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Uganda: Africans Are Too Promiscuous for Monogamy, Let's Circumcise Them

Charles Onyango-Obbo

31 July 2007

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column

Nairobi — Uganda has long been a leader in fighting Aids in Africa, and now it seems poised to break new ground by wielding the great new weapon against that disease - mass circumcision.

Of course, in order to achieve mass circumcision, the government would have to make it compulsory. And, presumably, those who refuse to submit to the knife will be sent to prison.

But that's jumping the gun. It is not surprising that circumcision as the wonder antidote is now all the rage. Early this year, the well-regarded medical journal Lancet published study data from clinical trials in Kenya, Uganda and South Africa that suggested that circumcision reduces a man's risk of contracting HIV by as much as 65 per cent.

On a continent where, a few years ago, there were fears that the population would be wiped out by Aids, and that cannot afford antiretroviral treatment for all the millions of its people infected with the disease, this news sounded like a reprieve from Heaven.

All of a sudden, a quick and cheap solution to halt the rampage of Aids seemed at hand; line up all males, nip off their foreskins, and voila, you have reduced the possibilities of future HIV infections by half!

I don't know enough about the science of this study to be able to either fault or laud it. But its politics is troubling. When this column wrote much the same criticism set out here in a Washington Post/Newsweek blog, the responses were strong. One respondent said he was happy to see some of us reject circumcision, so that the West can come and take over our rich lands after we all perish from AIDS.

Another agreed that it a cockeyed idea, and that as a Hindu he and his children weren't circumcised, and that as evidence from India showed, the Hindus were thriving. The answer, he said, lay in embracing the virtues of monogamy.

There are several ideological problems in both arguments. Take the case of Uganda. The success of its Aids campaign is attributed to the so-called "ABC" strategy: Abstain, Be faithful, and use Condoms. These ideas were sold in a very aggressive public information campaign.

In recent years, under the influence of the American right wing and evangelical groups, the Bush administration invested a lot of money and created huge incentives for poor countries to push abstinence.

The abstinence and circumcision approaches have one thing in common: They put a high premium on change of behaviour as the best "medicine" to deal with Aids.

Granted, Africa is poor, and where it has its own money, many governments have made the policy choice not to invest it in researching and developing a cure for Aids. Perhaps also as a result of the focus on behaviour, a lot of the scientific work on Aids in Africa isn't concentrated on finding cures.

ONE GETS THE UNEASY FEELING that that there is a widespread belief out there that Aids in Africa cannot be primarily solved by conventional medicine, perhaps because the African is a frightening beast who is "untreatable." Therefore, the obvious answer is to put a lock on the African people's zippers and underwear. But because they are also promiscuous and can't be monogamous, let us circumcise them.

Every doctor must make assumptions about his or her patient, before they treat them. If the doctor thinks you are too poor to afford "original" Pfizer or GlaxoSmithKline medicine, he will prescribe a cheap "imitation" one from China. In that sense, it seems that even those who mean well and are spending a lot of money fighting Aids on the continent have subconsciously assumed that African peoples are noble savages.

This obsession with caging people is profoundly undemocratic. But most of all, it has limited the possibilities of achieving some truly great medical breakthroughs against Aids on the continent.

Charles Onyango-Obbo is Nation Media Group's managing editor for convergence and new products.

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