AS The Statesman reports today, the first scientific survey to test male circumcision as an active intervention in AIDS infection suggests a strong correlation between the traditional practice and some level of protection against HIV – although not at this stage causality, medical experts have stressed.
And whilst some health officials are now promoting male circumcision as a possible method of slowing the onslaught of the apparent AIDS pandemic in Africa, others have cautioned against an overly hasty acceptance of the research; heralded as “landmark” and categorical “proof” of a long-time recognised relationship, but described as simply another “me too survey” by the Programme Manager of the National AIDS/STI Control Programme in Ghana. The Statesman, too, would counsel caution on several counts. Firstly, it notes that whilst condoms are 99 percent effective at preventing the transmission of the HIV virus and other sexually transmitted infections, the 60 percent reduction in chances of contracting HIV which may result from circumcision still means an untenably high possibility of infection. Of the 3,000 uninfected men who took part in the French National Agency for AIDS Research survey, 19 circumcised participants were still HIV-positive by the end of the trial. The 'news' that male circumcision may offer some level of protection should not therefore be taken as an invitation for irresponsibility, and certainly not as an excuse for men to neglect their part in ensuring safe contraceptive methods in the misguided belief they are no longer needed. Secondly, it notes that science is unclear about what causes HIV anyway. The 'virus' so often referred to as HIV is in fact a multiplicity of viruses and, as one virologist told this paper, this makes the possibility of ever finding a universal AIDS vaccine a far-off dream indeed. Suggested causes are also plethoric, with some medical experts even challenging the accepted notion that HIV is predominantly sexually transmitted. In the United States and Europe, for example, despite increased occurrences of STIs in recent years, AIDS has decreased to such an extent that it is now seen as an almost exclusively African blight. Of the 3.1 million deaths attributed to AIDS in 2004, 2.3 million of these were in Africa.
And thus we come to the crux of the issue. The relationship between male circumcision and HIV infection has long been suspected, but is yet to be proven. There may be a correlation between circumcision and infection rates, and such scientific studies and explorations are of course invaluable to understanding and eventually overcoming the pandemic. The achievements of scientists working in this field should not be belittled, and the role of sexual intercourse in the transmission of the infection should categorically not be down-played just because some scientists have questioned its centrality.
However, all of these theories remain just that: theoretical. The correlation between poverty and infection, on the other hand, is far from vague; the causal link between poverty and HIV is indisputable, and whilst we wait for scientific research and proof which may never come, it is these areas which need to be addressed now, effectively and immediately.
Yes, the responsibility for preventing the spread of a sexually-transmitted syndrome lies with individuals, and this paper counsels individuals not to neglect their duty. But the responsibility also lies with communities, and with governments, to tackle some of the wider socio-political problems and inadequacies which have undeniably contributed to the wildfire spread of the disease in our continent. Lack of education, lack of available contraception, lack of adequate health care are obvious contributors, and actions are being taken to slowly, gradually improve in these areas. But the issue of opportunistic infection is still too often overlooked; the disturbing diversity of diseases in our country – malaria, dysentery, TB, cholera – which are able to attack those suffering from immune deficiency, and often becomes entangled with it. Too often people die of a complicated and inextricable tangle of diseases, all of which can be loosely attributed to poverty, and all of which should be tackled as one complete bundle.
AIDS should be considered as part of the same problem, feeding at the same neglected trough. Safe water is needed as much as safe sex – not because safe sex is not of paramount importance, but because overcoming poverty is the biggest challenge we face in overcoming AIDS, whatever that might mean. Dr Nii Akwei Addo of the NACP, may be right to caution against the careless and irresponsible bandying around of epidemiological hypothesising, which he believes should be kept safely inside the scientific arena until the medical community is able to finally fathom the AIDS nemesis. He counselled that so-called breakthroughs such as the French survey reported in this paper today should be subject to peer review and discussed by scientists before they are offered as sensationalist and counter-productive hype to an audience keen to clasp on to any hope of a 'cure.'
Measured, critical and responsible reporting of these developments, however, is vital if we are to keep up the pressure on research bodies and on governments. The media and the public as a whole should not turn a blind eye to the sickening abundance of problems which together feeds into the complex, multifarious and essentially debilitating disease. Perhaps Dr Addo is right – we should leave the scientists to fight their corner, but we should certainly not neglect ours.