AIDS-Ravaged Swaziland Gears Up for Circumcision Fever

In Swaziland, where UNICEF estimates up to 40 percent of adults are living with HIV/AIDS, circumcision is increasingly being viewed as a tool in containing the epidemic. Results from recent circumcision trials in Kenya and Uganda showed 53 percent and 48 percent reductions in new infections, respectively. Government health officials are eager to roll out a mass circumcision program but are awaiting recommendations from the World Health Organization.

Any such campaign is likely to be hampered by the lack of health care workers in Swaziland. Just 100 or so doctors serve a population of 1 million in the tiny southeast African kingdom, where two-thirds of people live in poverty. "We have to make the medical establishment and policymakers ready for the go-ahead," said the country's only expert in the field, urologist Adam Groenevald. "If we are not ready and the go-ahead comes there will be chaos. A number of unqualified people will start offering circumcisions and we need to avoid that at all costs."

Apart from staffing concerns, mass circumcision faces deeper, cultural barriers in Swaziland. The procedure was barred by a king in the 19th century, so most Swazi boys are traditionally not circumcised. However, Vusi Dlamini of Family Life Association of Swaziland, the country's main nongovernmental HIV/AIDS organization, said many Swazis are interested in circumcision and do not view it as "un-Swazi."

To satisfy increasing demand for the operations, doctors are undergoing training and are asked to volunteer for "circumcision days" when the procedure is offered free. While about 40 men are typically operated upon during these occasions, up to 100 are routinely turned away due to lack of staff.

Activists caution that although circumcision is relatively inexpensive and effective, it does not offer complete protection from HIV. "We want people to be aware that it is not the answer, but an intervention within a package," said Faith Dlamini of the state-run National Emergency Response Council on HIV/AIDS.

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