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This is an archive of the Treatment Action Campaign's public documents from
December 1998 until October 2008. I created this website because the TAC's
website appears unmaintained and people were concerned that it
was becoming increasingly hard to find important documents.
The menu items have been slightly edited and a new stylesheet applied to the site. But none of the documents have been edited, not even for minor errors. The text appears on this site as obtained from the Internet Archive.
The period covered by the archive encompassed the campaign for HIV medicines, the civil disobedience campaigns, the Competition Commission complaints, the 2008 xenophobic violence and the PMTCT, Khayelitsha health workers and Matthias Rath court cases.
Male medical circumcision reduces the risk of heterosexual men contracting HIV. It is highly likely that the widespread introduction and encouragement of voluntary male medical circumcision (VMMC) in countries with generalised heterosexual epidemics will reduce HIV incidence substantially. There is also evidence that VMMC reduces the risk of men contracting HPV, the virus that causes cervical cancer. Therefore, there is likely a lower risk of circumcised men passing on HPV to their female partners.
Yet a number of commentators have raised objections to the introduction of VMMC.
An article by Halperin et al. titled Male circumcision is an efficacious, lasting and cost-effective strategy for combating HIV in high-prevalence AIDS epidemics has been published in Future HIV Therapy (September 2008, Vol. 2, No. 5, Pages 399-405, doi:10.2217/17469600.2.5.399). It answers the objections raised to VMMC. Its authors include many distinguished scientists, clinicians and activists, including members of the TAC.
There are few proven options available for reducing heterosexual transmission of HIV. The TAC's position is that VMMC is an important part of HIV prevention. It is not a "magic bullet"; it should be part of a comprehensive set of prevention interventions. The high uptake rates of circumcision in some pilot projects indicate that this is also a way of encouraging men to take greater responsibility for their health. TAC endorses the World Health Organisation recommendations on VMMC, particularly that "male circumcision now be recognized as an additional important intervention to reduce the risk of heterosexually acquired HIV infection in men."
TAC calls on the South African National AIDS Council (SANAC) to ensure that a national policy on VMMC is finalised before the end of the year.
TAC stance on VMMC
Have the TAC done all the relevant research into VMMC?
I ask this because the answer appears to be not at all. Which is of concern because the TAC is calling on the government to ensure that VMMC becomes national policy and scarier still seeing that the TAC has the private ear of the new minister of health who in turn is in need of putting out a new message and a proactive stance on departmental procedures and effectiveness.
Is it a possible knee jerk reaction?
We have a high prevalence of circumcision in South Africa through traditional practices and it is amongst these ethnic groups where we have the highest prevalence rate of HIV/AIDS. The age at which the procedure is performed,the practice of safe sex, education and stigma are major factors in the success that could include VMMC.
We already have catastrophic problems within our overburdened, underfunded and understaffed health care system. Can you imagine the possible demand on the system of a VOLUNTARY MASS MEDICAL CIRCUMCISION and one must include the above mentioned information/schooling that would have to compliment the procedure?
And the cost of all this?
It could be an effective part of the countries fight against HIV/AIDS,but only a link in a large chain. But one would have to take into account its effectiveness,cost and the timing of such a policy after a much more detailed analysis has been carried out.
Waste not want not.
Not quite so fast
The Halperin et al. is not all you crack it up to be. For example, one of its references for "ethics" is a grab bag article of reasons to circumcise for any and all reasons including zipper injury and "bathroom splatter" (by a well-known circumcision enthusiast) that does not contain the word ethics, and dismisses "human rights" with scornful quotation marks. Halperin et al. fail to answer the objection that the dropouts in the three Random Controlled Trials outnumbered the known HIV seroconversions by several times, begging the question that they were a random sample of participants, when clearly, finding you were circumcised and HIV+ would be more likely to disillusion you with the trial than other outcomes.
There are several unaddressed risks to male circumcision, even when voluntary (and the enthusiasts are happy to do it to the nonconsenting): it does nothing to protect women, though it can disempower them against refusing unprotected sex; it may give men a false sense of security; desensitisation may make them less willing to use condoms; risks of the surgery itself, including HIV transmission from dirty instruments; risk of increased HIV transmisssion if the men resume sex before their wound has properly healed. The experimenters seem happy to neglect these risks, declaring it is "safe" to circumcise HIV+ men, even though this will do nothing to protect anyone.
Some of the "distinguished scientists, clinicians and activists" are circumcision activists, not HIV activists. Halperin himself is on record as thinking his descent from a ritual circumcisor meant “maybe in some small way I’m ‘destined’ to help pass along [circumcision] to people in [other] parts of the world … .” (Cover Story: The Case for Circumcision. By Gordy Slack. The East Bay Express Online. May 19-24, 2000.) Whatever else that it, it’s not science.
The same few people (Bailey, Halperin, Grey, Auvert etc.) are the ones who first made a noise about the wonders of circumcision, carried out the studies, multiplied their results by the population of Africa to “prove” that “millions could be saved”, did other studies to show it has no effect on sex or behaviour, run clinics to circumcise Africans, and now run to the media to say how good circumcision is.
New studies by different researchers with different protocols would be more convincing.
For some reason, the idea of circumcision makes people lose their critical faculties. There has been far too little criticism of the lemming-like rush to circumcise, instead of using means that are known to work.
Read the article before repeating the same criticisms
When all the fluff is removed from the above comment, the criticisms made are the ones addressed by Halperin et al. Please
read the article
instead of repeating the same incorrect criticisms.
We have a high circumcision rate (at varying age groups) amongst the highest HIV prevalence group in the country. This surely must show that MC is of little use and that mass VMMC could easily put out the wrong message as is happening in Swaziland. The lessons from Cameroon,Lesotho and Malawi should serve as a warning!
There is far too much work still to be done on the actual effectiveness of VMMC. Will the department of Health and the relevant Activist's actually look into this subject thoroughly or will they merely follow like sheep the recommendations of the UNAIDS that was made on a report that was far too limited if not actually glassed house in its method.