Upton on HIV and Public Health in Botswana

Colgate students and faculty assembled in the Persson Hall Auditorium on Wednesday, March 29 to listen to a talk given by Professor of Sociology and Anthropology and Co-Director of Global Health at Depauw University Dr. Rebecca L. Upton. A Colgate alumna with a degree in anthropology, Upton discussed the ways in which the complexities of masculinity and fertility fears might be taken into consideration as Botswana moves forward with different HIV/AIDS prevention programs and policies.

Upton began her lecture familiarizing the audience with male infertility, a topic that is vastly understudied around the world. After spending 20 years in northern Botswana, Upton gathered enough ethnographic data to uncover ways in which Botswanan men discussed voluntary medical male circumcision (VMMC), a practice that contributes greatly to insights on the potential success of HIV/AIDS prevention programs such as the “magic bullet” and new public health strategies of voluntary adult male circumcision.

The latest tactic in the national strategy against HIV/AIDS in Botswana, and arguably worldwide, has been the introduction of adult male circumcision. In Botswana, this procedure can only be completed on men who are HIV negative. Even though this is not the newest innovative and effective weapon, Upton described it as a kind of “magic bullet,” or long-awaited weapon that is used as a promising means of prevention. Thus, young “lehewa,” or single men who are HIV negative, now find themselves in a curiously desirable and envious position in which they are willing to participate in this rapidly growing male circumcision program.

Despite this positive note by Upton in regards to HIV negative Botswanan men, Upton’s lecture also served as a cautionary tale resulting from the narratives offered by the Botswanan community. Although the ubiquity of billboards seen in Botswana suggests an emphasis on the facts surrounding VMMC, it also raises questions on how the messages of circumcision are being interpreted. 

An example of this is health institutions that have looked at male circumcision as a means to prevent the spread of HIV/AIDS and lower its prevalence. Yet, Upton accentuates that there is limited data from quantitative or qualitative research that can tell us how people are interpreting these messages.

First-year Margaret Pulte found Upton’s perspective on the use of billboards in Botswana particularly controversial.

“I think the billboards are effective in the sense that they keep the issue of male circumcision and HIV/AIDS prevention at the forefront of the public’s attention,” Pulte said. “I do think, however, that the issue needs to be fleshed out on the billboards so that the general public understands the main reason for male circumcision and the benefits and danger of the practice. In my opinion, schools should teach students about HIV/AIDS prevention. I think this is the best way to reach people at an early enough age so that they can be positively affected by the information that they learn.”

The idea of infertility and male circumcision also raises certain cultural debates, as the country of Botswana considers itself a “pro-natalist” nation. For Botswanan men and women, having children signifies the attainment of adulthood and recognition of one’s reproductive self.

According to Upton, because no one wants to be seen as “barren,” most people will risk unsafe sexual practices in order to fulfill traditional worries and personhood, especially for women.

Pulte commented on why this specific topic stood out to her.

“I was fascinated and disturbed by one story that Dr. Upton shared about a woman who said that most women in Botswana are concerned with reproducing and having children first, and about contracting HIV/AIDS second,” Pulte said. “In the culture of Botswana, having children is what makes people whole. In this type of environment, less emphasis is put on safe sex practices, and as a result, diseases spread. This is really why the practice of adult male circumcision has become part of the medical practices of the country. Men want to be marked as ‘safe’ so that they can continue to have sex and reproduce, as that, in my opinion, is the goal of most sexual interactions in Botswana.”

Although millions of dollars have been poured into the male circumcision strategies, only 15 to 20 percent of the Botswanan male population has been circumcised. 

First-year Alexandra Millett offered her opinion on why we haven’t seen any completion or success in this program.

“Personally, I was surprised to discover how even though the AIDS/HIV campaign had been going on for so many years, only 15 to 20 percent of the male population was circumcised,” Millett said. “Dr. Upton explained how, even though the message had been spread for so many years, the results still were not showing.”

Millett continued to say how important it is to communicate with other citizens on this campaign.

“I think that this situation reiterates how important it is to fully engage with the community and culture at hand when trying to spread a message and make sure that the message you want to be received is actually what is taken away from the campaign” Millett said.

Upton concluded her presentation with this final point about the value of anthropology and other studies that place socio-cultural factors at the center of the epidemic. She explained that this is not a call for a roll back of circumcision programs, but rather a call for critical recognition on how to understand male infertility and its physiological and social manifestations in contemporary contexts.

“In the same way that the circumcision strategy should not be seen as a magic bullet, I do not suggest that there is one simple cultural element that should be highlighted in the prevention strategy method,” Upton said. “Rather, I suggest the long-term methods as well as the clear recognition of the complexities of sexual desires and fears should also be placed at the center of discussions of circumcision and masculinity.”