There are somewhere around 25,000 people registered for the conference – an incredible scene. People from all over the world. The conference center is the largest I have ever seen. It is near no hotels, but that doesn’t mean that you don’t have miserable coming and going. Last night and tonight, it took us an hour and 45 minutes to return to the hotel. We’re on our feet all day, without really any kind of break, because there is such a TREMENDOUS interest in our booth.
You have never seen such a variety of people. There are diplomats, public health officials, clinicians of all types, grass-roots activists (from anti-discrimination organizations, sex-worker organizations, religious orgs, women’s orgs, gay orgs), researchers, journalists. People in business suits, men and women in native garb, transsexuals and people in drag (including a fabulously decked-out Indian guy in a sari), people in jeans and T-shirts, and a couple of knotty-dread Rastafarians with pictures of Haile Selassi and strings of condoms attached to their shirts.
So far, we have spoken with hundreds of people from more than 65 different countries. Of course, our concern here is the push by international health organizations to circumcise men in sub-Saharan Africa, as part of the overall HIV control strategy. Our position (in a nutshell) is that circumcision is not a magic bullet; that it may actually increase transmission because it will encourage men who are circumcised to believe that they are unable to get or transmit HIV; that it will further disempower women; that it is a terrible use of public health resources to push a surgical “solution” in countries without decent medical care infrastructures; etc. The majority of people who have stopped to talk either understand our position or have been interested in hearing about it. Many, many people have thanked us for being here, saying things like, “I am so glad somebody is opposing this crazy strategy”; “what are thinking? It will never work?”; “this is a travesty”; etc. We have also had a number of opponents, of course – some of them quite defensive and derisive.
Very briefly: The popular opinion is with us, but the powers-that-be are driving a freight train, and it is going to be difficult to stop it.
I attended a session today. The speakers were Bertran Auvert, Fred Sawe (the medical director of the U.S. Military HIV Research Program in Kericho, Kenya), Nicolai Lohse (an AIDS researcher from Denmark), Richard White (from the London School of Hygiene and Tropical Medicine), and John Krieger (a urologist from the Univ of Washington). The moderator was Kim Dickson, a Ghanaian woman physician (married to ??) who works for the World Health Organization.
Their official line is that circumcision is “only one of a multitude of strategies in HIV prevention,” but that it would be irresponsible not to promote it in sub-Saharan Africa, given the huge prevalence of infection and the three randomized clinical trials that found circumcision to result in reduced female-to-male transmission. They are completely dismissive of arguments about risk-compensation, about cultural imperialism, about comparisons between male and female circumcision (i.e., how can you promote the one, while opposing the other with the argument that women should be allowed to keep the body that God gave them?). One theme we’ve been hearing here is that anthropologists and other social and behavioral scientists have been utterly excluded from the discussion (the promotion of circ-as-HIV-prevention is based on a purely biomedical model); at the presentation today, in response to a question from the audience, Lohse said that they didn’t include anthropologists in the studies because “well, we never even thought about it, and actually, you have to remember that this research is very technical.”
Quite distressingly (and not surprisingly), this group is pushing medicalized circumcision in the general male population in Africa. At least two of the speakers noted that they believe the procedure should be done at an early age, and said that they envisioned the eventual “uptake” of infant circumcision in a number of countries.
Horrible. I can’t even begin to formulate a future strategic response tonight, because we have to go to bed, so we can get up and continue the struggle tomorrow.
Thanks again to everybody who worked to get us here and who contributed funds (through www.nocirc.org) to rent booth space. We are still way short of meeting expenses.
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The first presentation by Alvaro Bermejo has two intactivist images.
You must be Bananas.
You Wanna Cut off What?
Does anyone know who created the "You must be Bananas" graphic?
The third presentation by Marge Berer is worth watching. She said, "If I proposed a contraceptive method to the world today that was only 60% effective, I would be laughed out of the room."
When it was time for questions from the audience two of the volunteers staffing the ICGI booth asked questions. Georganne asked the first question and a few minutes later John asked a question.
With two days to recover from numerous maladies, probably acquired from my fondness for street food, I offer the following narrative of the XVIIth International AIDS Conference just past in Mexico City. You will already have read a preliminary report from attorney Georganne Chapin of Nyack, NY, who with Harvard physicians' assistant Brian O'Donnell of Boston, staffed a booth there. It was good to have a one-two-three punch medical-legal team.
We talked ourselves hoarse, Georganne, Brian, and I, with long days, 2-hour commutes in atrocious smog, and little time to relax. Our booth was controversial and so often we had people 3-deep waiting to engage us, and visitors before and after official hours. Luckily our banner 'Male Circumcision: a Dangerous Distraction” was directly across from the elevator, the first thing the delegates saw. My thanks to Dan Bollinger for the colorful banner and terrific brochure, a direct hit, and to all the other *ground crew* members -Amber Craig, Jeff Brown, Marilyn Milos, Jack Travis, numerous donors, and others who made our appearance possible.
[BTW-The cynical side of me noted that HIV has become an industry in its own right, with old friends greeting each other as if at an annual family picnic. It is also like the war on drugs -a full phalanx of economically dependent consultants, drug companies, and researchers. Small impoverished countries like Papua New Guinea sent such large contingents that I was tempted to think HIV stands for *Having Interesting Vacation.*]
Here are my observations after 5 days of engaging about 800 people -at the booth, in elevators, and on the bus -many of whom were AIDS workers on the front lines in Africa. We were sought out by multiple delegates from virtually every country in Africa except Liberia and Tunisia, and many others --and we kept track.
