Zimbabwe: Healthcare can wait, we need publicity

While the English Guardian debates about the need for contraception in developing countries, which is high, but probably not quite as high as those NGOs who stand to gain most from development funding for family planning claim it is, Zimbabwe is drawing attention to mass male circumcision. According to the BBC, 10 Zimbabwean MPs have been circumcised as part of a campaign "to reduce HIV and Aids cases".

But there's a massive difference between the two programs, which will both burn through several billion dollars. Reproductive health is grossly underfunded and some of the benefits will be felt by many millions of people, directly and indirectly. On the other hand, mass male circumcision is not even guaranteed to benefit those who undergo the operation. As for reducing HIV transmission from females to males, it may even increase it. The clinical trials that are blasted from the rooftops daily in the health and mainstream press show some potential benefit from circumcision, but that is potentially outweighed by the effect mass circumcision programs may have on behavior, and actually outweighed by the effect it will have (according to one of the hyped clinical trials) on male to female transmission.

One of the weaknesses of the call for putting so much money into contraception is that poor and inaccessible health services are partly behind high morbidity and mortality among woman, infants and children. And simply limiting the number of pregnancies doesn't address the problem of poor and even dangerous healthcare. Health, even reproductive health, is a lot more than just contraception. But at least there is a chance that many urgent needs will be met. With mass male circumcision it is unlikely that there will be any great benefit to anyone, aside from those providing the circumcisions.

Politicians in Zimbabwe must be pretty hard up for attention because yesterday twenty 'parliamentarians' and 23 parliamentary staff underwent 'public' voluntary counselling and testing for HIV (another article said 60-61 planned to do so). Less well publicized was the fact that Harare Central Hospital had to tell patients to buy their own ARVs because they had forgotten to put an order in. The estimated 3,500 people a week dying from Aids may well have helped the country to reduce their very high prevalence levels, but mass male circumcision will take a lot longer to have any appreciable impact on the epidemic.

It's said that the politicians who underwent voluntary counselling and testing are not obliged to make their status known. But if one does so, it's hard to see how the others can avoid doing so too. And some of this public spirit may stem from a call Mugabe made in March for MPs to declare their status in public. I'm not sure if the president himself did so. He claims that some politicians and party officials have died of Aids. Perhaps some time he and his colleagues are not craving instant media attention they will address the country's far more acute health needs, including but not limited to sexual and reproductive health.

[For more about non-sexual HIV transmission and mass male circumcision, see the Don't Get Stuck With HIV site.]