“Malawi’s Secret Weapon Against HIV: Male Circumcision”
by Sarah Witman
Pacific Standard, September 8, 2016
[Subject line] Freelance pitch: Male circumcision is abetting Malawi’s HIV crisis
I’m a science journalist based in Madison, Wisconsin, and I recently worked with [another editor] on a story for the Economy of Scales series (“In the Faroe Islands, fish is king”). I have a pitch for The Fix, in response to your tweet this weekend. The story I propose will transport readers to Malawi, a small country in southern Africa where 1 in 10 adults are HIV-positive, and explore an unusual way the country is combating the virus: by medically circumcising men and boys ages 15-49.
Last summer, a year ago this August, I visited a clinic in rural Malawi (Ntaja Health Center). To my sheltered eyes, touring the clinic felt like being in a haunted house, each room bringing new horrors: women groaning in labor, dusty operating rooms, wastepaper baskets overflowing with stained gauze. In one hallway, dozens of wide-eyed adolescent boys sat silently on benches, waiting (I was told by my guide, a Malawian doctor) to be circumcised.
The latter was (though perhaps counterintuitively) a positive sign. Malawi has the 10th highest percentage of people living with HIV/AIDS in the world; it’s the leading cause of death. In addition to providing testing and antiretroviral treatment, especially for pregnant or breastfeeding mothers, providing access to male circumcision services is one of the biggest international government initiatives aimed at treating and preventing the spread of HIV in Malawi. Since 2005, studies have shown that male circumcision can reduce female-to-male HIV transmission by about 60 percent. In 2007, the World Health Organization recommended scaling up male circumcision efforts in countries with high HIV and low circumcision rates, and in 2012 Malawi became one of 14 such countries to implement a program.
Since then, more than 150,000 male circumcisions have been performed in Malawi, but these numbers are still below the initial target goal (due to an insufficient number of trained medical professionals, and patients’ unwillingness to have the procedure, especially among adults). According to a National AIDS Commission report, Malawi plans to implement “a more aggressive approach” (training more doctors and nurses to perform the procedure, using more efficient tools and methods) throughout 2015-2020 to attain a 60 percent male circumcision rate (totaling 1,300,568 circumcisions). A recent study (published this month in PLOS One) aims to narrow the focus of Malawi’s male circumcision effort by age, finding that circumcising males ages 10–29 could help prevent 75% of HIV infections, and circumcising males ages 10–34 could help prevent 88% of infections, over a 15-year period.
I would aim to draw upon my personal experience visiting this clinic, supported by background research outlined above, as well as interview a Malawian doctor and/or a co-author of the recent PLOS paper on preventing HIV transmission through male circumcision. I have a few photos from my visit, and the statistics mentioned above (number of Malawians living with HIV/AIDS, number of males circumcised since 2012, number of infections that could be prevented by 2020, etc.) would lend themselves well to infographics.
Does this sound like a good fit for The Fix?
I had worked with this publication before (as a fact checker and writer) but not with this editor.