U.S. to End Funding of Anti-AIDS Program in Swaziland

By Craig Timberg
Washington Post Foreign Service
Friday, October 13, 2006

JOHANNESBURG, Oct. 12 -- The Bush administration has decided to end its funding of a groundbreaking program that has sought to curb the spread of HIV by offering subsidized circumcisions to men in Swaziland.

A statement issued Thursday night by the U.S. Agency for International Development said that it had only recently learned of the program and that it violated government policy supporting study of circumcision but not services offering the procedure.

More than 300 men have been circumcised in the past 12 months at the Family Life Association of Swaziland clinic in Mbabane, the capital of the southern African country. A growing body of research has shown that circumcised men are less likely to contract HIV, the virus that causes AIDS, which has infected an estimated one out of three Swazis between ages 15 and 49.

USAID contributed $149,285 to the program last year but did not renew it for the coming fiscal year, said Dudu P. Simelane, deputy executive director for the Family Life Association. She added that the decision against renewing the funding, part of the Bush administration's $15 billion anti-AIDS program, did not come as a surprise but that new donors had not yet been found.

"It's best we try by all means to continue, but funding is the determinant," Simelane said, speaking from Manzini, Swaziland, where the group is based. "We wouldn't like to stop, really."

In its statement, USAID said the funding "should not have occurred, and there will be no further circumcisions performed with U.S. Government funds until the PEPFAR Scientific Steering Committee reviews data from ongoing clinical trials and considers any recommendations on male circumcision from the normative international Agencies." PEPFAR is the Bush anti-AIDS program.

Circumcision removes the foreskin from a penis. Jews, Muslims and most boys in the United States are circumcised for religious or hygienic reasons. Many African tribes historically performed ritual circumcisions, but the practice has steadily declined for decades in southern and eastern Africa, where HIV rates are highest.

The procedure and its medical benefits remain controversial, but years of studies have shown that circumcised men have lower HIV rates than men who are not circumcised, even when they live in the same area. Scientists believe that circumcision removes the tissue that is most vulnerable to HIV infection. The removal of foreskin, which some researchers believe also transmits the virus more effectively than other tissue, may also limit the spread of the virus to a man's sexual partners.

A South African experiment among 3,274 men showed that circumcised men were at least 60 percent less likely to contract HIV than those who were not circumcised. Similar studies are underway in Kenya and Uganda, and most of the world's major health donors, including the Bush administration's anti-AIDS program, have said they will not pay for circumcision programs until those two studies release their results.

The program in Swaziland offered circumcisions to men for about $40, far less than the cost at private clinics. The fee was lower in public hospitals, but as news spread that circumcised men may be less likely to contract HIV, long waiting lists formed for the procedure.

Ending the U.S.-funded program means fewer options for Swazi men seeking circumcisions.

"That's not going to help," Adam Groeneveld, a urologist who has trained several doctors in circumcision techniques for the program, said from Mbabane. "I don't understand why that has happened."

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