Circumcision as a Weapon Against HIV

Concern is growing among health care professionals over the increasing trend against male circumcision, a practice that they say could avert more than 20 percent of new HIV infections by 2020, saving an estimated US$16.6 billion in future medical costs.

On May 7, 2012, a regional court in the western city of Cologne in Germany found that the circumcision of under-age boys for religious reasons was an unlawful act that caused bodily harm. Although the decision has no binding force on other courts, the decision has sparked uncertainty not only among health professionals but in Jewish and Muslim communities because male circumcision is a widely accepted religious rite.

Although the World Health Organization has estimated that some 665 million males aged 15 and older are circumcised, 70 percent of them Muslim, the numbers have been declining in many first-world states including the United States, Canada, the United Kingdom, New Zealand and Australia, although voluntary medical circumcision has been rising in South Africa, the epicenter of the HIV problem.

The practice of circumcision is undeniably painful since it involves moving the flap on skin on the head of the penis, perhaps the most sensitive part of the mail body. Arguments against the practice have been growing since the 1970s because of a belief that it causes psychological trauma that could affect the child later in life, and that the flap of skin is an important conductor of pleasure for uncircumcised men.

The Bill and Melinda Gates Foundation is supporting the wider use of circumcision its propagation and the World Health Organization is being urged to do the same, with critics arguing that any such campaign carries with it the real danger that societies in Africa, where the AIDS prevention efforts are mostly focused, will result in the large scale circumcising of infants who have no choice in the matter.

It should be noted that female circumcision has nothing to do with health. It is nothing more than the practice of female genital mutilation and is a gross insult to womanhood. It stems from male fears of women’s sexuality and usually involves cutting out the clitoris, which is enormously painful though milder versions which only involve trimming the labia may have no more effect on ability to be aroused than the male counterpart.

More than 40 observational studies among heterosexual men, however, show that circumcised men have about a 60 percent reduced risk of HIV compared to uncircumcised men. Three randomized controlled trials were conducted in Sub-Saharan Africa that showed circumcised men were at 60 percent less risk of HIV than uncircumcised men.

Thus the health benefits appear undeniable. “All these three trials were stopped by independent Data Safety Monitoring Boards as the effect was so strong and it was thought unethical to not offer circumcision to men in the control arm," had said Dr Helen Weiss, Reader in Epidemiology and International Health, The London School of Hygiene and Tropical Medicine (LSHTM) in an exclusive interview to Citizen News Service (CNS) at AIDS Vaccine 2011. Read more.

The Vulnerable Housewives

Hantu Laut

AIDS or HIV is like four letter word to a lot of people.Many still do not understand the disease.Aids victims often experience social ostracism and discrimination making them outcasts of society.Not all are responsible for the affliction.Some got it unknowingly from those they trusted.The innocent ones are mostly housewives who contracted it from their husbands who are licentious and chutzpah.

A doctor friend of mine sent me through email an article on the state of HIV and AIDS in Malaysia.The article was published in the Star on Sunday 4 January 2009.

It is also surprising to note that the states with the highest incident of HIV and AIDS are predominantly Muslim states of Kelantan, Trengganu and Kedah.Whether poverty and lack of education had a role to play in the high incidents of this heinous disease is difficult to say.Religion does not teach one to be reckless, in fact Islam forbids premarital sex and sex outside the marital sphere.

In any culture men have the tendency to stray but the degree seems to differ from one culture to another.Has culture got something to do with it? Maybe,maybe not ?

In majority of Muslim homes any discussion on sex is taboo and considered rude.Mothers don't talk to their daughters on any subject related to sex with a view to educating them.Just because Islam forbids premarital sex, there is no need to warn their daughters of the dangers of indulgence at young age, safely assuming that no such thing would happen to the girls.You often hear thing like we don't do this kind of thing because we are Muslims.That's probably is the most fallacious understanding of human desire, self-deception and living in total state of self denial.Sometimes, human desire can overwhelm even the most sensible of adult, let alone the young and restless.

A good example of how society can change with the influence of those in absolute power was Charles II of England.Before his reign, the Puritans had enacted several laws prohibiting sexual deviances, which carried harsh punishments. Charles' rake tendency and decadent relations with several women had an effect on his subjects.There were sudden change in the behaviour of his subjects where sex outside the matrimonial homes were no more taboo or a social stigma.

The writer has done an excellent job to write without, fear or favour, on the true HIV and AIDS situation in the country.It is now for the government to take up preventive measures on how to lessen the impact of the disease or before it becomes an epidemic as in the case of some African countries.Sex education may be the answer to this problem.

For my readers who have missed the one in the Star, below is the article.

Vulnerable housewives

SHARING THE NATION BY ZAINAH ANWAR

Women have moved from those least affected by HIV to those among whom the disease is spreading the fastest.

WHILE the number of men newly infected by HIV has decreased steadily in the past 10 years, the number of women and girls infected has seen a steep increase in Malaysia.

Women have moved from those least affected by HIV to those among whom the disease is spreading the fastest.

While most men are infected through injecting drugs, most infections among women occur through heterosexual intercourse. What is sad, but not shocking, is the fact that the most at risk category of women are housewives.

The just released Ministry of Health and Unicef report on “Women and Girls Con­fronting HIV and AIDS in Malaysia” revealed that in 2004, 44% of all women reported with HIV were housewives. In 2007, each month recorded an average of 28 housewives newly infected with HIV.

