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AIDS Forum: Circumcision A Major Means of Curbing HIV Infections

by Kilian Melloy
Thursday Jul 21, 2011

Three new studies support earlier conclusions that circumcision is a valuable tool in combating the spread of HIV, attendees at a conference in Rome heard, according to a July 20 AFP report.

In South Africa, a circumcision initiative resulted in a 76 percent drop in new HIV infections. This spared untold thousands of men and women; according to researchers, without the circumcision program, the infection rate would have been 58 percent higher.

The AIDS pandemic has ravaged parts of Africa. The king of one tiny nation, Swaziland, recently took the drastic step of appealing to all male subjects to undergo the medical procedure, which is thought to offer protection against the disease by removing tissue that is especially vulnerable to HIV, the virus that causes AIDS.

"This study is a fantastic result for a simple intervention which costs 40 euros (56 dollars), takes 20 minutes, and has to be done only once in a lifetime," declared the Society for Family Health's David Lewis, who is also associated with South Africa's University of the Witwatersrand.

The article noted that the new results bolster previous studies, undertaken in 2006, in several African nations.

"After pondering risks and benefits, health watchdogs set in motion circumcision campaigns in 13 sub-Saharan countries that have been badly hit by the AIDS virus," the AFP reported. "As of mid-2010, around 175,000 circumcisions had been carried out in the 13 countries considered priorities, according to UNAIDS."

The new results came from a three-year study carried out in a South African township, Orange Farm. Over 20,000 men in the township, most of them 15 - 24, underwent the procedure, the AFP reported.

Two additional studies also shed light on the issue, which has excited suspicion in Africa and controversy in America. One study done at the University of Makerere polled over 300 circumcised men, who said that they enjoyed sex more after the operation. interviewed 316 men, average age 22, who had been circumcised between February and September 2009.

A survey of Western Kenyan men who underwent circumcision found that getting the procedure done did not, as some feared, create a false sense of invulnerability to the virus. Circumcised men there reported that they used safer sex practices such as wearing condoms at the same rate as uncircumcised men.

King Mswati III has taken up circumcision as a weapon in the fight against AIDS, encouraging all the young of his nation to undergo the operation in order to fight the virus, which he likened to a "terrorist."

The Swaziland circumcision program is backed by $30 million in funding from the United States, and is intended to move quickly. The goal is to circumcise 80 percent of Swaziland's males between the ages of 14 - 49.

But going has been slow. The program started six months ago, and far fewer men than hoped have subjected themselves to circumcision -- a mere 3,000. Mswati's direct involvement is seen as a means to jumpstart the mass circumcision movement.

In the United States, circumcision has excited controversy and political activism. So-called "intactivists" gathered enough signatures to put a ban on the practice of circumcising infants and boys under 18 before voters in San Francisco later this year. The ban does not offer any religious exemptions, and its constitutionality has been questioned.

Legal counsel for the city of San Francisco says that there's no way for the proposed ban on male infant circumcision can answer both state law requirements and constitutional muster.

A coalition of opponents to the proposed ban have filed suit to take the measure off ballots this coming November. The plaintiffs in the suit said that the measure threatens religious freedoms and parental rights, and also violates state law, since California does not permit local governments to restrict medical procedures.

But a partial removal of the measure's language would not be acceptable, either. The city's lawyers pointed out that to avoid breaking state law, the ballot initiative would have to exempt doctors. But the ballot measure would then be reduced to targeting religious rites alone, rather than a blanket ban on circumcision carried out by doctors as well as by clerics.

Banning the practice by clerics but allowing it for medical personnel would mean violating the United States Constitution, the city's lawyers said. The First Amendment protects freedom of religion, and circumcision is a long-held rite for both Jews and Muslims.

Anti-circumcision activists say that the procedure is medically unnecessary and amounts to genital mutilation performed on an individual who is too young to consent. The ballot measure would criminalize circumcisions performed in the city on anyone under the age of 18. No religious exemption is offered in the ballot measure's language.

Although studies in Africa have indicated that circumcision might help reduce the spread of HIV in straight men by removing foreskin cells that are vulnerable to the virus, another study focusing on gay American men did not arrive at the same conclusion, in part because circumcision is already so prevalent in the U.S. Moreover, only a very small minority of men surveyed for the study said that they would undergo circumcision even if it were proven to reduce their risk of contracting HIV.

"Our study indicates that any potential benefit may likely be too small to justify implementing circumcision programs as an intervention for HIV prevention," said Chongyi Wei, a post-doc with University of Pittsburgh Graduate School of Public Health, which carried out the study. Wei is also an author of the paper on the results, which was presented at last summer's International AIDS Conference in Vienna.

Previous studies have also indicated that gay men do not benefit from circumcision the way heterosexuals seem to when it comes to HIV transmission. One study by the U.S. Centers of Disease Control and Prevention showed that circumcision seemed to make no difference in HIV transmission rates when it came to anal sex.

Kilian Melloy serves as EDGE Media Network's Assistant Arts Editor. He also reviews theater for WBUR. His professional memberships include the National Lesbian & Gay Journalists Association, the Boston Online Film Critics Association, The Gay and Lesbian Entertainment Critics Association, and the Boston Theater Critics Association's Elliot Norton Awards Committee.


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