PEPFAR To Blow Millions on PrePex

PrePex had been running paid ads on high-end news outlets bidding for the WHO approval that would allow them to cash in on the African HIV/circumcision pie. They had a video on BBC, and ran dedicated articles on the Washington Post and the New York Times, as well as others.

Well, it looks like PrePex entrepreneurs have finally gotten their wish. According to the New York Times, the WHO has finally given their approval for the PrePex device, and PEPFAR leader Eric Goosby has already pledged to buy PrePex devices to circumcise as much as 20 million boys and men in Africa by 2015, under the ostensible pretense of "reducing HIV."

Grinning like a french poodle

In the New York Times, PrePex CEO Tzameret Fuerst said that the estimated price for each PrePex device would be an estimated $15 to $20 range. If PEPFAR pays for 20 million devices, that's a minimum of $300,000,000 a maximum of $400,000,000 American tax dollars that the program would spend on a dubious practice with speculative benefits, a waste of money considering that there are cheaper, less invasive, more effective ways of preventing HIV transmission.

No Demonstrable Scientific Proof Circumcision Prevents HIV
The sound bite that "circumcision reduces HIV 60%" is repeated over and over like a mantra, the WHO has given their blessing, and interested programs and manufacturers are promising to circumcise millions for foreign aid, but there is actually no scientifically demonstrable proof that circumcision does anything to prevent HIV transmission.

Close scrutiny of the so-called "research," however, reveals that there is actually no demonstrable scientific proof that circumcision does anything to prevent, or even "reduce the risk" of HIV at all, let alone by "60%." Circumcision promoters brush past this fact by distracting their listeners with the less-than impressive "60%" figure, and by mentioning how many men are "lining up to get circumcised." They need the money now, now, now.

There have been recent attempts to posit yet another hypothesis that attempts to explain "how circumcision prevents HIV," but they miss the mark, instead arriving at irrelevant conclusions, and not coming anywhere closer to furnishing the causal link for the so-called "effect" the much talked about "studies" were supposed to measure in the first place. Without a causal link, the "studies" are nothing more than statistics embellished with correlation hypothesis, and the efforts to circumcise millions in Africa are myth-based, not evidence-based.

African Men Not Buying into Circumcision for HIV Prevention
Despite the hyped up "mass circumcision" programs in Africa, it's been report after report of programs failing to meet their quota of circumcising boys and men in the past year.

Though they tried and tried, the much hyped Soka Unkobe program failed in Swaziland, where approximately 34,000 out of the expected 200,000 men (about 17%) were circumcised. Rather than abandon the strategy to mutilate the genitals of the men of Swaziland, American organizers are trying to figure out "what went wrong."Apparently, they feel they feel getting men to agree to have part of their penis cut off is simply a matter of "sending the right message." There is something wrong with an HIV prevention program that measures its progress by how many men they've circumcised, and not by how many they've educated about condoms and safe sex.

Three years into the 5 year program, only 80,000 of 1.2 million targeted men (about 6.7%) have been circumcised in Zimbabwe, and here too circumcision promoters are scratching their heads. Why aren't the men biting?

[There is no evidence that circumcising men in Zimbabwe has any effect against HIV.]


Click to enlarge
In Botswana, programs are also failing to convince men to cut off part of their genitals. One program circumcised only 685 out of an intended 10,000. In another program, promoters convinced only 360 out of 2560 men (approx. 14%) to get circumcised. Here too, promoters are dumbfounded and can't find the right people to blame. It couldn't possibly have anything to do with the fact that they're trying to convince men to undergo permanently altering surgery on their genitals, could it?

In Zambia, circumcision uptake has also been low.

In Kenya, Homabay district, only 11,000 men have been circumcised out of the estimated 42,000 since September 2008 when the program was initiated. Here too, circumcision uptake has been low, so coordinators are targeting children who are neither at risk for HIV, nor putting others at risk, not to mention the ethical dilemma of forcibly cutting off part of the genitals of healthy, non-consenting individuals. (So much for "Voluntary Medical Male Circumcision.")

