Thursday, May 16, 2013

Ethics of implementing male circumcision in Swaziland

Dispatch from Maputo, Mozambique. As far as I know, the European Union has sent me here to discuss ethical issues in research with new ethics committee members. In the past, there was only one ethics committee in Mozambique, whose original mission was to review all health-related research. As requirements to get ethical approval (for funding, for publication, etc.) get more strict, and the number of local research studies involving human participants rises, having just a single committee is no longer workable or sustainable. So they are wisely decentralizing into a number of institutionalized ethics committees around the country. I am here to discuss the ins and outs of ethics committees, their ups and downs, their virtues and vices.

During downtime in the Hotel Cardoso, I noticed this piece about implementation of male circumcision initiatives in Swaziland. Apparently, these HIV prevention initiatives have not come close to reaching their targets, after millions of dollars have been spent, causing both soul-searching and finger-pointing. (The program spent almost 500 dollars per circumcised male in a country which has an average per capita annual income of roughly $5000). I've thought for a long time that much more bioethics attention -- to its detriment -- has been spent on research ethics than the ethics of implementing research results into practice. The latter has its own particular conundrums, such as: what do you do about a (less than) half-implemented program? Particularly when part of the reason why the implementation was partial is due to significant community reluctant/resistance towards the very idea of male circumcision for HIV prevention? Where should you go from here?

Community concerns about male circumcision and HIV prevention include: why do circumcised men still get counseling about using condoms? What happens with the foreskin? Is there any connection between these circumcision programs and witchcraft? Why must men need to refrain from sexual activity for some time afterward? Other forms of resistance or reluctance, in the Swazi case, reach up to the highest levels of policymaking. Local public health authorities may have been interested in gaining funds and collateral benefits from male circumcision initiatives, while being skeptical about the value of the intervention itself. Low community and governmental 'buy in' (as they call it) can derail any public health program. Add to this the work of the anti-circumcision groups and individuals worldwide, who can be found on the comments section of any news item on male circumcision and HIV, whipping up fears and debunking the science. For the latter, the ethics of implementing male circumcision programs is simple: just make it stop.  

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29 Comments:

Blogger Hugh said...

Actually, we don't just "debunk" the science. We rebut the science, and sometimes refute it.

Circumcision as HIV prevention has been embraced in some quarters with an enthusiasm that goes far beyond what is justified by the evidence. In Swaziland for example, 21.8% of circumcised men have HIV, 19.5% of non-circumcised men (and similar figures apply in 10 out of 18 countries for which USAID has figures) so how is circumcision supposed to reduce HIV?
Source: http://www.measuredhs.com/pubs... (p235, pdf p256)

The circumcision-HIV studies suffer from premature curtailment, lead-time bias, attrition bias, and more.

Circumcision is a peculiar custom with ramifications far beyong the strictly medical, since it intimately involves men and their penises. Circumcised men often embrace it for others because it vindicates their own status. Scientists are not immune from this, and the three RCTs of circumcision, being neither placebo-controlled nor double-blinded were wide open to experimenter and experimentee effects.

12:15 AM  
Blogger SUMMA POLITICO said...



A wash cloth before and after sex or a good blow job from a clean mouth are equally effective and leave the pleasure zones intact! Or castrattion! That would eliminate any kind of danger from that source!
http://www.circumcisioncomplex.com/fundamentals/

http://eewiki.newint.org/index.php/Is_male_circumcisionyou%3F_bad_for_


Making it a taboo to compare male with female sexual mutilation is the biggest scandal of the controversy. In both instances the most sensitive and most erogenous zone of the human body is amputated and severely damaged. In both instances, what counts primarily is the cutting of human sexuality. The imposition of control by the patriarchy. A good look at a book on embryology will show the development of the nerves and tissue and how they are the same.

What is lacking in all the talk about circumcision is discussion of its archeological dimension - that it is the left over of human sacrifice. What kind of god is it that demands that of an infant? If the Bris constitutes the identity of the male, what about the identity of a Jewish girl? Or is this an entirely homosexual ceremony?

http://analytic-comments.blogspot.com/2012/08/the-circumcision-debate-links-and.html

http://analytic-comments.blogspot.com/2012/10/michael-wolffsohns-foreskin-of-heart.html

Also, unfortunately it is / has been circumcision that has MADE for no end of anti-semitic sentiments. Freud found that it was the chief reason for unconscious anti-Semitism. And the myths surrounding it are at the core of the “blood libel.” Thus, it's time to eliminate the Brit Milah because if that is the chief reason for being anti-Semitic or anti-Abrahamic [Islam too practices the rite] then why hang on to this left-over of human sacrifice? that traumatizes the child, cutting off 5,000 nerves, that is the equivalent of female circumcision in the sense that it eliminates everything but the clitoris,and only serves the Ultra Orthodox to maintain their power? After all, reform Judaism sought to eliminate the rite in the 19th century, and Jewish identity depends on being born by a Jewish mother, or converting. Here a link to an archive of the entire German and then some debate, note especially Michael Wolffsohn's two pieces . Circumcision has been controversial also within Jewry forever.


