Bill Gates wants to Circumcise Africa?
There seems to be a growing mis-guided pro-circumcision movement that have clung on to some reports that male circumcision seems to provide men some level protection against HIV infection.
I was a even more disturbed to see Bill Gates and the Gates Foundation giving this strategy increased credibility.
I remember groaning the first time I heard this, because it does seem there are a LOT of people who every few years seem to find new reasons to basically preach what I think is really just a form of mutilation.
I don't want to turn this into a big "pro/anti circumcision" discussion. There are plenty of other sites that do that.
But instead - I'm worried that promoting circumcision as a credible anti-HIV strategy is very flawed and potentially dangerous.
Telling a man that he will have greater protection if he gets circumcised, could lead to greater amount of risky sexual behavior by creating a false impression of safety. Circumcised men are still getting HIV! If Health Workers start endorsing circumcision as an HIV prevention strategy, than it might lead to a reduced use of condoms, since circumcised men might feel like they don't need it. And there doesn't seem to be ANY study that indicates that it offers any level of greater protection over condom alone.
Circumcision offers NO protection for women. And over 60% of Africans living with HIV are woman. The partial protection is only seen for heterosexual men having vaginal intercourse. No studies show any protection for anal sex.
And it's MORE EXPENSIVE - about 95 times more expensive than condoms.
In the Sept 2008 edition of the International Journal of Men's Health, researchers McAllister, Travis, Bollinger,Rutiser, & Sundar wrote:
Our findings suggest that behavior change programs are more efficient and cost effective than surgical procedures. Providing free condoms is estimated to be significantly less costly, more effective in comparison to circumcising, and at least 95 times more cost effective at stopping the spread of HIV in sub-Saharan Africa. In addition, condom usage provides protection for women as well as men. This is significant in an area where almost 61% of adults living with AIDS are women.
Even one of the studies that "recommend" circumcision state that it will take 72 circumcisions to possibly prevent one HIV infection, and that
"Its impact on a population level will require consistently safe sexual practices to maintain the protective benefit."
Translated: Circumcisized men will STILL need to practice safe sex to see any benefit. It's like getting Lasik surgery - but you still have to wear glasses!
With cost estimates of $40-70 dollars for a single circumcision, that seems a very poor substitute for condoms that cost about $0.02 each.
The McAllister study estimated that agencies would have to spend about $5,844 in surgical costs to circumcise enough men to prevent ONE SIGNAL HIV infection. Meanwhile, it only takes $47 spent on condoms and education to prevent a single HIV infection.
Plus condoms prevent MUCH MORE than just HIV, they prevent a large number of other sexually transmitted diseases, and unwanted pregnancies.
It's also not clear if the real link between STDs and uncircumsized men, is simply a lack of education about hygiene and sex. And much of Africa lacks access to the clean water they need to even maintain a healthy level of cleanliness.
I'm always a bit startled by how quick people are to move towards circumcision as a strategy to prevent disease. By that logic, I am sure that I can reliably prevent a large number of the 250,000-500,000 deaths from influeza that occur worldwide each year, buy simply chopping off people's hands. People without hands will most likely see increased protection against getting the influenza, although it won't be 100% (Does this sound familiar?).
But instead we actually recommend sane and reasonable preventions of the flu - washing hands and covering their mouths when they cough.
There is already tremendous health concern that a circumcision decree made by King Goodwill Zwelithini of the Zulu tribe in South Africa - will actually lead to more men mutilated and HIV infected. A nearby South African tribe, the Xhosa, have been performing ritualistic circumcision for centuries, but health officials saw 80 death last year among Xhosa boys, whose circumcision is performed by a "traditional surgeon". Since the same knife is used on all the boys during the ceremony, HIV is often spread by the circumcision itself.
It's very worrisome when institutions, with the reach and influence of the Gates Foundation, continue to give circumcision any level of credibility as a public HIV prevention strategy. It's costly and unproven. It can be dangerous and deadly unless performed by skilled medical professionals. And it distracts from proven and inexpensive strategies that are saving lives now.
"I'm Not Dead Yet!"
Been mulling over how to restart the blog.
I named the blog Situation:Terminal as my lame and occasionally effective attempt to terrorize myself with reminders of my eventual demise. This fear is supposed to fuel some sort of inspiration to do something. Not exactly sure what that something is yet.
Of course, if you need real reminding - there is nothing better than a visit to a cardiologist!
And two weeks ago - I got to see real moving images of my beating heart.
It was the first time I had ever had any imaging done on my heart. There was no real health crisis. I had a very minor scare at the gym during my workout where I basically felt like I was about to pass out. There were plenty of other reasons that I had to pass out (lack of sleep, lack of water, lack of a regular exercise routine, lack of common sense). But because I had a few other "minor" health risks (and I suspect the fact that I HAD health insurance), my primary care physician didn't hesitate to refer me to a cardiologist.
"You won't get out the office without them putting you on a treadmill."
I have to admit, I was kind of excited. I secretly WANTED a stress test. It kind of appeals to the geek in me, while simultaneously feeding into my mid-life anxiety!
