Globe and Mail Examines African Governments’ Efforts To Increase Male Circumcision To Curb Spread of HIV

Toronto's Globe and Mail on Thursday examined the efforts of several African governments to provide male circumcision as a way of curbing the spread of HIV. According to the Globe and Mail, male circumcision could prevent "millions" of new HIV cases in Africa, where about 50% of men currently are not circumcised. Several African governments in response to recent studies about the procedure have implemented or are planning circumcision programs.

Swaziland hopes to offer the procedure to 200,000 men over the next five years; however, a shortage of doctors has complicated the government's efforts. The Family Life Association of Swaziland has "hundreds" of men on its waiting list for the procedure, and the clinic's one doctor performs about 10 circumcisions daily, the Globe and Mail reports. FLAS also has offered "Circumcision Saturdays" at clinics throughout the country. The procedure costs about $82 in the country, and the President's Emergency Plan for AIDS Relief is providing funds so the procedure can be offered at no cost.

Rwanda earlier this year also launched a campaign to increase male circumcision. The campaign is focusing on providing the procedure to military personnel, police officers and students. The country's Ministry of Health also is increasing efforts to circumcise infants. In addition, Kenya has decided to offer circumcision to all men in the country, and public health officials are examining ways to implement a safe and cost-effective program that recognizes cultural issues. Private urologists across Eastern and Southern Africa have reported an increase in the number of men requesting the procedure.

Peter Cherutich, who is leading the Kenyan team designing the program, said male circumcision campaigns are an "appropriate strategy from a scientific and public health perspective." He added that the campaigns "must be reconciled with the deep culturally embedded issues that define the procedure as a rite of passage, for circumcising communities, and more so as a mark of identity for noncircumcising communities."

According to the Globe and Mail, about 30 different pieces of research suggested a correlation between male circumcision and lower rates of HIV by the end of the 1990s, but a randomized, controlled trial was not conducted until after 2000. Daniel Halperin, an HIV/AIDS researcher at Harvard University, said such a trial was delayed because the "tendency" in HIV research is "to look for biomedical, technological solutions." Halperin added that although "circumcision is biomedical, in Africa, it's always been a traditional ... practice, so it has not been on the radar."

HIV/AIDS researchers had assumed that the procedure would be rejected in many traditional cultures that did not practice circumcision. According to Halperin, the challenge to increasing circumcision on the continent is to increase the number of medical workers who can perform the procedure and to provide the equipment to safely perform "hundreds of thousands, possibly millions," of circumcisions during the next few years (Nolen, Globe and Mail, 3/27).