Five African Countries Look at Male Circumcision to Curb AIDS

Botswana, Lesotho, Swaziland, Tanzania and Zambia are in talks with UNAIDS about making circumcision more accessible to men as part of HIV prevention efforts, according to UNAIDS adviser Tomas Lundstrom. The proposed strategy is based on a three-year study of 3,274 men, ages 18-24, at Orange Farm Township showing that circumcision reduced the risk of contracting HIV by 60 percent.

"By removing almost completely the foreskin, you are removing areas where the HIV virus could hide or gain access to the main circulation," said Adrian Purven, deputy director of South Africa's Institute for Communicable Diseases and the study's principal investigator. The results of the study were so conclusive that the South African and French researchers conducting it halted it in July for ethical reasons, offering all participants circumcision.

UNAIDS officials have launched similar studies in Uganda and Kenya involving nearly 8,000 men. Interim results are expected later this month.

"This could be revolutionary for prevention but it is important to say this is not the silver bullet," Lundstrom said, noting that condoms are still the best protection against HIV.

Less than 20 percent of men in southern Africa, where HIV prevalence is highest, are said to be circumcised. Cultural sensitivities and a shortage of surgeons contribute to the low rate of circumcision.

Helen Jackson of the UN Population Fund said a recent meeting of health experts in Lesotho concluded that southern Africa's failure to bring down HIV rates was driven by "a lethal cocktail of multiple concurrent partners and lack of male circumcision."

Estimates show that 3.7 million infections and 2.7 million deaths could be avoided over the next 20 years using male circumcision as a means of prevention, Jackson said.

Out of the worldwide toll of 2.8 million people who died from AIDS-related illnesses last year, 1.2 million were from southern Africa.

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