Tag Archives: HIV

Foreskin

The times I have tried to start projects on my own, or I should say without anyone’s desire except mine, I’ve been horribly unsuccessful. I have made the efforts to fill gaps where I see necessary, but I usually receive lukewarm pushback or disinterest. Reaching out to groups and people is generally how I get started and make myself known, but it’s important to find out what they want to do rather than imposing your own agenda.

This is part of Peace Corps ideology, and only in practice do I see how applicable it is to development. Regardless of what you see as necessary, it won’t catch on unless there’s genuine group interest. At this point in my service I’ve relegated myself to a mantra of “ask and you shall receive;” otherwise, I’m just wasting effort. With my organization, however, I have to be self-motivated. Our functionality is low, so I often have to set the wheels of an idea in motion.

I’ve discussed Safe (Voluntary) Male Circumcision on my blog before. It’s perhaps the best medical defense to HIV, and in my opinion, the best thing for Africa. It adds a layer of protection, breaking the HIV cycle and safeguarding failures in behavior change. A doctor at the hospital is heading up a campaign to bring in patients and sought my help, so this is something I’m (gladly) working on now. It’s nice to be asked. I’m hopeful that this project will spark something in the village since the number of circumcisions done here was in the double digits last year.

There has been international attention paid to campaigns like this, and even innovative medical solutions in the works (a ring that kills the foreskin gradually, with less pain and no surgery). The reactions I have been receiving to my insistence on the importance of circumcision are varied and sometimes silly. People laugh and say “what if I get circumcised and then I need my foreskin back?” They’re also curious about what the Bible says about circumcision; while the Old Testament obviously demands it, I’m unsure about newer books. I’m trying to get all my responses straight as we power ahead and try to get a lot of males snipped.

A couple weeks ago, a woman asked me if the skin on your forehead was called “foreskin.” By the way, foreskin is on the penis. The reason its removal is integral to HIV prevention is in the biology. It’s believed that there exist “target,” or highly susceptible immune cells in the foreskin; circumcision helps prevent female-to-male transmission, and thus breaks the chain. ‘Foreskin’ is mentioned seven times in this post.

Cheers

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HIV Solutions

To some extent, I think Volunteers all over the world have similar experiences. Location obviously plays a big role in dictating the work you do and the culture in which you immerse yourself, but we all share an uphill climb to enact change and a hope that what we do will be sustained after we’re gone. I’ve been corresponding with a PCV friend in Kyrgyzstan and I’m surprised by how many little commonalities have popped up. It’s a small world.

Botswana is a unique Peace Corps country – it graduated from the program in the ‘90s as the country raised itself up to middle-income status, but Volunteers returned when the government asked for help with the HIV epidemic. All Volunteers in Botswana are given an HIV focus as their primary assignments.

After the dust settled from my existential crisis a couple weeks ago, I decided to get busy. In the interest of doing something, my members and I have started planning to restart our STEPS films project at all of the schools in Rakops. The STEPS Films series was shot all over southern Africa and is constructed in a way that compels discussion. The strength of the STEPS films lies in their non-patronizing tone. They encourage thought about those issues and the message is for the audience to decide.

In the business of behavior change as a method of HIV prevention, a lot of ethical questions arise about which cultural norms should change and which should survive as African values. For example, the practice of multiple concurrent partnerships, or having many overlapping sexual partners, is seen as a big problem. In the states, we would like to say that we practice serial monogamy, and further, that it’s better. This is a complex issue that spans gender equality, human rights, and health. But in the end, there are scientific sure-fire prevention methods: wear a condom, get circumcised. These things have a data backing. Is it our place to tell men and women here which relationships are bad and which are good? Maybe we should encourage them to be honest with everyone at risk, and in the mean time give them condoms. There are no tangible ways to track the success of behavior change initiatives, aside from watching HIV infection rates over time.

As someone who believes in science, I see more promise in increased circumcision programs for men. Data supports this – there is a significant drop in the likelihood that one will contract HIV if he is circumcised. There are also cultural barriers and ethical questions surrounding this route: should children have the right to decide if they keep their foreskins? I think this venture has a better chance of succeeding, but it will mean changing some minds. That may have been more than you wanted to know about HIV for today, but these are the projects that will consume most of my time in February.

There are still a lot of other unfinished crusades on which I have embarked and I may discuss them at a later date. It remains to be seen which ones will come to fruition, so keep your fingers crossed that the ones I care about most gain some traction. At least for now I’m occupied.

Cheers

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