Dipesh Pabari
2 December 2008
column
About a year ago, CNN and Time declared the identification of male circumcision as a preventive measure against HIV infection as the biggest medical breakthrough of 2007. Having worked on one of the studies that led to this "discovery" several years before, I quickly penned something which was published on Africa News on the 20th December 2007 .
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"The powerful play goes on and you may contribute a verse"
About a year ago, CNN and Time declared the identification of male circumcision as a preventive measure against HIV infection as the biggest medical breakthrough of 2007. Having worked on one of the studies that led to this "discovery" several years before, I quickly penned something which was published on Africa News on the 20th December 2007 (http://www.africanews.com/site/list_messages/14084).
What followed was an onslaught of comments prompting the publishers to keep the article open as a discussion. In this little microcosm of cyberspace, individuals debated the "truth" behind male circumcision as a potential preventative measure against HIV/AIDS. Right from the start it was clear that the readers of this forum were equally as concerned with the value of the science behind this declaration as they were with the power of agency and socio-political dimension that could have influenced and skewed the science in favour of male circumcision. To many this was a "western conspiracy":
• "You need to be careful of these Americans who come to African forums to sell their ideas and to teach to the "stupid Africans."
• "Appeal to authority is nothing but intellectual laziness or incompetence. One should actually do a critical analysis of the evidence itself, and not rely on 'big brother" to do the thinking for them."
• ".... For all the good work Stephen Lewis does he is a hypocrite in this case. He speaks against programs designed to promote behaviour change as being 'neocolonialist' yet sees absolutely no problem with telling African Men what they should be doing with their own bodies."
Such reactions towards research in general are fairly common and well documented within medical anthropology journals and mainstream media. Four years before the article above was published, I had conducted an ethnographic study on people's knowledge, attitudes and beliefs towards medical research using a trial on male circumcision as a case study in a town in western Kenya. For several months, I held hundreds of interviews and group discussions with the young, the old; the poor and the not-so poor; both men and women. More often than not, young urban youth in particular would make similar comments as the ones above. As an ethnographer, my job was to document and report my findings. The questions then and now is, are the presence of such perceptions important enough to address? Do such perceptions have any impact on the social acceptance of western models of research? Do populist opinions matter enough to scientists to actually address them?
I believe it is safe to say that beyond documentation, medical research has done little to address engaging with public opinion and understanding why communities hold such opinions probably because it rarely has a direct impact on the actual studies especially in poverty stricken environments. There is certainly never any shortage of participants willing to sign up to a study out of desperation for the paltry "benefits" offered (free medical care, transport fare, compensation for time). My experience conducting the ethnography showed that the very same young men who expressed their anger against western research stating that "we are just guinea pigs for the scientists" were the very same people lining up to participate in the study. This particular study has always been very pro-participant in terms of addressing their immediate needs such as setting up income generating activities; increasing compensation for time and providing medical care but the issue at hand in this particular paper is the impact web 2.0 is having on widening the paradigm of inclusion. Whereas once upon time, the academic ivory tower would have easily been able to ignore the populist paradigm, the increasing presence and public and accessible documentation of such discourse is pushing academics to engage and respond within a public domain. No longer can scientists hide within the exclusive world of journals and peer review or discuss amongst themselves such perceptions but now must engage the public domain whether it is conspiracy or not. I believe one of the main reasons for this is web 2.0 has allowed public opinion to infiltrate a paradigm that was once only reserved for scientists. What was once only orally expressed and taken and documented in the third person by researchers is expressed in writing first hand by the very people who voice these opinions. Simply put, the internet has allowed oral opinion to invade the stronghold of the written word and more importantly that oral opinion can be shared with millions around the world who would never have known what people at the grassroots actually believed or felt.
As stated in a conference paper by Luc Van Braekel, "The new age is the age of opinion not facts."
Researchers are increasingly using web 2.0 tools. The Economist recently ran an article examining how web 2.0 is changing the shape of scientific debate: "With the technology in place, scientists face a chicken-and-egg conundrum. In order that blogging can become a respected academic medium it needs to be recognised by the upper echelons of the scientific establishment. But leading scientists are unlikely to take it up until it achieves respectability...Nevertheless, serious science-blogging is on the rise. The Seed state of science report, to be published later this autumn, found that 35% of researchers surveyed say they use blogs. This figure may seem underwhelming, but it was almost nought just a few years ago" (The Economist, September 2008). However, the issue at stake here is not about incorporating the tools within the exclusive domain of research but about using these tools to engage with the public sphere. Web 2.0 is a direct channel for anyone with access to the internet to interact and engage with one another on an equal ground no matter in what social category one is placed.
Blogging itself is an increasingly important paradigm for communications and it needs to be acknowledged and used. Today, there are over 72 million blog sites, making the practice of sharing your daily life and thoughts with the rest of the world one of the fasted growing areas on the internet.
Moreover, the impact of blogs on our world stretches beyond our immediate needs to be heard and is being used more and more to effect change. For example, the first blog-driven political controversy led to the eventual downfall of a U.S. Senate Leader exposed for his white supremacist sympathies. Just as one uses the mainstream media or traditional forms of communicating such as public gatherings, it is critical to use the World Wide Web. Just about everything that appears in the papers ends up being discussed on the internet whether on blogs, social networks, chat forums, comments, etc. Fine, this is the middle class who have a platform to voice their opinions and they are a minority of a minority in Africa but they are the ones that sit smack between the poor and the rich and connect those two worlds whether they are sitting in a bar and talking it through with a civil servant or when they return to the rural homes and sit with grandpa over a glass of a local brew.
As a blogger, I have been fascinated by the onslaught of blog posts, comments and campaigns (both for and against male circumcision) that have since emerged and for a brief time dominated the [public] sphere of public health. One particular post and the comments that followed caught my attention:
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