Category Archives: PEFPAR

More forced circumcisions – paid by American tax dollars

What is up with forced medical circumcisions in Africa, performed by NGOs on the bodies of minors?

Today we have this report from Noordgesig Primary School in Johannesburg, South Africa.  A few weeks ago, blogger Joseph4GI mentioned a case in Uganda. In the same article, he mentions previous cases in Kenya and Zimbabwe.

In this particular case in South Africa, we recognize that the NGO Right to Care became aware of the wrong doing of a provider, terminated its contract with the circumcision clinic and provided a public statement.

On their statement, Right to Care indicate: “Right to Care has supported the Department of Health (DoH) in this initiative over the past four years and has completed over 500,000 MMCs (circumcisions), through this partnership.

The Right to Care was founded by USAID (United States Agency for International Development) and the Global Fund to Fight AIDS, Tuberculosis and Malaria, so, again, this is a case of African circumcisions being paid for with American tax dollars.

A sport-based intervention to increase uptake of voluntary medical male circumcision

Last year we heard a story about HIV researchers / circumcision advocates in Africa. Of course, being just a story, having no evidence, we didn’t mention it. But the story seems to be now corroborated and will be presented at the AIDS 2014 Conference in Melbourne, Australia, July 20 to 25.

So this is what we heard:

“In one presentation I sat through at a world AIDS conference (summer of 2010), a young doctor with these circumcision campaigns [in Africa] (he was marketing chief) took to the podium and explained a “successful” program. They went into the poorest communities, where the boys were mad for soccer, and bought them all new equipment and uniforms. Built them beautiful pitches to play on. Brought in well-known soccer players to inspire the boys, and got coaches. Let the boys play and get to love it. And when it came time to play in the regional tournaments, the bar came crushing down: they’d be sponsored to travel and play only if the team captain could convince most of the boys on the team to get circumcised. The peer pressure was tremendous not to let the team and community down. This doctor was positively gleeful at how successful this strategy was.”

This story might come to be corroborated here: http://pag.aids2014.org/Abstracts.aspx?SID=1104&AID=5834

Abstract

MOPDC0106 - Poster Discussion Session

A sport-based intervention to increase uptake of voluntary medical male circumcision among adult male football players: results from a cluster-randomised trial in Bulawayo, Zimbabwe

Presented by Zachary A Kaufman (United Kingdom).

Z.A. Kaufman1, J. DeCelles2, K. Bhauti3, H.A. Weiss1, K. Hatzold4, C. Chaibva5, D.A. Ross1

1London School of Hygiene and Tropical Medicine, Epidemiology and Population Health, London, United Kingdom, 2Grassroot Soccer, Curriculum and Innovation, Cape Town, South Africa, 3Grassroot Soccer Zimbabwe, Bulawayo, Zimbabwe, 4Population Services International Zimbabwe, Harare, Zimbabwe, 5National University of Science and Technology, Bulawayo, Zimbabwe

The title of the abstract reads “adult male football players”. We are definitively interested in reading all the details.

We will be waiting for the full abstract, to be made public next Friday. But now you know what to wait for.

Manipulation. Peer pressure.

GRASSROOT SOCCER

PEPFAR, the U.S. President’s Emergency Plan for AIDS Relief, shared this photo a few hours ago through their facebook page:

In the Mchinji District of Malawi, local Peace Corps volunteer counterpart and Grassroot Soccer coach Henry Ching'ombe, works with the Kamwendo Youth Group on the GRS activity "Cut and Cover," which addresses medical male circumcision.

In the Mchinji District of Malawi, local Peace Corps volunteer counterpart and Grassroot Soccer coach Henry Ching’ombe, works with the Kamwendo Youth Group on the GRS activity “Cut and Cover,” which addresses medical male circumcision.

