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Stephen Lewis: Disease and Climate Change in Africa

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Hugh7 Avatar
Posted: 01.10.10, 01:09 AM
Stephen Lewis says Rwanda and Swaziland are working to promote safe male circumcision. He should know that according to the National Health and Demographic Surveys, 3.5% of the circumcised men in Rwanda have HIV, compared to only 2.1% of the non-circumcised men, and in Swaziland, 21.8% of the circumcised men have HIV, compared to only 19.5% of the non-circumcised men. Perhaps the "60% reduction" conferred by the three (non-blinded, non placebo-controlled) randomised (but not random samples of the populations) controlled trials (with drop-out rates several times higher than the infection rates) is not as "conclusive" as it it touted as being? Another trial, in Uganda, suggests that circumcising men may increase the HIV transmission rate to women, who are already at greater risk. Campaigns to circumcise may just pour oil on the fire. His remarks about "an orgy of male bonding" are telling. Circumcision is never a pure "technology". It always has a cultural context. For over a century it has been a "cure" looking for a disease, usually the most feared of the day, so it was almost inevitable that it would be pressed into service against HIV/AIDs, effective or not. If only adult volunteers were being circumcised, one might shrug sadly, but Lewis is also actively promoting the circumcision of babies (with no evidence of any protective effect to them), and that is a human rights violation.
PhillipNavyNurse Avatar
Posted: 12.19.09, 06:42 PM
Dr. Lewis nails several messy topics in this presentation. At its heart he does a very nice job of touching the heart of several underlying truths which must be acknowledged before we can move forward there. I'll just hit on two: 1. Interference by colonial powers and missionaries has introduced many non-native social constructs and societal organization rules to which countries in Africa are still adjusting (badly) [Ex. *Dominance of the male over the female when many societies had been female-centered or had equality of the sexes as a central organizing concept; *geopolitical lines drawn to create countries where none existed before - splitting tribes and creating competetition where there had been coexistence before). 2. Industrialized countries must stop poaching healthcare workers from Africa. Now that medicines have been forcibly lowered in cost to a manageable level - the problem of distributing medicines and healthcare is more evident than ever...and it is related largely to the UK, France, the US, and Canada actively recruiting nurses, doctors and other healthcare professionals out of African countries. Keep in mind that very often, African countries pay 100% of the tuition to train these professionals...only to see them stolen. Fantastic presentation, absolutely "must see" for anyone trying to get a grip on these complex issues.