Kedah, Terengganu and Kelantan, the three overwhelmingly Malay majority states in the country, recorded the biggest numbers of housewives infected. Kelantan has the dubious honour of recording the highest number – 379 cases as of December 2007. In Johor, it is estimated that 90% of HIV cases detected among women and young girls are Malay housewives.

Marriage is obviously no protection from HIV infection for a woman, even when she is monogamous and stays home as the dutiful wife and mother.

High-risk group

Being a housewife in Malaysia, a Malay housewife especially, has become a high-risk occupation in the context of the HIV and AIDs epidemic.

All research on women’s vulnerabilities to HIV infection points to gender inequalities as the key driver to this global epidemic, which now sees women constituting 50% of people living with HIV.

While the MOH-Unicef report acknowledges Malaysia’s progress in the empowerment of women, this effort is undermined by continuing gender inequality and, in particular, women’s subservient role in relationships.

Even then, the report finds that female sex workers are able to better protect themselves compared with housewives as they are able to negotiate the use of condoms during sexual intercourse.

A 2006 nationwide survey which examined knowledge, attitudes and risk behaviour in Malaysia found that almost all surveyed understood the nature of HIV and AIDS and knew the common routes of HIV transmission. Yet, translating this knowledge into behaviour change and safe practices remains a formidable challenge, confounded by social, cultural and religious expectations and norms, the report stated.

Thus, even if women have access to information and merchandise, for e.g. condoms, gender norms that prescribe an unequal and passive role for women in sexual decision-making undermine women’s autonomy, expose many to sexual coercion, and prevent them from insisting on abstinence or condom use by their male partners. A religious belief that women must be obedient and cannot say no to sex with her husband further increases their vulnerabilities.

At the same time, gender norms related to masculinity encourage men to equate manhood with dominance over women, sexual conquest and risk-taking, and for older men to have sexual relations with much younger women.

Launching the MOH-Unicef report, Datuk Seri Tunku Puteri Intan Safinaz Tuanku Sultan Abdul Halim, chairperson of the Sultanah Bahiyah Foundation, said the socio-economic factors underlying women’s vulnerability to HIV cannot be adequately addressed without the involvement and support of men willing to speak out against violence towards women and refraining from sexual behaviour that puts women and girls at risk.

The good news about this report is the fact that the Government has endorsed its analysis and has recognised the feminisation of the HIV epidemic in Malaysia.

The not-so-good news is the fact that policies are being announced to “protect women” that are not recognised as solutions to the problems. Enough has been written about the ineffectiveness of mandatory premarital testing which is done without the three requirements for testing to be effective and ethical – consent, counselling and confidentiality.

It also gives couples who test negative a false sense of security, as no post-test counselling is provided about safe behaviour. Or the virus was in gestation during testing and thus was undetected. The fact is that infections do occur later in marriage and younger children are born infected. Discriminatory beliefs

What is even more peculiar in Malaysia is that premarital mandatory testing is adopted not as a health policy, but a religious policy, driven not by evidence-based research but by ideology.

As Marina Mahathir wrote in her blog, for as long as women are unable to refuse sex with their husbands even when they suspect their husbands may be HIV+, they will be unable to protect themselves from infection.

The Government is expected to set up a task force to draw up national plans to address the steep increase in HIV infections among women. I can only hope that the task force will take the bull by the horns and confront the issue of gender inequality and discrimination comprehensively as a major strategy to halt the trend.

Research in various countries shows that social norms that promote gender inequality, such as those that encourage men to have multiple sexual partners or to maintain control over the behaviour of their female partners, increase both young men and young women’s risk of HIV, STIs (sexually transmitted infections), and partner violence.

It is a proven fact that gender inequalities are shaping the way the HIV epidemic evolves. Thus, changing gender norms is increasingly recognised as an important strategy to prevent the spread of HIV.

One research tool which measures attitudes toward “gender-equitable” norms is now widely used to provide information on prevailing norms in a community and the effectiveness of any programme that hopes to influence them.

In research done in Brazil, India, Botswana, and Swaziland, it is found that the more discriminatory beliefs an individual holds (e.g. “Women should worry less about their rights and more about becoming good wives and mothers”; “There are times when a woman deserves to be beaten”; “A man should have the final word about decisions in his home”), the higher the likelihood of him having unprotected sex with a non-marital partner or to have multiple sexual partners than those without such attitudes.

Women’s empowerment and progress over the decades show that norms can change. What is needed is leadership and political will to drive the change. Intervention programmes to change gender attitudes, promote sexually responsible and non-violent male behaviour have shown to work.

While change at the individual behavioural level is important, it is not enough. What is also needed is change at the institutional level. Men still dominate our political, economic and social structures.

The challenge is: How do we get men in power who make laws and policies that discriminate against women, who sanction bad behaviour in society by behaving badly themselves, men in uniform who shape young men’s gender attitudes, practices and sexual lives, to start becoming a part of the solution to end gender inequalities that are actually harmful to both men and women, family and society at large?

Research demonstrates that people are not mere products of gender norms – they are active constructors and contesters of them.

As the reality on the ground changes, as women become wage earners in record numbers and contribute to sustaining the family financially, as women increasingly become the sole providers and protectors of families as heads of households, as women become leaders and decision-makers, men’s sense of entitlement to power over women must necessarily change.

The time has come for men in power, men in the family and men in the community to acknowledge the changing realities on the ground and join hands with women to change norms and values so that women are treated as human beings of equal worth and dignity. If we are equal in the eyes of God, why do we remain unequal before men?