Notice that the photo mentions “Grassroot Soccer“. This is an organization with the following explicit goal, according to their facebook page: “Using the power of soccer to educate, inspire, and mobilize communities to stop the spread of HIV”

Combing through Grassroot Soccer’s website, the Bill & Melinda Gates Foundation makes its apparition:

The Bill & Melinda Gates Foundation and the Doris Duke Charitable Foundation (DDCF) are supporting Grassroot Soccer (GRS) in a unique and innovative randomized control trial in Zimbabwe that will assess the impact of an educational intervention using the power of soccer and its role models to increase awareness and uptake of medical male circumcision (MMC) as an HIV prevention measure. The trial, known as MCUTS (Male Circumcision Uptake Through Soccer), will target men ages 18-35 with educational outreach through soccer-related messages.

http://www.grassrootsoccer.org/2012/10/15/mcuts/

While this target age should be 18-35, some other articles on the website show a different panorama:

[May 12th 2012, GRS Zambia] for the first time ever at GRS, we held mobile Medical Male Circumcision (MMC) at the school grounds. The procedure was conducted by Marie Stopes International (MSI), and was sanctioned by the Ministry of Health for outreach service delivery.  There were four boys, between the ages of 16 and 24, who elected for the medical procedure. The operation takes between 25 to 30 minutes, and there is an additional pre and post counseling session dedicated to MMC. Each boy left the post counseling session knowing they now had 60% more protection against acquiring HIV.

http://www.grassrootsoccer.org/2012/05/25/grassroot-soccers-first-mobile-mmc/

 

“Make The Cut” (MTC)

Navigating more through the website we found a poster/report of just the very same abstract discussed above, the one that is still embargoed until next Friday. But now you can read it here: http://www.grassrootsoccer.org/wp-content/uploads/ICASA-Poster_MCUTS-Qual_6-Dec-2013_FINAL.pdf

Participants found MTC (in particular the Coach’s Story) persuasive because the MTC coaches had been circumcised and could discuss the procedure.

Future implementation should incorporate home-based follow-up and small incentives while avoiding delivery during the holidays and mid-season for professional soccer players.

http://www.grassrootsoccer.org/wp-content/uploads/ICASA-Poster_MCUTS-Qual_6-Dec-2013_FINAL.pdf

Goal Trial: targeting teenagers

goal

Generation Skillz is an eleven-session sport-based HIV prevention intervention delivered in secondary schools in South Africa, primarily focusing on age-disparate sex, multiple partnerships, gender-based violence, and male circumcision 

http://www.grassrootsoccer.org/wp-content/uploads/GOAL-Trial-IAC-Poster_Final-A4.pdf

 

Circumcision in Swaziland: your tax dollars working

CNSNews reports that  The United States Agency for International Development (USAID) is planning to spend $24.5 million to circumcise an estimated 150,000 to 200,000 male infants and males aged 10 to 49 in the kingdom of Swaziland by 2018, to raise the prevalence of circumcision from 19% (in 2010) to 70% (in 2018) and the prevalence of infant circumcision to 50% in 2018.

A demographic survey for 2006-2007 in Swaziland showed that the prevalence of HIV among circumcised males was 22% vs. 20% for those uncircumcised (see table 14.10, page 235)

Swaziland has the highest rate of HIV (26.5% estimated in 2012).

The United States has already invested over 15.5 million dollars in circumcision programs in Swaziland through the President’s Emergency Plan For AIDS Relief, PEPFAR in an ambitious and unsuccessful “accelerated saturation initiative” called Soka Uncobe (circumcise and conquer), a campaign that some say, could be interpreted to say that circumcised men no longer need to use condoms.

PEPFAR has particularly targeted infants (as opposed to voluntary adults) by encouraging hospitals to circumcise all male newborns unless the parents opt out.

The country is culturally polygamous. Multiple concurrent sexual partners are common.

Related:

15 May 2013, Circumcision plans go awry in Swaziland

July 2012, Why a U.S. circumcision push failed in Swaziland

 

 

Update on Rebeca Plank’s circleaks dossier

We updated the circleaks page on Rebeca Plank to include information on the 3 deaths during the 2013 Mogen vs. Plastibell trial, particularly one death from suspected sepsis within 24 hours of the procedure, yet dismissed as most likely not resulting from the procedure – even though no autopsy was performed.

http://circleaks.org/index.php?title=Rebeca_Plank

Zimbabwe: Clinic cuts off boy’s little manhood during circumcision

12-year-old Bulawayo boy’s penis was cut off during circumcision. Although the boy was under local anaesthetic, he screamed as blood gushed out of his organ. The boy was admitted at the United Bulawayo Hospitals (UBH) where the cut off organ has been sewn back on. A source at UBH said while he was in stable condition, it was too early to know if his penis would be normal again. Population Services International (PSI) spokesperson Paidamoyo Magaya was unreachable for comment. PSI sponsors the circumcision drive in Zimbabwe.

