Aids and male circumcision

Circumcision reduces a man's chance of becoming infected with the virus by up to 60%.

It was careful science - starting with a scientific hypothesis, following it up with observations in the field and ending with clinical trials - which proved that circumcision protects against infection. Indeed, amid the gloom about microbicides and vaccines, circumcision is the one bright spot in the field of AIDS prevention. Most forms of prevention have to be pushed on to people. But there are already parts of Africa, including South Africa, Swaziland and Zambia, where men are queuing up to have their foreskins cut off. The scientific basis of all this is that foreskin tissue is rich in a particular sort of cell that HIV likes very much. The field observation is that, within Africa, one of the two best predictors of the intensity of the epidemic in any given place is the prevalence of circumcision. The clinical trials suggest that circumcision by itself reduces a man’s chance of becoming infected by 50-60%. The upshot, according to Brian Williams of the World Health Organisation, is that if, in some ideal world, every sexually active man in sub-Saharan Africa were circumcised, 2m new infections would be avoided over the course of ten years, and 300,000 deaths prevented.

The demand for circumcision seems to have caught everybody off guard. Some surprising people disapprove of the whole idea. Yoweri Museveni, the president of Uganda, who is normally at the forefront of the anti-AIDS movement, has spoken out against it on the grounds that it might encourage men to become more promiscuous (although that does not seem to have been true of participants in clinical trials). And members of some groups who traditionally circumcise boys or teenagers as a mark of group membership seem equivocal about the idea of outsiders adopting the practice. But the main constraint is the lack of enough people trained to wield the knife cleanly and safely. Indeed, Tachi Yamada, the head of the Gates Foundation’s Global Health Programme, suggests bringing in volunteers from the rich world on a temporary basis, to clear the backlog.

Extract from The Economist's report on the XVIIth International Aids Conference held in Mexico, August, 2008