Our most effective argument, if confined to 30 or 60 seconds, was a simple three-part criticism of the Auvert/ Gray/ Bailey /Halperin plan, which seemed to resonate, and which we adapted as the occasion warranted:
A. The sheer cost of MC would siphon off much of the AIDS $$, a zero-sum game, which should properly go to condoms and education, themselves proven but barely implemented, and thwarted by the Bush administration;
B. The substantial risk of such surgeries in 'bush' settings where trained personnel, antiseptic conditions, or even clean water are at a premium, (and the cost of follow-up, if any);
C. BEST ARGUMENT--The risk to women, since even the claimed effect only protects men from HIV+ women and then only to 60% if you believe it. Thus men are likely to present themselves, especial to poor or illiterate women, as the proud owner of a 'medical' circumcision, immune to HIV. The partial-protection nuance will melt away at each telling. Even The Lancet this month concedes as much.
For the many visitors willing to linger we upped the ante:
Some men are likely to distinguish their *medical* circumcision (so far, under local anesthesia) as superior to tribal and bush initiation rites. Indeed, the (white, American) proponents of MC for Africa publicly claim the traditional initiation methods *are not thoroughgoing enough,* raising the lucrative, (and for Daniel Halperin,*** giddily titillating) prospect of re-circumcising all of Africa.
The notion that MGM would halt the progress made in discouraging FGC, or worse, where FGC is unknown, may cause it to spring up unbidden where it has never existed before. Reason: if mucosal tissue is the villain, women have much more of it than men. Ex: A Tanzanian study of infibulated women shows a protective effect.
The Europeans 'got it' with rare exceptions. Our few vocal critics were invariably Norte Americanos. with, curiously, a contingent from Toronto being the most vocal. This was a huge surprise to us, as we expected more accommodation from our more civilized neighbors to the north. Likely this was a statistical fluke but maybe not. It was at the very least a huge disappointment.
African women were the most astute in their instant recognition of the social risks, African men less so. I venture to say that more than 90% of these women --to be fair, educated, traveled and urbane-- thought the Bailey, Gray, Halperin, Harvard, Johns Hopkins, WHO, UN plan was not only wasteful, but also a *trap* for village women, pure and simple. They often arrived already fully skeptical and took little effort to convince. The question remains whether their resistance will make a difference at the coal face, or whether they will be marginalized or steamrolled.
All in all, this was an upbeat if exhausting conference judged by our contact with many hundreds of delegates. The mystery remains why WHO and UNAID have *drunk the Kool-Aid* while individual citizens of the target countries understand the village-level risks.
Partly this is due, we were told, to failure to consult social scientists, who streamed by our booth to complain bitterly that their warnings had been ignored in favor of purely biomedical computer modeling. Partly it is due to the huge sums, upwards of $68 billion, made available by the Gates Foundation and UNAID, and publicly flogged by Bill Clinton, who appeared again as he had in Toronto in 2006. Query: If you were the Health Minister or Chief Medical Officer of a small impoverished African country, would you turn away billions no matter how it was earmarked?
I didn't think so.
Indeed, we cheered ourselves up that much of the money is likely to be evaporate into SUV's, helicopters, junkets to Dubai or Capetown to visit the mistress, etc. We decided we could live with that.
Flying back to the States, I sat next to Dr. Marcus Conant (*The Band Played On*) an HIV doc in San Francisco who two decades ago before ART lost 5,000 patients he later said. Initially I did not know who he is. When he asked me whether I was at the conference, I offered him my DOC card, to which he said “Well, meet another doc opposing circumcision.” He agreed that voluntary adult circumcisions will soon descend into coerced, and are merely a stalking horse for universal RIC, a melancholy thought we agreed. And indeed, WHO and the other Kool-Aid recipients are already floating that plan.
Doctors Opposing Circumcision
|...The risk to women, since even the claimed effect only protects men from HIV+ women and then only to 60% if you believe it. Thus men are likely to present themselves, especial to poor or illiterate women, as the proud owner of a 'medical' circumcision, immune to HIV. The partial-protection nuance will melt away at each telling. Even The Lancet this month concedes as much.|
The battle against Female Genital Mutilationi such an uphill striuggle that for such a retrorade step to be taken regarding Male Genital Mutilation is gut wrenching, deplorable, infuriating and more.
But for the medical profession to back it - knowing that it is a "solution" which offers only 60% protection and leads to coerced / enforced male genital mutilation is something which makes me so so ANGRY that I have no words for it.
Even if it were a medically proven fact, to me it is Like saying that
1 in 20 women will get breast cancer therefore the 'gold standard' in medcine should be enforeced mastectomes for all women.
The suggestion is beyond lunatic.
The amputation of a perfectly healthy part of a perfectly healthy non-consenting human being is mutilation - PERIOD. Surgeons do not perform non-medically nccessary surgery on children. Why is circumcision any different. Foreskins should not be the exemption on ANY pretext.
"Marge Berer highlighted confusion among men about the degree of protection that circumcision affords, and the danger that men may use condoms less frequently or not at all following the operation. To counteract such problems, she suggested that circumcision should be publicly described as like a cheap condom that breaks 40% of time." Great line!
Of course the studies are just complete crap. It's the old "Circumcision is a solution looking for a problem" in a long line of arguments that circumcision cures/prevents disease.
Thanks for sharing this important info and for all your work.
Can you point me to any good related info in Spanish?
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