Circumcision of the mind and soul: The way to go in HIV prevention

We do not learn superlative adjectives for nothing. A thought struck me about this when I heard the initiative, still based on controversial research, that circumcision drastically reduces the chances of HIV infections in groups at risk and that Malawi has already bought the idea and started implementing it.

This is disturbing coming on the backdrop, for all we know, that even the sectors that practice circumcision across Africa – South Africa as an example, have not escaped the devastating effects of HIV. So when money has been poured into the country to roll out a method that is not a panacea and one that even adds a cost burden that compromise, if not defeating those interventions already in place, I wonder why as a nation our policy makers in the concerned ministries are not engaging whoever the donors are to help pour this money to priority areas. This is where I felt the grammar lesson on superlative adjectives makes sense: good, better, best.

Medical guidelines circumcision can reduce the risk of urinary tract infections and cut the risk of penile cancer and sexually transmitted diseases. Photograph: David Levene

I consider circumcision, if at all it works based on the touted research, a GOOD method for fighting HIV for the respect sakes of science. I consider the following methods to fall into the BETTER and BEST categories: Abstain, Be faithful to a partner and condomize always for the hard-heartened. Of course to these methods I also add TREAT for resources to target those that are HIV positive.  The ABC methods for all I know have not failed or are not failing; otherwise the HIV rate in Malawi would not have been stabilizing.

The reality or challenge to these methods however, seems to be the fact that all the areas in the country that need to be reached using these methods have not been reached because of financial and human constraints. For example awareness may have reached everywhere – but this does not translate to knowledge and attitude change but require more follow up; HIV test kits are not fully available in every corner of the country and condoms likewise.

Therefore, why must Malawi go for a GOOD intervention when the BEST ones have not been exhausted? Is not this an example of misplaced priorities and introducing interventions that are not backed by evidence? Circumsicion of men with a high sex drive would make more sense if this resulted in reduced sex drive; it is this which puts men or indeed women on a go. But sex drive resides in the mind; it resides in the heart and not in the manhood! This is why we do not cut lips for people trying to stop drinking or smoking; nor do we cut the manhood for defilers. I think we are having our priorities upside down. It is our mindsets, our attitudes that we must circumcise to fight the HIV pandemic; I do not believe that circumcising body parts is good enough.

Behavioural change initiatives, or initiatives targeting the heart and mind in social context, are the models that will fight HIV; and for those that are already infected, we can concentrate on prolonging their lives with budgets on medicines. Otherwise, circumcision is the BEST tool for strengthening people’s cultural identities and religious faith and not for fighting HIV.

This is because even after circumcision, the circumcised are still going to need a condom which is a double cost!!! I have a feeling that the whole story is not coming out in this circumcision movement. I hope some donors out there are not doing it to satisfy a research agenda. For I see a fantasy where the researcher and the researched will operate from.

The circumcised are likely to see the circumcision as making them immune to contracting HIV and likely to engage in wild unprotected sex – which seems to be the undeclared fantasy of those behind the “circumcision” bandwagon to later use the subjects for a confirmatory study. For surely it does not make sense to circumcise and then still say, “use a condom or ABC”.

The original ABC has already been working well I believe and simply require more commitment and not the ABCC which only contributes to more resource misallocation.


*Ndumanene Devlin Silungwe is a Mzuzu based psychologist

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