S. Africa Slow To Encourage Circumcision To Curb HIV

JOHANNESBURG -- In the year since a major South African study indicated that circumcision reduced the rate of HIV infection among men, several African countries hit hard by the disease have moved toward embracing the procedure in the battle against AIDS.

But not South Africa.

Swaziland and Zambia have begun offering discounted circumcisions in pilot programs to men who want them or to boys whose parents request them, and Botswana, Uganda, Lesotho and Tanzania are contemplating the idea.

Yet in South Africa, where more people are infected with HIV than in any other African country, the results of the research have rarely been reported, much less publicly discussed. If anything, AIDS activists here say, circumcisions will soon become less common because of a law signed by President Thabo Mbeki last month.

"They might have made it more difficult to implement what may be our most important HIV-prevention strategy ever," said Francois Venter, president of the Southern African HIV Clinicians Society.

The law, which has not yet taken effect, bans the circumcision of boys younger than 16. It was aimed at curbing circumcisions performed as a tribal rite, a practice that leads to dozens of deaths and injuries each year. The measure includes exceptions for religious reasons, meaning it will have no effect on the country's small Jewish and Muslim communities, and on medical grounds, though they were not defined.

In the debate on the measure, the research into the procedure's effect on the transmission of HIV was not discussed, participants said.

"That was not the issue at all," said Tseliso Thipanyane, chief executive of the South African Human Rights Commission, a leading supporter of the law, which addresses several issues regarding the rights of children. "The concern in our country has been the number of kids who have been dying, the number of kids who have lost their manhood."

Circumcision removes a penis's foreskin, which is made up of cells particularly susceptible to infection with and also possibly effective at transmitting HIV, the virus that causes AIDS. In addition, researchers believe that the foreskin traps fluid, allowing the virus to live longer on an uncircumcised penis after intercourse and increasing the likelihood of infection.

Jews and Muslims worldwide have practiced circumcision for centuries, and it is common among most ethnic and religious groups in the United States.

In Africa, most tribes historically included circumcision as part of coming-of-age rituals, but the tradition has faded as countries have become more urbanized. Researchers have noted for several years that African countries with the highest HIV rates generally have low rates of circumcision.

The South African study, conducted at the impoverished, densely populated Orange Farm township south of Johannesburg, was the first to measure experimentally the effects of circumcision on the spread of HIV.