Complete article: http://www.crazynews24.com/news/4856-clinic-cuts-off-boy-s-little-manhood-during-circumcision.html

700x450-crop-90-images_djmediatools_a.jpg.2

Circumcision Goes Wrong: 1-yr-Old Loses Manhood to Cutting

Posted: http://frontpageafricaonline.com/index.php/news/963-circumcision-goes-wrong-1-yr-old-loses-manhood-to-cutting

1 year old boy loses his penis in a circumcision performed on January 5th by a doctor in Liberia. Phillip Zinnah, Sr. 25, father of the boy explained that he took his son to the TB Annex to one Dr. Nimley for circumcision, but it all went wrong when the doctor completely cut off the boy’s penis, leaving him in severe pain. The doctor is not responding for the damages, and the institution, TB Annex, says they don’t perform circumcisions and this would have been done in secret by the doctor.

Meanwhile, a child’s life has been irreversibly damaged in a way to seems to echo the baby hurt by a rabbi from Pittsburgh and a Memphis baby hurt at Christ Community Health Centers last year. A Saudi baby also had his penis partially cut off last November.

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What Brian Morris, in conjunction with Richard Wamai (research on HIV), Aaron Tobian (Johns Hopkins University), Ronald Gray (Johns Hopkins University and director of one of the 3 African trials on HIV and circumcision), Robert Bailey (responsible for another one of the 3 African trials), Daniel Halperin (author of several papers on HIV and circumcision),  Thomas Wiswell (author of the often cited study on circumcision and UTIs) and others, wrote on their propaganda paper from 2012, “A ‘snip’ in time“:

Infant circumcision is safe, simple, convenient and cost-effective. The available evidence strongly supports infancy as the optimal time for circumcision.“ 

Of course, for those illustrious individuals, this child’s horrible experience is simply an “adverse event“. According to a 2012 paper by Robert Bailey cited by the World Health Organization:

“In developed countries, adverse events following neonatal circumcision are well documented and their incidence is very low, from 0.2 to 0.6%.5 Before the RCTs, outcomes in Africa for male circumcision among adults were poorly documented. In a review,6 adverse event rates following African male circumcisions ranged from 0 to 24%. The RCTs, which provided services in a clinical trial setting, reported the following adverse event rates: 3.8% in Orange Farm, South Africa; 1.5% in Kisumu, Kenya; and 3.6% in Rakai, Uganda.1,7,8 Most recently, at the former Orange Farm RCT site, 1.8% of medical male circumcisions offered in one high-volume facility resulted in an adverse event”

Let’s stop treating children as statistics. Let’s respect children. Children of all genders deserve to grow with intact genitals.

Your tax dollars, hard at work – circumcising African males

So while the U.S. struggles with its own health system, taxpayers continue funding African circumcisions.

According to an article in the Huffington Post, “New Achievements on AIDS Show Targets Matter — So Let’s Set New Ones “, “By the end of this year, PEPFAR reports that it will have supported 4.7 million voluntary medical male circumcisions (VMMC), meeting a goal the President announced in 2011. Nearly all of these procedures, almost four million, were performed in just the past two years.

Also “The ultimate goal of global VMMC efforts is for 80 percent of men to be circumcised in 14 priority African countries. That requires some 20 million circumcisions, meaning that we’re just a quarter of our way to the goal.

This article was authored by Mitchell Warren, Executive Director of AVAC (AIDS Vaccine Advocacy Coalition).

So now you know where your tax dollars are going.

491442-Bielefeldt

Harmful practices against women and girls can never be justified by religion – UN expert – What about boys?

Special Rapporteur on freedom of religion or belief Heiner Bielefeldt. UN Photo/Paulo Filgueiras

 http://www.un.org/apps/news/story.asp?NewsID=46370&Cr=religion&Cr1=#.UnEPW-I4HLc

29 October 2013 – Harmful practices inflicted on women and girls can never be justified in the name of freedom of religion or belief, an independent United Nations human rights expert told a General Assembly committee dealing with social, humanitarian and cultural issues today.

Scarification and Tattooing of children of both genders in Benin

“Countless women are exposed to complex forms of human rights violations based on both religion or belief and their sex,” said Heiner Bielefeldt, the Special Rapporteur on freedom of religion or belief.
The expert’s latest report, which he presented to the Third Committee, focused on two human rights, namely freedom of religion or belief and gender equality. “My main message is that there is much more room for synergies between those two rights than people generally assume,” he told reporters after his presentation.

