WOMEN SUFFER FROM MALE HIV POLICY

Women in Swaziland are reporting that men who have been circumcised as part of the government’s anti-HIV drive are refusing to use condoms during sex because they believe the ‘snip’ means it is impossible for them to spread the virus.

Many of the women did not realise that men who have recently been circumcised must not have sex for six weeks after the operation.

And six in ten women believe they will be victims of gender violence, because men would refuse to use condoms after being circumcised.

These are some of the findings in a report published this month (December 2010) by the Women’s HIV Prevention Tracking Project (WHiPT).

WHiPT, a project that brings community perspectives, particularly women’s voices, to the forefront of the HIV and AIDS response, concluded that the Swazi Government was ignoring the impact its circumcision policy was having on women in the kingdom.

There has been much reported about how male circumcision can supposedly reduce the risk of spreading HIV. In Swaziland, the Government has whole-heartedly bought into the idea that all sexually-active males should get the snip, even though there is ample evidence that circumcision doesn’t prevent the spread of HIV, or at best it makes no difference one way or another.

The WHiPT report called Making Medical Male Circumcision Work for Women is believed to be the first attempt to find out from Swazi women what their experiences are with men who have been circumcised.

WHiPT says that although the Swaziland Government’s policy of male circumcision includes monitoring and evaluating how the policy is working there is nothing in place to see whether women are benefiting, being harmed or not being affected at all, by the policy.

WHiPT interviewed a total of 73 women in 10 communities in rural and semi-urban areas of Swaziland. Of these 73 women, 64 had heard about the Medical Male Circumcision (MMC) project.

When asked if they were aware that there is need for consistent condom use after MMC, only 61 percent (39 out of the 64 women who knew about the project) said: Yes. This same percentage of respondents was aware that MMC does not provide 100-percent protection. Only 52 percent (33/64) knew that men need to abstain from sex for six weeks after MMC.

There’s a fear that men would increase their sexual risk-taking behaviors because they feel more or completely protected by MMC. This fear was expressed by 55 percent (22/40) of the women.

One of the women interviewed told the researchers, ‘Men would think they are 100 percent protected and they will continue to have sex without condoms with multiple partners putting me as wife at risk of getting HIV.

Only 47 percent (30/64) of the women said they talk about MMC with their partners. However, 86 percent (55/64) of the women were willing to be involved in the decision-making process to support their male partners during the healing process and to discuss circumcising their male children.

Fifty-two percent (33/64) of the women reported they are not comfortable asking their male partners to use male or female condoms, as men are the sexual decision-makers.

Only 33 percent (21/64) of the women said that they are currently and consistently using condoms.

WHiPT reported, ‘This number may be higher than other cohorts in Swaziland, given that the women surveyed were assumed to be predominantly HIV-positive.’

The women who are currently not using condoms said that their male partners would refuse to use condoms even when circumcised because they’ll falsely believe that they are 100-percent protected.

One woman told the researchers, ‘My partner does not want to use condoms even now. Nothing will make him to change his mind to use it. Men are difficult to convince.’

About 61 percent of the women said MMC would negatively impact gender-based violence, because men would refuse to use condoms after being circumcised. Condom negotiation would be even more difficult after MMC, given its current challenges, the women reported.

One woman told the researchers, ‘We were asked to use condoms and now circumcision. We are confused. Men are refusing to use condoms and we are not in the position to defend or negotiate for safe sex.’

WHiPT recommended, ‘Swaziland’s HIV/AIDS policy makers along with implementers and civil society advocates must address gender implications of MMC in the current policy by identifying, messaging and monitoring for potentially harmful outcomes of promoting MMC, such as increased behavior risks and sexual violence against women.’

The WHiPT report surveys women in five African nations, including Swaziland. To read the full report, click here

CIRCUMCISION AND HIV PREVENTION

My post last week (16 November 2010) about the plan in Swaziland to get 80 percent of men circumcised to prevent HIV infection spreading provoked a lot of response from people who were in favour of the move.

I’m against it because the surgery is pointless. Evidence in Swaziland is that circumcision doesn’t work. But that hasn’t put off some people advocating for the snip.

Those in favour of circumcision rely on a small number of research reports that suggest that in Africa circumcision does work. I’ve written here about how these reports are contested by some scientists and doctors.

I am genuinely puzzled about why circumcision has become so popular in Africa. Why is surgery being offered, when there is a non surgical solution available for resolving this problem? Circumcision means cutting off healthy body parts, it has no medical benefit. Why are we being told we must cut off healthy body parts out of fears of HIV?

We are being told that circumcision reduces the risk of HIV infection being transmitted. But we are also told that circumcised men must still use a condom. That means that circumcision doesn’t stop HIV transmission but condoms do. The response to this is simple: use a condom whether you are circumcised or not. It therefore follows that there is no need to be circumcised – just use a condom.

It really is that simple.

Think carefully: why would a man cut off part of his penis to maybe slightly reduce the chances of getting HIV instead of using a condom, which dramatically decreases the risk?

A man doesn’t need to undergo mutilation instead of taking the sensible path of practising ‘safe sex’. This includes staying faithful to a single partner who is faithful to you.

Some people say that the HIV pandemic is so dangerous that we must try anything that might reduce its spread. Circumcision might work, these people say, so why not try it? Think again. I don’t want to be flippant, but cutting off a man’s penis completely would reduce the risk 100 percent, so shouldn’t we do that?

