Global Health Policy

Of the 44 million people living in South Africa today, over 5 million of them may have their life cut short due to AIDS. What is the government’s response? As Jessica brought to our attention, it is a continued reluctance to address the growing pandemic. It is reported that the start up costs of a wide scale circumcision program would be $32 million over the first few years and prevent around 150,000 infections a year, while the circumcision ban may save “dozens” per year. Is this really fair to the people of South Africa? It is easy to pick out South Africa as a beacon of hope in the often bleak developmental landscape of the African continent. But the allegiance to a policy that denies the seriousness of AIDS (and a cadre of political leaders that have openly denied the harm AIDS brings upon their citizens) shows us that South Africa might not be the role model Sub-Saharan Africa needs after all.

As with everything in life, context is crucial to understanding this policy. As the article makes clear, the reasoning for this law is the ongoing practice of taking rural teenagers into the bush, starving them for a week or two, then performing circumcision without any medical care whatsoever. As the previous commenter notes, "only" a few dozen have died from these practices this year, but what would the US government would do in the face of 25 high-profile, entirely preventable deaths each year?

It is not clear from the debate around the issue how the loophole "for medical reasons" will be interpretted. Given the research from Orange Farm and elsewhere, it seems reasonable to argue that circumcision to reduce the risk of HIV infection should, in the near future (following confirmatory findings elsewhere), fall into this category.

The South African government has made many mistakes on HIV-related issues, but this is not in the same category as allowing Matthias Rath to sell vitamins as a cure to AIDS or denying ARVs to the population at large. They have generally been proactive around prevention, if not treatment.

And the title "SA slow to encourage circumcision..." is somewhat disingenuous. Given that there has so far been only one randomised trial to show a effect, it seems reasonable to wait for confirmatory studies before launching into a national campaign. As Mark Heywood suggests, what the government will do on circumcision is uncertain, but that does not make them criminally liable. Yet.

Guy, you're absolutely right about the context - this is the least of South Africa's AIDS policy sins and seems to be a genuinely well-intentioned effort to curb unsafe medical practices in the context of cultural rituals (not unlike similar efforts to combat female genital mutilation, which are widely supported). However, what I found most frustrating was the fact that the counterevidence indicating that the law might end up causing more deaths (through AIDS) than it prevents didn't seem to be taken into account during the policy-making process.

The fact that they are even considering circumcision on babies to combat aids is ridiculous. Penis's are not the cause of aids and aids is contracted many ways other then through sex. Having sex with random partners and having unprotected sex will contribute greatly to someone catching AIDS or STD's. It is unfair to begin circumcising healthy babies in order to protect them from catching AID's. The boy may be someone who grows up to be knowledgable to how have safe sex and may be someone who doesn't go on sexcapades. The answer to stopping aids is to 'educate' the poplution on what AID's is and how it's contracted. If circumcised men do have a less chance of contracting AID's it should be up to the individual to have the procedure done. Circumcising babies is abuse, it's the removal of healthy skin and any problems that can occur in a natural penis are rare.