in heaven.

Simon Collery HIV transmission could be entirely uninfluenced by circumcision status, and yet the results of the current circumcision program in Kenya could be used to make it look extremely effective. A match made in heaven. tag:blogs.poz.com,2012:/simoncollery//75.400302 2012-09-19T17:38:31Z 2012-09-19T17:40:20Z

Each of the much loved explanations of high HIV transmission, that depend on the belief that most HIV is transmitted sexually and that Africans have lots of sex, collapses if you start to look for evidence. And like other stereotypes, biases, myths and various kinds of pseudo explanation, they then continue under their own inertia, no less loved for being entirely without foundation.

Simon Collery Each of the much loved explanations of high HIV transmission, that depend on the belief that most HIV is transmitted sexually and that Africans have lots of sex, collapses if you start to look for evidence. And like other stereotypes, biases, myths and various kinds of pseudo explanation, they then continue under their own inertia, no less loved for being entirely without foundation. tag:blogs.poz.com,2012:/simoncollery//75.400298 2012-09-17T18:11:20Z 2012-09-17T18:13:31Z

Driven by greed, ambition and a large amount of bigotry, it is a long shot to get Kenya to take another look at the HIV epidemic and question the emphasis on sexual transmission, and to question the VMMC before it goes any further. But it would be a good start if Kenyans themselves started to ask questions.

Simon Collery Driven by greed, ambition and a large amount of bigotry, it is a long shot to get Kenya to take another look at the HIV epidemic and question the emphasis on sexual transmission, and to question the VMMC before it goes any further. But it would be a good start if Kenyans themselves started to ask questions. tag:blogs.poz.com,2012:/simoncollery//75.400297 2012-09-15T11:17:38Z 2012-09-15T11:25:41Z

The victims of this kind of human experimentation without informed consent (people do not consent to being part of an experiment and they are not given adequate information about the risks of circumcision nor the level of protection against HIV they can expect, although that is not even known) are not just the Luo men and possibly infants who will be circumcised under the VMMC program. The sexual partners of those circumcised are also deceived about levels of protection and risk. And even Kenyans who already circumcise, for traditional or other reasons, are deceived about protection and risk involved where HIV and circumcision are concerned, although it does not taget them, specifically.

Simon Collery The victims of this kind of human experimentation without informed consent (people do not consent to being part of an experiment and they are not given adequate information about the risks of circumcision nor the level of protection against HIV they can expect, although that is not even known) are not just the Luo men and possibly infants who will be circumcised under the VMMC program. The sexual partners of those circumcised are also deceived about levels of protection and risk. And even Kenyans who already circumcise, for traditional or other reasons, are deceived about protection and risk involved where HIV and circumcision are concerned, although it does not taget them, specifically.