Lisa Russel and USAID DoubleThink

So USAID has found a new champion in Lisa Russel, a supposedly "independent filmmaker" with a "background in humanitarian and international development work." She has recently completed a circumcision/HIV propaganda video which USAID is pushing through one of their groups, AIDSTAR-One.

"In It To Save Lives," her video is called. But is she really?

In a comment to a blog post by Virgin's Richard Branson who is pushing her video, she toots her own horn:

"I can assure you that in the research I have done in preparing for the film and in the personal situations I encountered during making the film, I am 100% behind the efforts in getting the procedure out to as many people as possible. Simply stated, male circumcision can reduce the number of people living with HIV."

How can she "assure" us? Has she seriously done the research? Is she simply not aware that circumcision hasn't prevented HIV anywhere else? Who is this woman, and how can she spew these claims in a way that is so matter-of-fact?

"For those who have bore witness to the devastation that AIDS has had, particularly on the African continent, you might agree with me that if a procedure came along that can decrease the number of people dying from this horrible disease, it should be available for those who request it."

This statement is based on a dubious premise; that circumcision is actually effective at "reducing the risk" of HIV. Real world data shows us that this simply isn't the case. I wonder what this woman's stance would be if this procedure were a variation of female genital cutting. You know? One that removed only those parts of the vulva which are "extra" and whose absence would not affect sexual satisfaction. Something like sunat. Would she back this up if it "came along?" Would she agree that it needs to be made available "for those who request it," or would she have a different take?

 "If you lived in a country like Swaziland, where 1 in 4 people are infected with the virus, wouldn't you fight for a procedure that has scientifically been proven to decrease men's risk by 60%?"

More matter-of-fact pontification. Swaziland may indeed be a country where 1 in 4 people are infected with HIV. It is also a country where HIV transmission is more prevalent among the CIRCUMCISED population. Did she somehow overlook this little detail in her "research?"

Me, personally, if I lived in Swaziland, and somebody told me it's get circumcised or use a condom, and they told me that circumcision "reduces the risk of HIV by 60%, condoms by over 95%, but you'd still have wear a condom if you chose circumcision," I'd choose to screw circumcision and wear a condom. What kind of a stupid question is that? This makes me wonder, if men are "choosing" circumcision in Africa, what are they actually being TOLD?

As Table 14.10 shows, the relationship between HIV prevalence and circumcision status is not in the expected direction. Circumcised men have a slightly higher HIV infection rate than men who are not circumcised (22 percent compared with 20 percent). (p. 256) (PDF available here.)

Russel continues:
"I have met and filmed numerous men, women and children who were dying or lost family members to AIDS - in countries where condoms were widely available and prevention efforts were top notch but HIV rates were still high - and I ask, if people in these countries are voluntarily willing to go through this medical procedure to better protect themselves and their families from AIDS, who are we to tell them they can't?"

Lisa tries to be emotionally emphatic, but she is either misguided, or deliberately begging the question. She attempts to secure acquiescence for what is actually yet to be proven. DOES circumcision prevent AIDS? And if so, how does this happen? The answers to these questions are always foregone conclusion, but the fact of the matter is that not even the very authors of the circumcision "studies" know that circumcision actually prevents AIDS. The best they can do is present a range of carefully selected statistical data and then give the post-hoc/ad-hoc explanation that it was indeed circumcision that prevented HIV. Few people are aware of the fact that the three big African trials all lack a working hypothesis, and that nobody actually knows how circumcision prevents HIV, if at all. It is just assumed it does a priori.

Bigger questions need to be asked. The United States is also a country where condoms are widely available and prevention efforts are top notch. It is also a country where 80% of the male population is already circumcised, and yet HIV rates are still high. If circumcision is so effective at "reducing the rate of HIV," why then, are HIV rates in fact higher in America, where the majority of the male population is already circumcised, than in Europe, where the majority of the male population is not?

UNAIDS, World Health Organization.

Global HIV/AIDS and STD Surveillance Project: Report on the global HIV/AIDS epidemic 1998.

 
If circumcision is so effective at "reducing the rate of HIV," why are countries where circumcision is already wide-spread suffering increased HIV transmission rates? Countries like Malaysia, the Philippines, and Israel? (Haaretz reports on Israel's AIDS crisis here, here, here, and here.)

If circumcision is so effective at "reducing the rate of HIV," then why was HIV found to be more prevalent among the circumcised in 6 different African countries?