The WHO may have given their coveted blessing to plunder African HIV funds to PrePex, and PEPFAR leader Eric Goosby may have pledged American money to pay for their devices, but it remains to be seen whether the devices will actually ever be used, or if they'll simply remain sitting in storage compartments unused.

While a failure to implementing PREPEX would be ironically heartening insofar as it shows that African men aren't buying into the circumcision propaganda, it remains disturbing that millions of dollars that could be providing more effective aid and advances in public health are being wasted and squandered by PEPFAR.

Real World Data Fails to Correlate with "Findings"
While the "60% reduction" claim is repeated, it fails to manifest itself in the real world.

It is interesting that PEPFAR is so eager to help circumcise millions of men in Africa, while circumcision has done America no favors in terms of HIV reduction.

80% of America's male population is circumcised from birth, yet AIDS rates in some US Cities rival hotspots in Africa. In some parts of the U.S., they're actually higher than those in sub-Saharan Africa. According to a 2010 study published in the New England Journal of Medicine, rates of HIV among adults in Washington, D.C. exceed 1 in 30; rates higher than those reported in Ethiopia, Nigeria or Rwanda.

The Washington D.C. district report on HIV and AIDS reported an increase of 22% from 2006 in 2009. According to Shannon L. Hader, HIV/AIDS Administration, Washington D.C., March 15, 2009, "[Washington D.C.'s] rates are higher than West Africa... they're on par with Uganda and some parts of Kenya." (Hader once led the Federal Centers for Disease Control and Prevention's work in Zimbabwe)

According to a recent report:

"HIV/AIDS is the seventh leading cause of death in the United States among people age 15 to 24, and half of young people infected with HIV are not aware of it. An unbelievable 26 percent of all new HIV infections are among those 13 to 24."

According to HIV prevalence data in the CIA Factbook, and circumcision prevalence figures in Wikipedia, the United States, where 80% of the male population is circumcised from birth, has a higher HIV prevalence rate than 53 countries where circumcision is rare (e.g., falls below 20%).

Countries where circumcision falls below 20%, and HIV is less prevalent than the United States (By rank in HIV prevalence):
 

Colombia, Argentina, Uruguay, Cambodia, Peru, Nepal, Switzerland, Vietnam, Ecuador, France, Chile, Spain, Moldova, Mexico, Italy, India, Iceland, Costa Rica, Canada, Belarus, Austria, Paraguay, Netherlands, Ireland, Denmark, Bolivia, Bhutan, United Kingdom, Belgium, Nicaragua, Laos, Bulgaria, China, Cuba, Cyprus, Czech Republic, Finland, Georgia, Germany, Greece, Hong Kong, Hungary, Japan, Lithuania, Mongolia, New Zealand, Norway, Poland, Romania, Serbia, Slovakia, Sri Lanka, Sweden

There is a prevalence of European, South American and Asian countries. Countries where one might expect a higher HIV prevalence rate have a surprisingly low prevalence rate. One would expect a higher prevalence of HIV in these countries, but they fare better than the United States, where 80% of the men are circumcised, instead.

Before handing out millions to gold-mining circumcision device manufacturers, PEPFAR ought to address the question of why something that never prevented HIV in this country is suddenly going to start working miracles in Africa.

PrePex CEO Tzameret Fuerst Gloats
In the following video, Tzameret Fuerst can be seen gloating about securing billions from PEPFAR, one can almost see the dollar signs in her eyes, as if she actually cared about HIV prevention. She repeats the same old circumcision/HIV propaganda, touting circumcision as a "one-time intervention with the efficacy of a vaccine." Sharp viewers may note other thinly veiled interests.

It'd be interesting to see her credentials. She holds degrees in urology, surgery and epidemiology, and can explain to us the mechanism whereby circumcision immunizes a man against HIV I'm sure.





But all is not lost; this new device makes the argument that circumcision would be "more painful, more complicated and more traumatic as an adult" a moot point, if in fact, as Tzemeret tells us, her product is "virtually painless and simple to do."