Studies done in Kenya, South Africa, suggested that men who were circumcised were less likely to contract HIV. But the United States has high rates of HIV and the highest rate of circumcision in the West (about 50 percent of males). Circumcision has failed miserably to stem HIV infection there. And why is it that countries such as New Zealand, where they abandoned infant circumcision 50 years ago, or European countries, where circumcision is rare, have low rates of HIV?

Not all countries in Africa have fallen for the circumcision myth. In September 2010 the government of Malawi rejected calls to promote circumcision as a prophylactic against HIV. At Malawi’s 2010 HIV & AIDS Research and Best Practices Conference, the chairman of the country’s National Aids Commission, Archbishop Bernard Malango, said that a comparison of the rates of infection in Muslim districts, where most men are circumcised, to that of Christian areas of Malawi, where circumcision is not practiced, showed no difference in the rate of infections.

‘We have no scientific evidence that circumcision is a sure way of slowing down the spread of AIDS,’ Dr. Mary Shaba, the government’s chief HIV/AIDS officer said.

SWAZILAND’S HEALTH SHORTAGE

In the week that it was announced that approximately 35 doctors and 245 nurses per day for a year would be taken away from front line health services so they can perform pointless circumcisions on men, comes news that Swaziland’s health service is in such a state that community leaders are being given basic medical training because there are not enough doctors or nurses available.

Doctors Without Borders said that nurses are taking on doctors’ roles and community leaders are receiving rudimentary medical training.

The group said a ‘dire shortage’ of health professionals prompted them to implement a plan using lesser-trained workers to treat people with HIV and AIDS.

Community workers are performing HIV tests and providing counselling in 21 health facilities in the Shiselweni region, the kingdom’s poorest and most remote region with the highest number of HIV cases.

The medical group, which is also known by its French acronym MSF, said vacancies in the health field are dire. In a report released on Wednesday (17 November 2010), they cited statistics from 2004 in which they said 44 percent of posts for doctors, 19 percent of posts for nurses and 17 per cent of nursing assistant posts were unfilled.

MSF said life expectancy in Swaziland has dropped from 60 to 31 in the past 20 years because of AIDS.

MSF reported that of the approximately 170 nurses and midwives who graduate each year, a large proportion emigrate. Staff attrition to HIV is high – at around 4% each year.

‘Currently, the Swazi health system is benefiting from an influx of skilled Zimbabwean healthcare workers. However, if the Zimbabwean economy recovers, many of these workers may repatriate. The staffing crisis is further exacerbated by absences from work due to training courses, holidays or sick leave – there is often only one nurse on duty for a catchment population of between 7,000 and 16,000.

‘In rural areas, in particular, the lack of accommodation for health workers makes recruitment and retention of staff very difficult,’ the report said.

U.S. BACKS MUTILATION OF SWAZI MEN

The Americans are backing a plan to mutilate 152,000 adolescent and adult Swazi men – 80 percent of the total population of this age range.

The plan is an experiment to see whether circumcision can prevent HIV infection spreading.

The Swaziland Ministry of Health has teamed up with the United States Government in what is being called the ‘Male Circumcision (MC) saturation initiative.’

According to the MC Co-ordinator, Ayanda Nqeketo, circumcising at least 80 percent of Swazi males will have a drastic decline on the HIV/AIDS rate in Swaziland.

A ‘drastic decline?’ Where’s the evidence? The only figures publicly available on whether circumcision has any effect on HIV spread in Swaziland shows it probably makes no difference at all.

The Swaziland Demographic and Health Survey (SDHS) of 2007 says the infection rate for circumcised males is 22 percent while for those uncircumcised it is 20 percent. So, on these figures circumcision is LESS likely to prevent HIV spreading – but allowing for statistical error, it is fair to say the figures probably show there is no difference one way or the other.

Circumcision could also be dangerous as there is evidence that men who have the snip do not practice ‘safe sex’ afterwards – some believing they no longer need to wear condoms.

But all of that hasn’t stopped the Americans using Swaziland as a test ground – and to get the data for their research, men in Swaziland must be mutilated.

Nqeketo is reported saying that the effectiveness of the Male Circumcision campaign will be evaluated and results will inform MC programs in 13 other countries in Southern and Eastern Africa.

Let’s just look at that again: the ‘campaign will be evaluated’ – that means they don’t know what the results will be, but the programme is being sold on the ‘fact’ that it will lead to a ‘drastic decline’ in HIV infection.

Nqeketo is reported in the Times of Swaziland, the kingdom’s only independent daily newspaper, saying that the programme will take a year and will use already existing Swaziland health staff.

‘At full capacity, he said, they anticipate requiring approximately 35 physicians and 245 nurses daily,’ the Times reported him saying.

So not only do we have a mad experiment of mutilation, it will take healthcare staff away from doing proper medical work for Swazi people who are sick.

The Swaziland Government has signed up for circumcision in a big way over the past three years. According to the government just about every male should get the snip and even newly born babies, who have no say in the matter, are expected to be cut.

They have been badly misled by crackpots who for whatever reason have an agenda to spread the lie that it is proven that circumcision will stop HIV.

If you think it is true that circumcision stops HIV ask yourself these questions: Why is it that no ‘first world’ country follows a policy of circumcision to prevent HIV? Why is the experiment taking place on African males and not back in the United States on men over there?