This week I am in Lilongwe at the National Aids Commission of Malawi: National HIV & AIDS Research and Best Practices Conference. It is a gathering of researchers, health professionals, and CBO’s from around Malawi sprinkled with an international presence from Medicines Sans Frontiers, the WHO, MDICP, and some U.S. university-based researchers. Two of the professors (Dr. Susan Watkins [Univ. Penn/UCLA], and Dr. Ann Swidler [Berkeley]) who run the projects I am affiliated with here in Malawi are presenters, along with a couple of sociology graduate students from Austin and UCLA. (Julie would be in heaven here at this conference!) It’s not really my area of research interest but I did have the opportunity to help two of the grad. students get their presentations into shape for public consumption, so I feel I’ve earned my keep.
The highlight thus far was a presentation by Dr. Swidler on “Organizational and Cultural Obstacles to Male Circumcision as a Prevention Intervention”. Dr. Swidler is far and away one of the best presenters I have seen in a long time. Granted the topic itself was attention grabbing, but she held and entertained her audience, and never missed a beat. She presented data from three recent, groundbreaking, randomized controlled trials that unequivocally demonstrated the protective effect of male circumcision on HIV transmission to the tune of 50-75% (Auvert et al., 2005; Bailey et al. 2007; Gray e al., 2007). She then discussed organizational, political, institutional, and cultural barriers to uptake of a prevention intervention that has been proven to be effective. Imagine if we failed to implement the use of some of the vaccines that have effectiveness rates of the same degree?
It was an interesting dynamic, this white, American woman presenting to a room of predominately male Malawians on male circumcision. Never directly saying “look, to not plan to implement this intervention strategy would be ludicrous,” but presenting very compelling evidence and analysis of the barriers and recommending that Malawi and other AIDS-affected countries set their own, HIV prevention priorities and try to do so independent of the influence of donors and international agencies. A difficult thing to do indeed, given the flow of money for HIV prevention in Africa and the depth of the organizational and cultural barriers. She successfully captured this idea of independent intervention planning when she stepped to the center of the room with raised arm and said “After centuries of coming to this continent, taking the people, enslaving them, colonizing, oppressing, and stealing their natural resources, what are U.S. and European based donors going to do? Show up with knives and say give us your foreskins!?” – Not a direct quote, but something to that effect which drove the point home of the immense political and cultural barriers to uptake of male circumcision, and revealed the need for it to be an indigenous based policy if it will work. And to not uptake a proven effective strategy due to such barriers may be a dangerous choice.
A related picture demonstrates some other cultural barriers to HIV in Malawi – this is a sign from Mchinji that indicates news to all of us : There is a curable vaccine for HIV/AIDS!
Translation:
We cure HIV and after that we allow you to go to the MACRO and Government hospitals or VCT center freely.
Let's join hands with the government in the fight against AIDS.
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