CIRCUMCISION AND AIDS IN AFRICA

By Roberto Giraldo

June 2000

The idea that HIV, the virus that supposedly causes AIDS, is "heterosexually transmitted" in African countries and mostly "homosexually transmitted" in Western countries cannot be explained by known epidemiological rules.

This is why, since the beginning of AIDS in Africa, when reports were showing that the syndrome was equally distributed in men and women, researchers have been speculating about explanations for what they name "An Epidemiologic Paradigm" (1).

The problem is that the belief that HIV is the cause of AIDS does not allow health care professionals, researchers, journalists, and lay people to see the real explanations for the ways that the AIDS epidemic is manifesting itself within different communities, countries, and continents. HIV is an obstacle to finding the objective causes of AIDS. Nor does the HIV theory permit the proper measures to be taken to stop the spread of the epidemic. This is the true danger of HIV!

The following are some of the reasons that researchers who believe that HIV is the cause of AIDS have given to explain why in Africa AIDS affects both sexes equally: late age at marriage; sexual cravings and excesses; gross heterosexual promiscuity; highest levels of polygyny; the rubbing of monkey’s blood into cuts as an aphrodisiac; truck drivers who get HIV from prostitutes and then infect their wives; duration of postpartum abstinence; women being allowed to participate in commerce and maintain separate budgets from husbands; high levels of sterility caused by widespread sexually transmitted diseases; unusual sexual practices that facilitate transmission; the practice of female circumcision; the lack of male circumcision; etc. (2-6).

Western health experts and journalists accuse Africans of gross heterosexual promiscuity. Do they have proof for it? Recently, Nobel Prize winner Nadine Gordiner wrote in the New York Times that African promiscuity "is difficult to condemn when sex is the cheapest or only available satisfaction for people society leaves to live on the street" (7).

Regarding male circumcision, the following are some of the arguments that defenders of HIV as the cause of AIDS provide to promote male genital mutilation in Africa (2,8-12):

"A joint Canadian-Kenyan medical research team working in Kenyatta Medical School in Nairobi, where the epidemic is intense, had reported a year earlier that AIDS rates were higher among Luo migrants from western Kenya than among the Kikuyu from central Kenya". Later the authors "surmised that the Luo were at greater risk because, unlike the Kukuyu, they were not circumcised" (2,10).

"An American team led by John Bongaarts of the Population Council published a paper showing that the regions across sub-Saharan Africa with high levels of HIV infection among local peoples corresponded well with the areas where men were typically uncircumcised" (9).

"Most of the ideas we investigated failed to explain the extraordinarily high rate of infection in the AIDS belt. One factor did stand out, however: lack of male circumcision. In the area where men are typically uncircumcised, HIV rates are among the highest in the AIDS belt" (2).

"We noted that the areas of Africa with large numbers of uncircumcised men were almost exactly the same as the regions suffering from the severe AIDS epidemic", and "The link between lack of circumcision and elevated levels of HIV infection appears robust" (2).

"For uncircumcised men, thorough cleaning of the genitals can be particularly challenging" (2).

"Outside the AIDS belt, in the city of Abidjan, the capital of Ivory Cost, levels of HIV infection are as high as they are in some cities of the AIDS belt; we believe the epidemic in Abidjan is very likely sustained by immigrants who come from a surrounding area where the majority of men are uncircumcised" (2).

"Thus, we concluded that in the AIDS belt, lack of male circumcision in combination with risky sexual behavior, such as having multiple sex partners, engaging in sex with prostitutes and leaving chancroid untreated, has led to rampant HIV transmission. Unsafe sexual practices have certainly contributed to the spread of AIDS across Africa and indeed around the world" (2).

HIV researchers have gone further: "In sub-Saharan Africa, circumcision could be offered as a reinforcement of other protective measures" (2).

"These men are appearing at hospitals in sharply increasing numbers, requesting circumcision for themselves and often for their sons. Clinics that offer adult male circumcision as a protection against AIDS now advertise in Tanzanian newspapers" (2).

However, HIV researchers know in advance that these measures are not good enough: "Although the epidemic in sub-Saharan Africa may subside somewhat, because of greater use of condoms and probably increased incidence of circumcision, Africans in the AIDS belt remain at extremely high risk of HIV infection" (2). They are opening doors to pharmaceutical companies to bring to Africa the expensive "help" of the World Bank, to medicate with immunotoxic antiretrovirals HIV-positive Africans or simply those who are presumed to be positive (13).

The words of a professor of African History speak by themselves: "Racist assumptions about African sexuality merit scrutiny. Generalizations about African sexual practices are analytically useless but perpetuate racist stereotypes about insatiable sexual appetites and carnal exotica. Media misinterpretations of African sexuality and its alleged link to AIDS have spawned inordinate anxieties and pervasive despair in regions already afflicted with extreme poverty, ravaged by war, and deprived of primary health care delivery systems" and, he continues, "the political economy of underdevelopment and environmentally caused endemic sickness, not extraordinary sexual behavior or a sexually transmitted virus, are what’s killing Africans. The so-called AIDS epidemic has become the medicalization of poverty to justify Western medical intervention in the form of vaccine trials, drug testing, and evangelistic demands for behavior modification. AIDS scientists and public health planners must reconsider the role of malnutrition, poor sanitation, anemia, and parasitic and endemic infections for producing the clinical AIDS symptoms that are manifestations of non-HIV insults" (5).

Belief in HIV prevents the understanding that AIDS in Africa is happening now because never before has poverty been so prevalent and intense as it is now in the African areas where AIDS is epidemic. The only rational way to stop the spread of the AIDS epidemic in the African continent is by finding solutions for the economic disparities that are rampant in Africa (14,15).

AIDS in Africa is not an epidemiologic paradigm. There exists a serious crisis in the scientific methodology; currently, the problem is that epidemiologic ignorance is pandemic. Lets go back to the teaching of epidemiology to find a solution to AIDS in Africa and elsewhere (16-41).

President Thabo Mbeki is absolutely right when he demands a scientific answer to the question: "Why is HIV/AIDS in sub-Saharan Africa heterosexually transmitted while in the Western world it is said to be largely homosexually transmitted?"

I am certain that Africans will continue questioning and rejecting the ethnic fictions and racial slanders described here. They are already standing up to defend their integrity.

This article was written in June 2000 and posted during the Internet Discussion of the South African Presidential AIDS Advisory Panel

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