"Circumcision Saturday"
Some say things like this could be the wave of the future for sub-Saharan Africa in terms of the AIDS epidemic. Maybe
[PEPFAR = President’s Emergency Plan for AIDS Relief (U.S.)
NERCHA = National Emergency Response Council for HIV and AIDS (Swaziland, one of the “Three Ones” recommended by UNAIDS) ]
Today (Saturday) I spent most of the day at the hospital, with “Circumcision Saturday”. I think it was only the second mass adult male circumcision done in this country. They say the recent data on circumcision corresponding with a reduced risk of HIV transmission has been promising. A study in South Africa had to be halted, on ethical grounds, because they had to recommend to the control group that they get circumcised. Two studies from Kenya and Uganda, published in December, ended early in a similar fashion.
Besides the 40 brave male patients (mostly from my area but a few from quite far away), also present were two UNAIDS reps from Jozi and Swaziland, a doctor from WHO in Geneva, the PEPFAR coordinator for Swaziland, a doctor from the CDC, someone from the Ministry of Health, PSI, myself, a nurse from Baylor. Plus the three NERCHA people (ex-Peace Corps) who were running the show, and the doctors and nurses actually doing the operation.
It was a pilot program done on behalf of the Ministry of Health, partly for the NERCHA people to figure out how much it would cost to do these operations on a large scale. Christine, the lady from PEPFAR, leaned to me and insisted that because so few circumcision programs have been implemented in sub-Saharan Africa to counteract HIV and AIDS, today was history in the making. I hope it’s a good history – time will tell.
It’s no magic bullet, and this is emphasized in pre-op counseling, but I think many people in sub-Saharan Africa might treat it as such and continue to practice unsafe sex. We will most likely end up spending a buttload of aid money rolling this out, but by no means will it solve the problem, in my opinion. I hope it makes a decent dent though. If guys don’t want to test, or use a condom, maybe they can contribute a little by circumcising– all three alternatives can be free of charge thanks in large part to foreign aid money. The difficult thing is to think about is, I think a physician is supposed to worry about saving lives no matter the cost, which can be at odds with a businessman/economist who’s worried about cost-effectiveness.
We shall see how effective it is. Maybe I’m being cynical for no good reason. I want it to work but I’m not sure… Sometimes though, I guess for lack of better options, and for the existence of pretty decent data, you just have to try a plan that has a chance of working. Some will say that science has shown that it’s more than a chance, but people’s behavior is hard to predict. It’s hard to tell how the “risk reduction math” of all these different prevention methods is gonna sum up due to the behavioral and attitudinal components of the response to novel approaches.
Though they were undoubtedly quite stressed today with running the event, Paul and Beth and Brendan seem so enviably confident about the principle. They did do a good job. I am pretty impressed on how well they organized it and how open-minded they seem about taking suggestions from the crowd about how to make the program better next time.
My brother (from my host family) was one of the patients today. I know the one thing he would want changed is slightly more powerful painkiller. But overall, he says he happy that he did it. I’m pretty proud of him, because he was a little nervous about it. He’s still afraid to test for HIV though. One thing at a time, I guess.
[PEPFAR = President’s Emergency Plan for AIDS Relief (U.S.)
NERCHA = National Emergency Response Council for HIV and AIDS (Swaziland, one of the “Three Ones” recommended by UNAIDS) ]
Today (Saturday) I spent most of the day at the hospital, with “Circumcision Saturday”. I think it was only the second mass adult male circumcision done in this country. They say the recent data on circumcision corresponding with a reduced risk of HIV transmission has been promising. A study in South Africa had to be halted, on ethical grounds, because they had to recommend to the control group that they get circumcised. Two studies from Kenya and Uganda, published in December, ended early in a similar fashion.
Besides the 40 brave male patients (mostly from my area but a few from quite far away), also present were two UNAIDS reps from Jozi and Swaziland, a doctor from WHO in Geneva, the PEPFAR coordinator for Swaziland, a doctor from the CDC, someone from the Ministry of Health, PSI, myself, a nurse from Baylor. Plus the three NERCHA people (ex-Peace Corps) who were running the show, and the doctors and nurses actually doing the operation.
It was a pilot program done on behalf of the Ministry of Health, partly for the NERCHA people to figure out how much it would cost to do these operations on a large scale. Christine, the lady from PEPFAR, leaned to me and insisted that because so few circumcision programs have been implemented in sub-Saharan Africa to counteract HIV and AIDS, today was history in the making. I hope it’s a good history – time will tell.
It’s no magic bullet, and this is emphasized in pre-op counseling, but I think many people in sub-Saharan Africa might treat it as such and continue to practice unsafe sex. We will most likely end up spending a buttload of aid money rolling this out, but by no means will it solve the problem, in my opinion. I hope it makes a decent dent though. If guys don’t want to test, or use a condom, maybe they can contribute a little by circumcising– all three alternatives can be free of charge thanks in large part to foreign aid money. The difficult thing is to think about is, I think a physician is supposed to worry about saving lives no matter the cost, which can be at odds with a businessman/economist who’s worried about cost-effectiveness.
We shall see how effective it is. Maybe I’m being cynical for no good reason. I want it to work but I’m not sure… Sometimes though, I guess for lack of better options, and for the existence of pretty decent data, you just have to try a plan that has a chance of working. Some will say that science has shown that it’s more than a chance, but people’s behavior is hard to predict. It’s hard to tell how the “risk reduction math” of all these different prevention methods is gonna sum up due to the behavioral and attitudinal components of the response to novel approaches.
Though they were undoubtedly quite stressed today with running the event, Paul and Beth and Brendan seem so enviably confident about the principle. They did do a good job. I am pretty impressed on how well they organized it and how open-minded they seem about taking suggestions from the crowd about how to make the program better next time.
My brother (from my host family) was one of the patients today. I know the one thing he would want changed is slightly more powerful painkiller. But overall, he says he happy that he did it. I’m pretty proud of him, because he was a little nervous about it. He’s still afraid to test for HIV though. One thing at a time, I guess.
posted by Mark at 4:38 AM
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