S. Africa Slow To Encourage Circumcision To Curb HIV

Researchers recruited 3,274 young men there and performed the surgery on half of them. After 18 months, 49 of the uncircumcised group had become infected with HIV, but only 20 who had been circumcised were infected. The researchers suggested that circumcised men were 60 percent less likely to contract HIV than were uncircumcised men.

Articles on the study and on similar ones underway in Uganda and Kenya have appeared in dozens of journals and newspapers throughout Africa and the world. But in South Africa, where discussions of AIDS frequently are tense and highly politicized, a search of online databases found only two references to the research in a publication here.

The polarized nature of the AIDS debate in South Africa dates to 2000, when Mbeki questioned whether HIV was the sole cause of the disease and whether antiretroviral treatment was safe and effective. Activists here have long argued that Mbeki's doubts undermined the South African response to AIDS.

At a meeting on circumcision last month at Chris Hani Baragwanath Hospital in Soweto, the first gathering of its kind in South Africa, Martin G. Veller, a University of the Witwatersrand medical school professor, argued that South Africa could reduce its HIV rate by two-thirds through circumcising males between ages 15 and 24.

Veller estimated a one-time cost of $32 million to set up new surgical facilities and annual operating costs of $32 million the first several years. Over time, Veller said, the intervention would prevent 150,000 infections a year and save nearly $1 billion in annual medical costs in treating HIV patients. An estimated 5 million now have the virus in a country with a population of 44 million.

But Veller said there was no sign of government interest in any approach involving government-supported circumcisions.

"There's a kind of quietness about it," he said. "It really needs to be discussed."

South African officials say they will continue to monitor the research on circumcision and change policy and law if the evidence becomes sufficiently compelling.

"The research is ongoing," said Joel Netshitenzhe, a senior policy adviser to Mbeki, speaking from Pretoria. "Once they've finalized it, there would have to be policy work based on the outcomes."

Yet activists say the government's record on AIDS gives them little confidence that it will act quickly or prudently, no matter what the research shows.

"The thing that remains unpredictable is how this is received and processed, and whether it's acted on at all," said Mark Heywood, an official with the Treatment Action Campaign and the head of the AIDS Law Project at University of the Witwatersrand in Johannesburg. "The whole HIV policy and thinking is in disarray."