HIV Loosens Tribe's Resistance to Circumcision

Erick Onyango Otieno, 21, is willing to defy tradition and undergo circumcision. "I do not want to die at this early age," he says. (By Craig Timberg -- The Washington Post)
By Craig Timberg
Washington Post Foreign Service
Friday, September 7, 2007

MBITA, Kenya -- Family gatherings for Collins Omondi once were boisterous affairs here on the verdant shores of Lake Victoria. But in just 11 years, AIDS has killed seven of his uncles, six aunts, five cousins and both his parents. His extended family now consists of one surviving uncle, an aunt and their 2-year-old child -- all of whom have AIDS.

Omondi, 28, a tall, broad-shouldered fish trader, has come to believe that a quirk of culture contributed to the decimation of his family. They were Luos, members of the only major tribe in Kenya that does not routinely circumcise boys. The absence of this ritual, Omondi said, helps explain why Luos are dying from AIDS at a rate unheard of among other Kenyans and rare in East Africa.

Twenty years after the first reports of a connection between HIV rates and circumcision, scientists are saying it is essential to understanding the path of the disease through Africa and possibly to reversing its course. President Bush's $15 billion anti-AIDS program is pledging millions of dollars to Kenya and other countries so they can offer circumcision services in communities long defined, in part, by their reluctance to perform the procedure.

The unprecedented effort already has provoked a backlash from the Council of Luo Tribal Elders, which decided last year to officially oppose it. But along the beaches of Lake Victoria, where fishermen push their colorful sailboats into the waves before dawn each day, many express a willingness to leave this tradition behind if it means surviving an epidemic that seems to have no end.

"We are the people who are sick," said Omondi, who recalled the haunting feeling of walking through his father's empty home on a nearby beach. "We are the ones who lose people every day."

Most African tribes traditionally circumcise boys in rituals marking the onset of manhood. But the Luos and some other Nilotic tribes, whose ancestors migrated south from Sudan, used to mark the end of childhood in a different but also painful way -- removing six bottom front teeth.

AIDS emanated from the jungles of Cameroon or Gabon but hit massive epidemic levels after reaching the uncircumcised tribes around Lake Victoria and, later, southern African tribes that had abandoned their own traditional circumcision rites. These differences help explain why West Africa, where circumcision is routine, has HIV rates much lower than in southern or East Africa. Within Kenya, roughly one in 17 adults has HIV. Yet among Luo adults, the virus has infected one in five.

Scientists say the cells in a man's foreskin are unusually easy for HIV to penetrate. Removing it through circumcision also makes the skin on the penis head grow thicker and more resistant to infection. Trials in Kenya, Uganda and South Africa have shown that circumcised men are 60 percent less likely to contract HIV. The World Health Organization endorsed it as a key prevention strategy in March.

"It's now the most proven, effective HIV prevention strategy we have for male heterosexuals, so it's really important that we make this widely available," said Robert C. Bailey, an epidemiologist at the University of Illinois at Chicago who oversaw the Kenyan trial in nearby Kisumu.

Bailey has calculated that a well-run program could lower the HIV rate among Luo men from 18 percent to 8 percent over 20 years, averting tens of thousands of infections. Women would also be less vulnerable to HIV because of the decreasing infection rates of their sexual partners. Across Africa, widespread circumcision programs could save 5.7 million lives -- far more than any prevention strategy yet tried, U.N. officials have estimated.

Several countries, including Zambia and Swaziland, are exploring how to expand circumcision services, but none is further along than Kenya. Peter Cherutich, a top health official overseeing the issue, said a policy on making circumcision "available in a safe and voluntary manner" probably will be completed in the next month or two.

Officials for the Bill and Melinda Gates Foundation have expressed interest in helping expand circumcision services in Africa but said no final decisions have been made. Several Kenyan health experts said a multimillion-dollar grant from the foundation supporting the effort is expected to be announced soon after Kenya's policy is adopted. The U.S. contribution, worth $5 million to Kenya this year, also is due after the government policy is released.

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