A BBC documentary was made about the Rakai research. The documentary was reviewed in the British Medical Journal in the following way:
[The TV-programme] turned out to be a first-rate virological detective story. [.. .]An impressive array of witnesses—doctors, scientists, anthropologists—were lined up to present the evidence, which seemed to suggest overwhelmingly that having a foreskin could make men more vulnerable to HIV. It all hinged on the natural protection offered by keratin, found in much lower quantities in the foreskin, and so making uncircumcised men much more vulnerable to heterosexual transmission of HIV. There was a wonderfully dramatic white coat and Petri dish moment when an American scientist used a live foreskin taken from a just circumcised adult male to test the rate at which HIV invaded the cells. They changed colour in a jiffy, proving they had succumbed to infection. This was television science at its best (Jackson 2000:1419).
There are examples of success in risk reduction programmes in several African countries (Waldo and Coates 2000). Women’s grass-root movements in Africa are very clear about there already being enough knowledge on ways to prevent HIV transmission. Access to health care and antiretroviral drugs, support groups for women, and promotion and availability of (female) condoms are among prevention strategies that are known to work effectively—and are crucial for women’s empowerment. Such projects, however, are less likely to gain news attention. Even less likely to gain visibility are projects that focus on not specifically ‘African’ problems, but feminist political issues like power dynamics in (hetero)sexual encounters.
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The male circumcision debate seems more involved in reproducing imagery on ‘African sexuality’, than in envisioning actual change. In our analysis, the media interest in male circumcision research is connected to, first, medicalization, and second, a media fascination by ‘African news’ that feeds the Western fantasy about ‘African sexuality’. Medicalization has been described as a typical feature of modern Western societies: it is easier to see social problems in terms of medical, preferably clinical, problems than in terms of social power relations (Conrad 2000). It is obvious that Waldo and Coates’ (2000) statement about the bias towards individual-level solutions and randomized clinical trials in prevention research applies in this case too: “HIV prevention scientists are not connected to prevention efforts outside their own academic lives. Community-based interventions have been occurring in affected communities since the beginning of the epidemic, but HIV prevention scientists are frequently not involved in them” (Waldo and Coates 2000:24—25). In this chapter we have wished to turn the attention to the constructions of ‘Africa’ and the marginalization of women in the male circumcision debate.
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Neither medical articles nor media reports on male circumcision discuss the question of what the consequences of possible male circumcision campaigns will be for women. The writers do not consider how a promotion of male circumcision as HIV/AIDS prevention may affect infection rates for women. Women’s organizations, in contrast, have focused on the social conditions that make wom-
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Preventing HIV? Medical Discourses and Invisible Women
en more vulnerable to becoming infected with HIV. When considering social and economic circumstances, gender inequalities and sexism, it becomes quite clear that young women should be the main targets of interest in HIV/AIDS research and media attention (Gilbert and Walker 2002).
Women’s organizations promote a change in power relations between men and women, and a radical change in how heterosexual relations are perceived. The male circumcision model, on the contrary, reproduces a stereotypical assumption of heterosexual practice where the involved parties are an active male penetrator who will not take an interest in his (passive female) partner’s health and safety— indeed a rather stereotypical and offensive representation of ‘African masculinity’ that resonates with colonial imageries (cf. Mama 1997). The texts display a consistent inability to reflect on the politics involved in representations of sexualities and race as well as a belief in their enterprise as being objective, neutral science— and it is this combination that makes the male circumcision research highly problematic.
Patton (1999) maintains that in media AIDS is constructed through a deadly set of assumptions about cultural and political difference. She is concerned with the way scientists and policy makers have the power to produce “masks of otherness”. This article shows that unfortunately Patton’s concern is valid even for recent expert accounts on how to deal with HIV/AIDS in Sub-Saharan Africa. In face of the knowledge of how the virus actually is spread in Africa, there is every reason to be alarmed about the promotion of male circumcision (as an already available strategy, or in the form of “more research needs to be conducted”) that may actually increase the spread of the virus.
The tragic of the medical construction of ‘African AIDS’ is that it hampers the implementations of effective prevention programs. Local HIV activists are among the most important forces for changing deadly[75] discourses around HIV and AIDS, and to provide resistance on a global scale. Having contrasted local activism with the ‘heroic’ stories of an assumed medical breakthrough, we argue that the understandings of HIV in medical research and medical media, as well as in popular news media, remain seriously distorted if they do not make use of the knowledge that activism generates.
Arnfred Page 110 Wednesday, March 3, 2004 2:38 PM
Katarina Jungar and Elina Oinas