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Zulu King Promotes Circumcision to Fight HIV/AIDS

July 2, 2010

A South African tribal king in a province where one in seven residents are HIV-positive is promoting circumcision to help protect his people from the epidemic.

"I don't want to lose any of my Zulu people," explained King Goodwill Zwelithini. In KwaZulu-Natal province, about 350 people are infected with HIV every day and another 320 die from the complications of AIDS.

African studies have shown that male circumcision reduces the risk of female-to-male HIV transmission by 60 percent.

In promoting circumcision, Zwelithini, with the support of the provincial Health Minister Dr. Sibongiseni Dhlomo, is reviving a long-standing tradition among Zulu men. The king and public health officials are careful to note that circumcision does not provide absolute protection, so other measures, such as wearing condoms, must be used as well.

"Use the condom when the time's come to prevent the problem," Zwelithini said. Public health officials use the occasion of the circumcision itself to inform men about how to prevent HIV infection.

Circumcision is believed to reduce the risk of HIV transmission by removing cells that are susceptible to infection. "By removing [the foreskin] completely, one limits the exposure for HIV to gain acquisition or entry into the body," said Dr. Adrian Puren of the National Institute for Communicable Diseases, an author of a 2005 study on the subject.

"This is a perfect example of government working within the bounds of tradition, and that tradition working with modern medicine," Dhlomo said.

Back to other news for July 2010

Adapted from:
07.01.2010; Xolani Gwala

This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.
See Also
Quiz: Are You at Risk for HIV?
10 Common Fears About HIV Transmission
Male Circumcision for HIV Prevention

Reader Comments:

Comment by: Hugh7 (New Zealand) Sat., Jul. 3, 2010 at 7:41 pm UTC
"60 percent" risk reduction is hype. That is a relative risk reduction, the ratio of the difference between two small figures. (From 2.5% to 1.2%). The absolute figures are that less than two years after circumcising 5,400 men in South Africa, Kenya and Uganda, 64 circumcised men contracted HIV, and 137 of a similar number not circumcised. The difference, 73 men, is the TOTAL basis of the claim that "circumcision could protect millions".

327 circumcised men dropped out of the studies, their HIV status unknown, easily enough to conceal enough extra HIV+ men to make it statistically insignificant.

And a study by Maria Wawer et al. in Uganda found 18% of the woman partners of circumcised HIV+ men became HIV+, compared with only 12% of the partners of non-circumcised HIV+ men. That study was stopped "for futility" before the figures could reach statistical significance. (There would have been no ethical objection to allowing the study to run, because they had established that circumcising the control group would not protect the women.)

So encouraging men to have themselves circumcised may actually increase the risk of passing HIV on to their partners.
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Comment by: Mark Lyndon (Manchester, UK) Fri., Jul. 2, 2010 at 9:17 pm UTC
Circumcision is a dangerous distraction in the fight against AIDS. There are six African countries where men are *more* likely to be HIV+ if they've been circumcised: Cameroon, Ghana, Lesotho, Malawi, Rwanda, and Swaziland. Eg in Malawi, the HIV rate is 13.2% among circumcised men, but only 9.5% among intact men. In Rwanda, the HIV rate is 3.5% among circumcised men, but only 2.1% among intact men. If circumcision really worked against AIDS, this just wouldn't happen. We now have people calling circumcision a "vaccine" or "invisible condom", and viewing circumcision as an alternative to condoms. The South African National Communication Survey on HIV/AIDS, 2009 found that 15% of adults across age groups "believe that circumcised men do not need to use condoms".

The one randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised btw.

ABC (Abstinence, Being faithful, Condoms) is the way forward. Promoting genital surgery will cost African lives, not save them.
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