Day of Ashura

“Often you find the assumption that, you go either for religion or for gender emancipation and you can’t really combine the two, which I would find not only wrong but dangerous.”
The expert urged Governments and civil society to look for these synergies, noting that in virtually all traditions, there are persons or groups who use their freedom of religion or belief to promote equality between men and women, often in conjunction with innovative interpretations of religious sources and traditions.

Throwing babies of both genders from tower in India for good luck

In his presentation, Mr. Bielefeldt also called on States to identify and close human rights protection gaps in personal status laws, including denominational family laws, which disproportionately affect women from religious or belief minorities.

Circumcision in Turkey

“The purpose must be to create family law systems that fully respect equality between men and women while at the same time doing justice to the broad reality of religious or belief diversity, including persuasions that go beyond the realm of traditionally recognized religions,” he stated.

Bris Milah (Jewish circumcision) with Metzitzah b’Peh (oral suction) – as practiced by Hassidic Jews

One particularly grave abuse when freedom of religion or belief clashes with gender equality is forced conversion in combination with forced marriage, said Mr. Bielefeldt.

Coptic Christian tattoos

“In a number of countries, women or girls from religious minorities run the risk of being abducted with the purpose of forcing them to convert to mainstream religion – often in connection with an unwanted marriage.”

The expert’s report offers recommendations to, among other things, integrate a gender perspective into programmes designed to protect and promote freedom of religion or belief.

Head Binding

Independent experts or special rapporteurs are appointed by the Geneva-based UN Human Rights Council to examine and report back, in an unpaid capacity, on specific human rights themes. They also make annual presentations to the General Assembly’s Third Committee.

Circumcised boys

 What about harmful practices against boys?

3883624368

South Africa: 4 year olds child dies after hospital circumcision

Johannesburg – “They killed my child.” These were the pained words of a Germiston father whose son had to be taken off life support on Wednesday evening after he was declared brain dead by two surgeons following a medical circumcision operation a week ago.

Reggie Mokalapa, 39, took his four-year-old son, Gugulethu, to Medicross Germiston for what doctors had assured him would be a “less than two-hour” procedure last Tuesday.

On Sunday, monitors showed that Gugulethu’s brain was not responding, and on Monday he was declared brain dead.

On Wednesday, a second doctor confirmed that Gugulethu was brain dead and the family elected for doctors to take him off life support.

“We are always advised to circumcise our children young, and we did this so that he’d be okay in future. Unfortunately, we took him to a slaughterhouse,” said Mokalapa.
 
 
 
 
Rest in Peace, Gugulethu.
 
Please, let’s stop cutting minors.
 
WHO, PEFPAR, Bill and Melinda Gates Foundation, UNAIDS, please stop cutting minors.

patrick_izimba

Safe Male Medical Circumcision in Uganda results in penile amputation

Circumcision, like every other surgery, carries some risks. The problem is when promoters argue for a surgery without medical indication and minimizing every risk in order to entice the patients to undergo the procedure.

As we know, the West is currently promoting VMMC (voluntary male medical circumcision, safe male medical circumcision) in some countries of Africa as part of the package for HIV prevention. A lot of emphasis has been set on reducing the costs of the procedure by looking for new methods (such as the PREPEX, the TaraKlamp, the Shang Ring) and trying to perform the procedure without the need for a surgeon, with minimally trained personnel.

Of course this is going to lead to complications, such as what happened to Patrick Izimba in Uganda, reported on July 16th of 2013. Patrick Izimba was enticed by one of the signs offering safe male medical circumcision, and what followed is every man’s nightmare. His penis suffered gangrene and was transferred to a specialist. Plastic surgery will be used to reconstruct his penis, but he won’t be able to have sex.

When you promote mass circumcision, these events are bound to happen. Yet, this the the message that circumcision promoters are sending to Africa:

Check out the explicit manifesto on their page: “Importance of establishing circumcision as a social norm is stressed“. It’s not about health, it’s not about preventing a disease, it’s about creating a social norm.