In Cameroon, where 91% of the male population is circumcised, the ratio of circumcised men vs. intact men who contracted HIV was 4.1 vs. 1.1. (See p. 17) In Ghana "...the vast majority of Ghanaian men (95 percent) are circumcised... There is little difference in the HIV prevalence by circumcision status..." (1.6 vs 1.4 See p. 13) In Lesotho, 23% of the men are circumcised, and the ratio circumcised men vs. intact men who contracted HIV was 22.8 vs 15.2. (p. 13) In Malawi, 20% of the male population is circumcised. The ratio of circumcised vs. intact men who contracted HIV was 13.2 vs 9.5. (p. 10) According to a demographic health survey taken in Rwanda in 2005, the ratio of circumcised vs. intact men who contracted HIV was 3.8 vs 2.1. (See p. 10)  And for Swaziland, in a recent demographic health survey (2006-2007), the ratio of circumcised vs. intact men who contracted HIV was found to be 22 vs. 20.(p. 256)

Just what "research" has Russel actually done? Is she aware of the following studies that contradict the "reduces the risk by 60%" party line? Is she aware that even though USAID is pushing circumcision as HIV prevention, according to none other than USAID, "there appears no clear pattern of association between male circumcision and HIV prevalence—in 8 of 18 countries with data, HIV prevalence is lower among circumcised men, while in the remaining 10 countries it is higher?"

Other studies:
"Conclusions: We find a protective effect of circumcision in only one of the eight countries for which there are nationally-representative HIV seroprevalence data. The results are important in considering the development of circumcision-focused interventions within AIDS prevention programs."

Results: ...No consistent relationship between male circumcision and HIV risk was observed in most countries.

One study which aimed at measuring male to female HIV transmission was ended early, because the results were not looking favorable. The Wawer study showed a 54% higher rate of male-to-female transmission in the group where the men had been circumcised. The figures were too small to show statistical significance, but there will be no larger scale study to find out if circumcising men increases the risk to women. Somehow that's considered unethical, yet it's considered ethical to promote male circumcision while not knowing if the risk to women is increased (by 54%?, 25%?, 80%? - who knows?).

The latest study in Kenya finds no association between male circumcision and lowered HIV rates:
'Using a population-based survey we examined the behaviors, beliefs, and HIV/HSV-2 serostatus of men and women in the traditionally non-circumcising community of Kisumu, Kenya prior to establishment of voluntary medical male circumcision services. A total of 749 men and 906 women participated. Circumcision status was not associated with HIV/HSV-2 infection nor increased high risk sexual behaviors. In males, preference for being or becoming circumcised was associated with inconsistent condom use and increased lifetime number of sexual partners. Preference for circumcision was increased with understanding that circumcised men are less likely to become infected with HIV.'

So who is this Lisa Russel person? Does she actually care about humanity and public health? Some of us have tried to reach out to her, only to get back the exact same remarks that I show above verbatim. She simply cut and paste. Is Lisa really "in it to save lives?" Or is she in it to make a few bucks? Is she actually a concerned world citizen, or is she merely an attention whore who finally found somebody to sponsor her? Is this really her opinion? Or is she being paid by USAID to toe the party line?

"It's hard to get a man to understand something, when his livelihood depends on his not understanding."
~Upton Sinclair

I'm not sure about everyone else, but I see a resemblance...

The latest "studies" in Africa are a scientific scandal waiting to explode. Circumcision does not prevent HIV. Never has, never will. The promotion of circumcision in Africa is already proving to be disastrous, and when the world finally realizes that the WHO, UNAIDS and American organizations effectively bankrolled the spread of AIDS, not to mention needless genital modification in boys and men, people like Russel will be embarrassed to ever mention the fact that they were directly involved in helping spread these lies.

EDIT (added July 2nd):
I almost forgot to mention, Russel and others keep talking about so-called "VMMC" or "voluntary male medical circumcision." (Does "VMFC" or "voluntary medical female circumcision" exist?) As if stigmatizing "mass circumcision campaigns" like Soka Uncobe weren't enough,  it looks like a law has been proposed in Swaziland to make circumcision compulsory for men. And, it looks like once all the men are circumcised, PEPFAR and UNICEF want the Swazi government to start circumcising children as well. I'm not sure how this can be considered "voluntary" at all.

It is devastating to me that my tax dollars are being used for the deliberate deception of African people, and for the blatant violation of basic human rights. Additionally, I'd never imagine that UNICEF promote and bankroll the genital mutilation of children. Yes, UNICEF too has jumped on the bandwagon, and they are using the latest rubbish "studies" to promote the deliberate abuse of children. This is absolutely despicable. "For those who request it" indeed.

Related article:
Lisa Russel: Attention Whore Confirmed