Related Posts:

CIRCUMCISION: BBC Runs Paid PrePex Ad

CIRCUMCISION: The Washington Post Folds to the PrePex Ad Campaign

NYTimes Plugs PrePex, Consorts With Known Circumfetish Organization

Where Circumcision Doesn't Prevent HIV 

Where Circumcision Doesn't Prevent HIV II

CIRCUMCISION "RESEARCH": Rehashed Findings and Misleading Headlines

 

Politically Correct Research: When Science, Morals and Political Agendas Collide

African Prostitutes: "Circumcised Men Take Too Long"

Along with a "60% reduction in HIV transmission," circumcision "researchers" in Africa promise that circumcision "doesn't diminish sex life" for men.

In fact, not only does it not negatively affect men, circumcision boosts sex life for both men and their partners!

Why, their "research" confirms it. And we all know that the more "researchers" promoters quote, (especially if it's "research" they conducted themselves) the truer their statements are.

But as I always say on this blog, there is something wrong with "research" and "findings" that don't correlate with reality.

A random survey was recently conducted amongst sex workers in the Harare red light district, Zimbabwe, by publication Zim Diaspora, which has made some interesting discoveries.

Apparently there are different prices for circumcised vs. intact clients, and circumcised men get charged more.

The reasoning behind this is that circumcised men take longer to orgasm, perhaps due to a diminished sensitivity, as a result of the removal of nerve endings in the foreskin. A longer sex session means less time to spend with other customers, and therefore a loss in potential clientele.

Said one prostitute to Zim Diaspora: "You see the problem with circumcised clients is they take too long to complete a single round. I might risk losing revenue from other clients and waste time on one guy for the same price, so we therefore push our charges upwards if one is circumcised."


According to other sex workers, the price increase can be from 20 to 30 US dollars if the client in circumcised.

Diminished sensation and therefore a longer sex session makes sense, considering research that shows that circumcision removes the most sensitive part of the penis.

According to the Sorrells sensitivity study, which measured different points on the intact and circumcised penis, the foreskin contains the most sensitive parts of the penis, which are more sensitive than the most sensitive parts of the circumcised penis.

In addition, research outside the all-too-famous "African trials" fails to coincide with "researcher" claims that circumcision makes sex great and wonderful.

A Danish study found that "Circumcision was associated with frequent orgasm difficulties in Danish men and with a range of frequent sexual difficulties in women, notably orgasm difficulties, dyspareunia and a sense of incomplete sexual needs fulfilment," for example.

Another recent study from Belgum found that circumcised men reported decreased sexual pleasure and lower orgasm intensity. Coinciding with the Zim Diaspora survey, circumcised men in the Belgian study reported that more effort was needed to achieve orgasm.

Be that as it may, some promoters of circumcision try to market the undeniable decrease in sensitivity as an advantage, because this makes men "last longer" in bed.

Perhaps it is an advantage for those insatiable women who want a long sex session.

This ceases to be an advantage when the sex session lasts a little too long.

The sex begins to hurt, the man becomes frustrated because he is not any closer to climaxing, and the woman wonders to herself when in the world he's going to finish.

This is my own speculation, but it may be in fact, that the men aren't finishing, which could be ironically the reason these men procure the services of a prostitute, and why men are willing to pay the extra price.

Interesting facts:
According to the latest health demographic survey in Zimbabwe, HIV is more prevalent in circumcised men. (The figures were similar - circumcised 16.6%, non-circumcised 14.2% - in 2005, before the circumcision campaign began in 2009.)

Image courtesy of Circumstitions News.

In spite of the fact that circumcision hasn't helped prevent HIV in this, and many other countries, "mass circumcision campaigns" continue in Zimbabwe, and other countries with similar statistics.

Related Posts:

Where Circumcision Doesn't Prevent HIV 

Where Circumcision Doesn't Prevent HIV II

ZIMBABWE: MPs Shun Deputy Prime Minister's Call for Circumcision

According to BBC, Deputy Prime Minister Thokozani Khupe has called on Zimbabwe's male MPs to "set an example" in the fight against AIDS and get circumcised. And who can blame her, if she's bought the line (or maybe she has been paid to say?) that "circumcised men are 60% less likely to get infected with HIV?" (Actually, it doesn't.)