Let’s quickly visit the WHO’s manual for male circumcision with anesthesia, and on page 16 let’s check the listed risks:

Risks
As for any surgical procedure, there are risks associated with
circumcision. While the benefits of circumcision may be wide-ranging
and long-term, any problems generally occur during or soon after the
procedure. They include:

•pain;
•bleeding;
•haematoma (formation of a blood clot under the skin);
•infection at the site of the circumcision;
•increased sensitivity of the glans penis for the first few months
after the procedure;
•irritation of the glans;
•meatitis (inflammation of the opening of the urethra);
•injury to the penis; 
•adverse reaction to the anaesthetic used during the circumcision.

These complications are rare when circumcision is performed by well
trained, adequately equipped, experienced health care personnel, and
are usually easily and rapidly resolved. Data from controlled trials
show that fewer than 1 in 50 procedures result in complications.

Did I miss loss of the penis? Or is the loss of the penis darkly lumped into “injury to the penis”? When considering the reality of a man who just lost his sexual organ, does it make sense that these complications are rare and easily and rapidly resolved?

The news article about Patrick Izimba mentions anesthesia as possible cause of the gangrene. The WHO’s manual on male circumcision with anesthesia indicates:

“Lidocaine with epinephrine must not be used because there is a risk of constriction of the blood vessels to the whole penis, which can cause gangrene and loss of the penis”. 

Is this what happened? Was he told that gangrene and loss of the penis were possible risks of the procedure? If not, his consent was not informed consent.

Page 148 of the manual also states indicates:

Worsening wound infection with signs of gangrene. A rare risk
of genital surgery is infection with multiple bacteria, causing
progressive skin loss. In this situation, the blood supply is cut off,
and the skin becomes necrotic and turns completely black. This
condition is known as Fournier’s gangrene (synergistic gangrene
or necrotizing fasciitis) and is more common in men who have
diabetes. Any man with signs of spreading infection or black
gangrenous skin should be urgently transferred to a referral
centre. At the referral centre, it is usually necessary to give a
general anaesthetic and remove all the dead skin

And while we are in page 148 of the manual, let us wonder if men are advised about the possible late sexual complications, or are they reassured that their sexual function won’t be impacted? Page 148-149 describes late complications such as:

In the long term, the client may complain of:

• decreased sensitivity of the glans;

• oversensitivity of the glans;

• unsightly circumcision wounds, ragged scars or other cosmetic
concerns;

• persistent adhesions at the corona and inclusion cysts. These
problems can be avoided if the foreskin is fully retracted during the
operation and all adhesions carefully divided;

• discomfort during erection from the scrotal being skin pulled up the
shaft of the penis and a tight scrotal sac. This can result from
removal of too much skin during the circumcision. These problems
can be avoided by careful preoperative marking of the incision
lines.

• torsion (misalignment) of the skin of the penile shaft. This can be
avoided by taking care during the operation to align the midline
raphe with the frenulum.

Is this the new social norm? Males with unsensitive glans, unsightly scars and uncomfortable erections when the scrotum is pulled up by the penis because it doesn’t have enough skin to accommodate a normal erection? Is this the American gift to Africa? Are we transferring the American wound?

Appendix 6.2 of the WHO’s Manual shows a sample consent form for a minor. The consent form does not list the risks and complications of circumcision. It merely states that the parents were counseled on the existing risks. Without a written record, how are they to ensure that providers won’t be lying about the complications and exaggerating the benefits, when their expressed intention is to establish circumcision as a social norm?

Background

Gangrene and loss of penis is a frequent complication of traditional African circumcisions, due to the risk of infections and terrible conditions in which the procedure is usually carried. However, loss of the penis also occurs in sterile conditions. It happened in 2012 to a man in China, 2 weeks before his wedding.  In 2008 a man in Kentucky had his penis removed without consent during a circumcision because the doctor found a cancerous tumor; the man sued on grounds that he should have been waken up and given information prior to the amputation, and yet the court sided with the doctor as the consent form enables the doctor to perform any other procedure deemed necessary. And of course there is the well known case of David Reimer, who lost his penis while being circumcised as a baby, was raised as a girl until his teenage years, was reverted (breast reduction, penile reconstruction…), and committed suicide at 39 years.

Circumcision for HIV prevention remains nothing but speculation about a protective effect, with no proven causal reason. The African studies have been challenged by scientists and general public, but for some reason the UNAIDS and the WHO continue to promote circumcision as part of the HIV prevention package without stopping to think critically, sponsored by PEPFAR and the Bill & Melinda Gates Foundation.