Photographer : mvcorks @ flickr
The history of HIV/AIDS is inexact and mysterious—sometime last century, somewhere in the deepest jungles of Central Africa the virus passed from monkey to human, with dire consequences.
Between 33.4 and 46 million people are now living with HIV, most of whom reside in Africa. Generations of HIV-positive men and women have left their mark on the continent. With social instability, overstretched health care systems and millions of orphans growing up infected or affected by the disease, it seems the future of HIV/AIDS is clearer than its past. It looks as though HIV/AIDS in Africa is inevitable.
New research has discovered that male circumcision could reduce HIV infection rates by up to 60%, preventing 5.7 million new cases and 3 million deaths over 20 years in sub-Saharan Africa. At the recent International AIDS Society Conference in Sydney, Professor Robert Bailey presented the results of three randomised trials conducted in South Africa, Uganda and Kenya.
Bailey highlighted that in African regions where HIV infection is highest, the rate of male circumcision is less than 20%. Where HIV infection rates are low, most of the male population happen to be circumcised. The correlation is not a coincidence. The news has the medical world, as well as Africa, all shook up. Bailey urged, “Let’s finally take the turn from the long road of contemplation to the highway of action. We must make safe, affordable, voluntary circumcision available now.”
Yet concerns about circumcision as a barrier against HIV have been raised. The procedure is only partially protective and can increase the chance of infection if the area is not allowed to heal completely before resuming sexual activity. There are also concerns that the operation could give rise to foolhardy behaviour in men who think they are totally protected from HIV. To be effective, circumcision would have to be performed in a safe and clean environment with trained practitioners, alongside sexual education and counseling. It’s not as easy as a snip in your lunch break. But most of all, it’s expensive. Bailey estimated the “exceptionally low cost” would be less than $200 per patient. But in Africa’s under-resourced health care systems, that spells I-M-P-O-S-S-I-B-L-E.
Discussion about the HIV/AIDS crisis in Africa often leaves out one crucial factor—African people. In The East African newspaper, Charles Onyango-Obbo’s column headline drips with sarcasm—“Africans Are Too Promiscuous for Monogamy, Let’s Circumcise Them”. Onyango-Obbo finds the politics surrounding the study unsettling:
“one gets the uneasy feeling that there is a widespread belief out there that Aids in Africa cannot be primarily solved by conventional medicine, perhaps because the African is a frightening beast who is ‘untreatable’”.
But there is cause for optimism. Rachel Jewkes of South Africa’s Medical Research Council thinks male circumcision can be viewed as a social process rather than a medical intervention, “I think culture is very flexible and to the extent that circumcision has been associated with manhood, I think that gives it enormous potential for equating it with better manhood”. Traditional rites of circumcision usher boys into manhood and greater responsibilities. Within the traditional cultural context of circumcision, young men could gain greater protection from HIV while learning safer attitudes about sex.
The central African country of Zambia has already begun implementing a national male circumcision program. In fact, Zambian men were so enthusiastic about protecting themselves and their partners, that by the time the World Health Organisation got around to formally endorsing male circumcision for HIV prevention in March 2007, 1500 men had already passed through just two clinics.
President of the International AIDS society Dr. Montaner says “inaction against HIV/AIDS could be considered as a crime against humanity”. Anything that could save 3 million lives has to be taken seriously.
How do I know this?
Epstein, H 2007, ‘There is no room for sexual morality in an honest conversation about Aids’,
The Guardian, 9 August,
www.guardian.co.uk/comment/story/0,,2144455,00.html
International AIDS Society 2007,
http://www.iasociety.org/
Lee, J 2007, ‘Circumcision could save millions from AIDS: studies’,
Reuters, 24 July,
www.reuters.com/article/healthNews/idUSSYD18190020070724
Onyango-Obbo, C 2007, ‘Uganda: Africans Are Too Promiscuous For Monogamy, Let’s Circumcise Them’, All
Africa, 31 July,
http://allafrica.com/stories/200707310595.html
PLOS Medicine, The Potential Impact of Male Circumcision on HIV in Sub-Saharan Africa,
The Public Library of Science,
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030262&ct=1#toclink3
Rose-Innes, O 2007, ‘How a foreskin ups HIV risk’,
Health24.com, 7 August,
www.health24.com/news/HIV_AIDS/1-920,41252.asp
Sibeene, P 2007, ‘Namibia: Circumcision Arouses Interest in Country’,
New Era (Namibia), 30 July,
http://allafrica.com/stories/200707300941.html
Susman, E 2007, ‘Analysis: Circumcision urged in AIDS fight’,
United Press International, 27 July,
www.upi.com/Health_Business/Analysis/2007/07/27
/analysis_circumcision_urged_in_aids_fight/1953/
The Global HIV Prevention Working Group 2007,
Bringing HIV Prevention to Scale: An Urgent Global Priority, June,
www.globalhivprevention.org/pdfs/PWG-HIV_prevention_report_FINAL.pdf
United Nations IRIN 2007, ‘Africa: At the Cutting Edge—Male Circumcision and HIV’,
All Africa, 22 July,
http://allafrica.com/stories/200707220017.html
United Nations IRIN 2007, ‘Africa: Mass Male Circumcision— What Will It Mean For Women?’,
All Africa, 24 July,
http://allafrica.com/stories/200707240695.html
United Nations IRIN 2007, ‘Zambia forges ahead with circumcision plans’,
Mail & Guardian Online, 5 August,
www.mg.co.za/articlePage.aspx?articleid=315825&area=/insight/insight__africa/ 