Of the eight MPs the BBC has spoken to, only one said he might consider it. Another has rightfully called it "madness," while another said he was setting a good example through his behavior.

Moses Mzila Ndlovu, Minister of National Healing, told the BBC that some of his cabinet colleagues had described Deputy Prime Minister Khupe's suggestion as "madness" and "bizarre". His colleague Nelson Chamisa said it should be a matter of individual choice. (EXACTLY!)

It's nice to hear smart Africans speaking up, and that not everybody is buying into the whole circumcision/HIV gravy train.

Indeed, even the very World Health Organization, who has all but decreed that all Africans should be circumcised, is careful to say that, even if the latest "studies" were correct, "[m]ale circumcision provides only partial protection," and that it should be part of a "comprehensive HIV prevention package" that includes HIV testing and counseling services, treatment for STD infections, the promotion of safer sex practices and the provision of condoms and the promotion of their correct and consistent use.

Even if the recent trials were accurate (and their credibility is highly questionable), circumcision could only reduce the relative risk of acquiring HIV between circumcised and uncircumcised men by 60% over a period of about one year. Condoms have an absolute reduction risk of acquiring HIV that's over 95% (closer to 100% when used properly), making circumcision a moot point.

Of all the legislators, Edgar Mbwembwe, from Zanu-PF was the only one who said he would go ahead with the procedure. Another, Willias Madzamure, said the call was a good idea and said he was "seriously considering" it but did not firmly commit himself.

Two female MPs backed Ms Khupe. "Politicians, especially elected politicians, have a responsibility beyond the personal - they would set a good example if they did so, " Jessie Majome said.

Yes, it's always very easy to support circumcision when you're not the one who has to undergo it, eh Jessie? There are actually "studies" that show a "lowered risk" in HIV transmission in circumcised women here, here, and here. Maybe she should "lead by example" and go get circumcised herself?

More to the Deputy Prime Minister's Call than Meets the Eye?
Zimbabwe is one of the countries worst hit by AIDS, and the government launched a campaign to circumcise up to 80% of the country's young men (some three million people) last year. Only a few of Zimbabwe's ethnic groups practise circumcision for cultural reasons, and as evidenced by the attitudes of the MPs, there is notable resistance.

Now WHY has the Deputy Prime Minister openly made the call for MPs to "lead by example," get circumcised and announce it to the world? Why is she calling for a public display of endorsement? Could it be that like Swaziland, Botswana and now Kenya, not very many men are jumping to get part of their penises cut off, and "mass circumcision campaign" organizers are failing to meet their quotas in Zimbabwe? It would be interesting to know how far along their 80% quota Zimbabwe circumcision promoters have gotten. It might reveal the real reason for Khupe's call.

So What is Plan B?
I will keep asking; have "mass circumcision campaign" organizers ever considered the possibility that some men may never agree to get circumcised? That some men treasure their bodies and would prefer an alternative? What alternatives do circumcision campaign organizers have ready for such men? Or was preferring to stay intact simply not supposed to be an option?

Much "support" is offered to men who go in for circumcisions. But is that same "support" offered to the men who would rather learn proper hygiene and the proper usage of condoms?

One of the prime ministers has said that he was setting a good example through behavior. Why should men who intend on staying faithful to their partners be pressured to consider an operation that does not benefit them?

Nelson Chamisa said it should be a matter of individual choice, an excellent point. What of the men who don't want circumcision? Shouldn't there be an "education package" for those who opt out of circumcision?

Again, is circumcision supposed to be the only option?

These are questions that these program organizers must answer. What if despite all the efforts, the men would prefer an alternative to circumcision? Do they have that scenario in mind? Have they prepared education packages as part of these "mass circumcision campaigns" for men who do not want to be circumcised? Or are they simply not going to offer these men that option?