Israeli Surgeons Helping Swaziland in Drive to Curb HIV

Israeli surgeons and Swazi doctors are working together to curb the world's highest HIV infection rate by increasing the number of male circumcisions.
Israeli surgeons and Swazi doctors are working together to curb the world's highest HIV infection rate by increasing the number of male circumcisions. (By Inon Schenker -- Jerusalem Aids Project)
By Craig Timberg
Washington Post Foreign Service
Sunday, October 21, 2007

MBABANE, Swaziland -- The young men seated in a cramped waiting room in Swaziland's capital twitched with nerves. Feet tapped. Fingers drummed. The occasional brave joke was delivered with a smirk.

Beyond a wooden door a few feet away, two Israeli doctors donned blue hospital scrubs adorned with faded Hebrew script. Stepping into a modest room where only a dangling sheet separated the operating tables, they prepared to perform the world's oldest surgery.

So began Day 10 of an uncommon experiment in international assistance. Small teams of Israeli surgeons have begun circumcising Swazi men, deploying an ancient ritual in hopes of curbing the terrible modern malady of AIDS.

A series of studies have shown that circumcised men are at least 60 percent less likely to contract HIV. Far less clear is how meager public health systems already overwhelmed by the AIDS epidemic can offer the procedure widely enough to slow the epidemic's ruinous spread.

"For us the major constraint is surgeons, doctors," said Dudu P. Simelane, executive director of the Family Life Association of Swaziland, a nongovernmental group hosting the Israelis.

Medical experts in Swaziland, which has fewer than 100 doctors and the world's highest rate of HIV infection, say that over the next five years, they would like to offer the procedure to all 200,000 of this tiny southern African nation's sexually active men, at a rate of roughly 200 a day. That's 20 times faster than the current pace in this country of 1.1 million.

No country has ever attempted anything like it -- save for Israel, whose doctors circumcised 80,000 men after the fall of the Berlin Wall in 1989 brought a flood of new immigrants, mostly adults who had grown up in Soviet bloc countries that prohibited Jewish rituals.

The value of circumcision remains hotly debated in many countries, including the United States. Some activists regard it as a form of genital mutilation with no redeeming medical benefit. In African countries that have traditions of ritual circumcision, unsterile conditions and poor training sometimes cause serious complications, including the mutilation and even death of adolescent boys.

But scientists say that the foreskin has cells unusually receptive to the AIDS virus and that removing it causes the penis head to grow thicker and more resistant to sexually transmitted infections. The World Health Organization said in March that making circumcision widely available, inexpensive and safe could prevent 5.7 million HIV infections over the next 20 years.

Swazis, like several southern African ethnic groups, have abandoned their own traditional circumcision rituals, but widespread publicity of recent studies has spurred renewed interest in the procedure, in modern medical facilities.

The men waiting for the free circumcisions Friday morning said that they had friends or relatives who already had been circumcised and that, based on their advice, they wanted the easier hygiene and HIV protection offered by the procedure. One said his girlfriend had urged him to do it.

Africa Sihlongonyane, 26, said his father died of AIDS in 2004, wasting away over several months. When a friend was circumcised by the Israeli doctors last Monday, Sihlongonyane decided to do the same.

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