Chopping off foreskins NOT the answer to HIV in our prisons

In an attempt to curb the spread of HIV in its overcrowded prisons the authorities of Kwa-Zulu Natal have come up with a Plan d’Excellence Supreme Edition. Instead of focusing on key problems that form the root of HIV pandemic in its prisons, the province put all their eggs in the ‘let’s treat the symptoms’ basket by circumcising inmates. Epic fail, as far as I am concerned.

Look, we all are aware – myself included – that circumcision can make a man less vulnerable for HIV infection compared to their counterparts who have their penises intact. As a 2009 International Aids Society fellow (which does not make me an expert by the way), I am not disputing that the link between circumcision and HIV infection.

However, by going through the various studies and reports, I have come to the conclusion that chopping off a man’s foreskin does not make the patient invincible for the virus. It neither prevents a circumcised man living with HIV, whether the infection happened before or after his operation, from passing on the disease to someone else.

Just have a closer look at South Africa. In this country, circumcision is pretty much a custom in all segments of society. Whites, blacks, coloureds, Indians, Jews, Christians, Muslims – it happens everywhere and it is not something of the past recent years. If circumcision would be the answer, why are there over 5 million South Africans, little less then half is male, living with HIV?

“But studies show that circumcision does make males 50% less receptive to the virus,” you’d say. Yes indeed, and I acknowledge these studies, which form part of the key in finding a proper solution to this dreadful disease.

However, without being a pessimist, “50% effective” means that infection can still very much occur. It is basically comparable to handing out condoms that work half of the time: there might a 50% chance you are protected, and there is a 50% chance you won’t be. Would you use such ‘Russian Roulette 2010 style’ condom? Not me.

In addition, please note that the “50% effectiveness rate” of circumcision applies to men who are involved in heterosexual relationships (non anal). The stats therefore do not and cannot apply to our prison environment – where woman and men are strictly separated and where HIV is spreading from man to man to man to man (various explanations exist why men who are engaged in anal sex are more prone to the virus compared to men who ‘do it’ with women and their female bits).

So based on the above: even if male inmates would be circumcised en masse, what are the chances they will not end up popping ARV pills every single day after all?

Just to be clear on this matter: I do appreciate the fact that the KZN authorities are thinking about ways to fight HIV in our prisons. I however, don’t agree with their shortsighted plans. Circumcision can be part of the strategy, but I think much more time and energy should be spent on fighting what causes the high HIV infection rates in our prisons.

To name a few: rape and other forms of violence, drugs, gangs, and overcrowding. Abuse by wardens. Condoning of rape by wardens. Overworked wardens who are not equipped to deal with violence and rape in their prisons.

Sending inmates to the doctor for an operation will simply not eradicate these said elements.

“Ag, but why bother? They are just inmates right? We do not owe them anything as they broke the law,” could be a reply to this blog post, one I do not agree with.

Firstly, at some point inmates will pay their dues and make their way back into society; to their wives and girlfriends or partners to be. By protecting inmates from an HIV infection, you help protecting innocent outsiders from this nasty virus too. Circumcision alone just does not make the cut. More is needed.

Secondly, you cannot forcefully subject people to circumcision. That would be a contravention of their human rights. Yes, inmates have human rights.

Thirdly, circumcision might make men less prone to an infection, but it does not prevent someone who is already HIV positive to give the disease to someone else

Finally, my main reason why I think KZN should elaborate on their strategy: an inmate’s punishment is to serve X number of weeks, months, years behind bars – not the exposure to a fatal virus (death sentence) which will eventually kill them – and the others they will infect in due course.