http://www.facebook.com/mike.roloff1?ref=name


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Thank you Dr. Okuns herbal your medicine is a good remedy for herpes cure, and Removing Warts you can contact him via E-mail: herbal.home247@yahoo.com for any types of diseases solutions or WhatsApp him on: +2348078467513

My name is Mary Hanson, am from United State. I want the general public
to know how this great man called Dr. Okuns cure me and my sister from GENITAL HERPES with the herbal medicine gotten from Dr. Okuns, he cures other diseases too like STD, My own was worst I have suffered for Human papilloma virus HPV) for 2years he cure me too, herbal is a great medication. he have a medicine that is 100% percent assured to cure any type of disease and you don't need to spend so much money anymore . I want you to contact Dr. Okuns on: herbal.home247@yahoo.com My family is now a brand new one, so stop your worries and go get your herbal medicine now to get your family free from deadly disease. Once again thanks to Dr. Okuns you can contact him now via phone number: +2348078467513 or email him on: herbal.home247@yahoo.com

5:15 PM  
Blogger Sandra Elis said...

Hello...
i am a proud mother and herpes free,now all thanks to Dr. Ogunamen,email: OGUNAMENHERBALCENTRE@YAHOO.COM for your own cure and testimony. happy and grateful i am to share my testimony to you all.today is like a dream i never thought would be a reality,for each day now,it gets clearer to me that i have been blessed by encountering Dr ogunamen.a herbal doctor and his trusted herbs,which transformed my life....


I was diagnosed of hsv_2 viral infection which i got from my husband,when i was 5 months pregnant of my first child...the doctor told me that for my health i have to decide between the baby and myself because the virus is affecting my womb...my husband left,abandon us both to fend for ourselves ,i was heart broken,devastated, i couldn't bear to lose my baby also. so i sought for help and found Dr. Ogunamen, he gave me hope and asked for my information,present conditions...he prepared a herbal mixture,sent it to me through DHL EXPRESS,i used the herbs with his instructions,a week later,my test result were negative,no effect to my baby and my health.the time came i delivered my baby and my virus infections cured...i am a proud mother now all thanks to Dr. Ogunamen. email him now: ogunamenherbalcentre@yahoo.com

7:26 PM  
Blogger murray bruce said...

i am Murray Bruce from the united state of america.i am here to testify of how i got cured of my HIV aids that has been with me for the past 4 years now i have been leaving in pain and tears,i have visited so many doctors,herbalist and spiritualist but all my effort was in vain i even went as far as thinking of killing my self.on this faithful day when i was on Facebook chatting with an old friend i saw a post of one Mr Gilbert uhuru from Kenya talking about this doctor called dr. prince talking about how he cured him of his h i v and he drooped his number and his mail immediately i gave him a call and i also emailed him and i told him my problem he tolled me not to worry any more that my problems were over and then he prepared the medication and he sent it down to me true the courier and i followed the instructions giving to me by him on how to use it which i did and he tolled me that after two weeks i should go to the hospital for a test which i did and to my greatest surprise i was tested negative are you out there passing true any kind of sickness or disease please contact dr.prince today at dr.princearataabraham@gmail.com or whatsapp him on +2348163241499 he his the only solution to your sickness and disease

3:01 PM  
Blogger More Morgan said...

The Great Dr.OGONI herbal medicine is a good and perfect cure
remedy for HIV Virus, I was diagnose of HIV for almost 5 years,
everyday i am always on research looking for a perfect way to get
rid of this terrible disease as i always knew that what we need for
our health is right here on earth though the scientist say there is
no cure for this disease,on my search I saw some different
testimony on how Dr. OGONI cured my HIV with is
herbal medicine. I decided to contact this man, I contacted him and
he guided me on how to get the cure. I asked him for
solutions and he started the remedies for my cure. Thank God,
now everything is fine, I’m cured by Dr. OGONI herbal medicine, I’m
very grateful to Dr. OGONI, reach him now on
( dr.ogonisolutiontemple@gmail.com ) or you can also call him on or
WhatSSAP+2348079887907.
Dr. OGONI Also Cure:
1. HIV/AIDS
2. HERPES 1/2
3. CANCER
4. ALES (Lou Gehrig’s disease)
5. Hepatitis B
6. chronic pancreatic
7. Emphysema
8. COPD (Chronic Obstructive Pulmonary Disease)
9. Asthma
10.Acute angle-closure Glaucoma
11. Diabetes
12.CHRONIC PANCREATIC
13.CHLAMYDIA
14.ZIKA VIRUS

2:17 AM  

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