So a week later, I got to arrive in my cardiologists wearing shorts and sneakers (an odd thing being that it was 59 degrees outside) and got the wonderful opportunity to strip down to my shirt in front the attractive technician. 10 minutes later she is slapping electrodes inches from my nipples and slathering sonogram goop on my "not-as-flattering-as-I-would-like" gut.
All while I mentally try to silence my egotistical fears with self-centered affirmations like "I can't be the least sexy bare chested man she will have to suffer through today."
The test itself is basically a sonogram, followed by a treadmill run, followed by a 2nd sonogram that must be done IMMEDIATELY upon getting off the treadmill. So I had a little lesson in how to to swiftly move from the treadmill into "the position" (on my side, with my forearm raised over my head) all while navigating the web of wires glued to my chest.
Despite the awkwardness and strangeness of it all, I was genuinely entranced by the cloudy moving shapes that the medical technician extracted from my chest. She had this magic swiftness - pressing the wand against me at just the right angle and suddenly another dark chamber would appear on the screen. I didn't know if was an atrium or a ventricle. But each little room she found had a tiny flapping door.
Open, close, open, close, open, close.
(Note - this is NOT my heart!)
It gets a bit hypnotic.
So after the initial set of pictures, I couldn't start running yet - because my cardiologist was late.
So I had to wait. And wait. And wait.
And there isn't much to do when you are wired to a machine, but stare at the monitor. No more pretty pictures, but a nice little number... 75 bps... 80 bps.. 90 bps..
I remembered reading about monks who could lower their heart beats just through sheer meditative will power. I was bored. So I sat and stared at this ever changing number - trying to resurrect everything I learned in my "zen meditation years". Breathe... relax.. let go...
Fuck. EVERY TIME I tried to lower the number - the EXACT OPPOSITE happens. My numbers lift up to 80's or even 90's. After the 3rd or 4th attempt it seems scientifically conclusive - all my attempts at meditation only seem to make my heart beat faster!
Stare some more. My blackberry is trapped in my coat and possibly out of reach of my tethered chest and it could effect all these crazy electrodes. I'm bored.
But now it seems like every time I day dream away from the heart monitor and glance back - I can SEE I nice low number 68 or 70 suddenly jump back up to 80 or more. It's like the very act of staring at my heart beat, made it jump.
Finally, the cardiologist arrives and apologizes and we start the stress test. I'm supposed to keep running until I feel like I have to stop. And I muster all the macho athleticism my geeky frame can muster. I don't even remember how many times he raised the level. Somewhere around 15 minutes (4th or 5th stress level?) I'm now at nice 16 degree angle and going at some unknown speed and I actually beginning to feel my inner wimp voice ("stop..stop!") but I take my doctor's instruction to heart - don't quit until I have to.
But just as the machine is about to hit the next stress level, my doctor tells me that's enough and shuts the treadmill down. And before I can complain (or agree) I remember my "training" and with some tiny amount of genuine grace on my part, spiral around into my lying position on the cable, without stumbling or tangling a single wire.
"Nice!" says the cute medical technician. I swallow her tiny morsel of praise even though it feels like such an unpraiseworthy accomplishment. I wanted to keep running. I wanted to be noticed for my athleticism and determination - not for my ability to quit gracefully.
This time she worked even faster. The she quickly grabbed a new set of snap shots, furiously organizing them. Soon they were looking at my before and after photos - placing them all side by side. They added dancing blue and red pixels. She made the little flapping valves move in slow-motion.
And then the doctor told me how my heart was fine, and how I had actually done just fine on the treadmill. Nothing wrong. I'm cleared for any and all sorts of athletic punishment I want.
But I haven't been able to stop thinking about that little tiny flaps of muscle - those little valves in my chest that just keep moving. They seem so disconnected from the clutter in my head - so easy to forget about. But they flap away - without them all this wondrous and
Apparently, it's already given me about 1.5 to 1.8 billion beats so far. Statistically speaking I'll get maybe another 1-2 billion more. I'm like to assume I'll get a tiny amount of boost from brilliant output of people like Aubrey de Grey - and I'll get a nice 3 billion or so. It's nice to think things like that - even if it's just wishful thinking.
41 Christmases, 17+ years of education, 19 years of random time at the office or on the road, two kids, 15 years of "first" marriage, a few failed novels and screenplays, lots of failed projects mixed in with the occasional success, probably not enough sex, drugs and alcohol, but mostly just a lot of time wasted on self centered, egotistical anxiety about doing the right thing. That - plus too much TV and video games.
Meanwhile, my little fist-sized lump of flesh, slaved away - doing it's simple job.
Since it's his birthday today - I'll end with my favorite Neil Gaiman (Happy Birthday Neil!) passage:
In scene where Death is escorting a "god" to the afterlife:
"But I did okay, didn't I? I mean I got, what, fifteen thousand years. That's pretty good, isn't it? I lived a pretty long time."
"You lived what anybody gets. You got a lifetime. No more. No less."
