Swaziland men pick circumcision

HIV infection threat increases popularity of male procedure


MBABANE, Swaziland -- Slipping into a green hospital gown in the waiting room, Sipo Mnisi acknowledged he was "a bit nervous."

But the 31-year-old businessman, who had been waiting months for an appointment, said he was nonetheless eager to take part in the hottest medical trend in Swaziland: male circumcision.

New studies suggest that circumcised men are 60 percent to 75 percent less likely to contract the virus that causes AIDS through sexual contact. In Swaziland, a deeply traditional nation with the world's highest rate of sexually transmitted HIV infection and one of the lowest rates of circumcision, that is prompting a medical revolution.

In January, when a health advocacy group advertised a one-day free circumcision clinic, stunned doctors had to hand out circumcision rain checks to pacify the shoving, yelling crowd. "It was almost a lynch mob," said Dr. Mark Mills, the hospital's administrator.

For Swaziland, a tiny southern African kingdom tucked between South Africa and Mozambique, circumcision has been a rarity since the mid-1800s, when then-King Mswati II banned it as an impediment to war.

Young men at the time customarily were circumcised before going into battle, but the monthlong recovery was hampering the kingdom's wars to acquire territory, so the practice was ended, said Brig. Gideon Dube, Swaziland's royal historian.

Today, however, Swaziland is fighting a new war, against HIV, which infects about one in three adults and 42 percent of pregnant women. And studies, including one in neighboring South Africa, suggest that male circumcision could be one of the more effective ways to reduce the spread of HIV in Africa.

Doctors and AIDS activists in the region have for years been preaching the benefits of abstinence and faithfulness to a single partner, but with limited effect in countries such as Swaziland, where polygamy remains popular and men often work for months at a time in cities far from their wives.

Condoms, if used in every sexual encounter, have an 80 percent to 90 percent effectiveness rate, researchers say. But the reality in many African countries, where HIV is often passed among married couples or regular sexual partners, is that "nobody uses a condom every time," said one AIDS researcher in Mbabane.

Scientists theorize that circumcision has a protective effect - at least for circumcised men - because the foreskin, which is removed, harbors cells that easily absorb the HIV virus and has an inner mucus lining that can be prone to tears.

Scientists say circumcision might explain some of the discrepancies in HIV infection rates that have been a puzzle in Africa for years. Cameroon, for instance, with fairly high rates of what AIDS researchers term risky sexual behaviors - multiple partners, little condom use - has only a 5 percent rate of HIV infection, while Botswana, which has the highest rate of condom use in Africa, has a 25 percent infection rate. Nearly everyone in Cameroon is circumcised, and nearly everyone in Botswana is not.

Doctors worry that lower vulnerability to HIV could cause circumcised men to feel safe and have riskier sex, leading to a continued spread of the disease.

Laurie Goering writes for the Chicago Tribune.

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