Circumcision makes comeback in AIDS-hit Swaziland
REUTERS: 24.02.2006
By Rebecca Harrison
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It's not every day that hordes of men fight to forego their foreskins --
especially not in a country where circumcision was banned by a 19th century
king.

But in the tiny African kingdom of Swaziland, circumcision is making a comeback
after research showed the age-old rite may help stop the spread of HIV.
Volunteers eager for the snip almost rioted at an overbooked clinic in the
capital last month.

"There was a stampede," said Dr. Mark Mills, administrator at the
Mbabane Clinic. "There is not a family in Swaziland unaffected by HIV
and people are desperate ... In some countries you have food riots, we nearly
had a circumcision riot."

Swaziland has the world's highest rate of HIV, with around 40 percent of the
adult population believed to be infected with the virus that causes AIDS.
Analysts say the pandemic could threaten the existence of this nation of 1
million people.

The reasons are complex: many Swazis work in mines in AIDS-ravaged
neighbouring South Africa and polygamy is common. But new studies show
circumcision could also play a part.

Circumcision, practised by Jews and Muslims, is common in many African countries
either as part of rite-of-passage ceremonies, or in Muslim communities mostly in
West Africa.

Swaziland's King Mswati II banned it in the late 1800s because young men
recovering from the surgery were distracted from waging war. The
country, wedged between South Africa and Mozambique, has one of the
world's lowest circumcision rates.

Researchers have noted links between high rates of HIV and low rates of male
circumcision since the 1980s, but last year the first controlled study in South
Africa found circumcised men were around 60 percent less likely to contract HIV.

Circumcision's benefits may stem from the fact that the foreskin has
cells that the virus seems able to easily infect.

The study by French and South African researchers was published in the Public
Library of Science Medicine journal -- and its findings filtered down to Swazis
through newspapers, talk shows and politicians.

MOTHERS PROTECT SONS

The response -- which has nothing to do with religion and everything to do with
health -- has been huge as deeply traditional Swazis discard their cultural
heritage in droves.

Mbabane Clinic, a private hospital, is performing some 10 circumcisions a week
compared to less than one a month prior to the study. The Family Life
Association of Swaziland (FLAS) has two new doctors working full-time to keep up
with waiting lists.

In Swaziland, where the majority of people are Christian although
indigenous beliefs are often incorporated into their faith, mothers are a key
driving force behind the new trend.

Phindile Maseko, a nurse at Mbabane clinic, fears for her 13-year-old
son's future and will do all she can to protect him.

"I decided he needed to do it for safety and for the future. Children
are so naughty these days -- they start doing these things so young and then
they get sick," she told Reuters at her home in Mbabane. "I want to protect him
from all this HIV mess."

Her son Matshidiso said he was initially terrified but that staying
alive was more important than upholding Swazi norms.

"HIV doesn't come from Swaziland so maybe you need to protect yourself with
something that doesn't come from Swaziland," he told Reuters a week after the
operation.

The United Nations is waiting for more studies before making male
circumcision part of its fight against HIV, but the U.N. Children's Fund and
other health officials in Swaziland are already promoting it.

"In countries in crisis ... we need to put the information out there," said Alan
Brody, country director for UNICEF.

MIXED MESSAGES?

Male circumcision is common in the United States and other countries for
religious and cultural reasons and to help prevent urinary tract
infections and sexually transmitted diseases.

But some health officials in Swaziland worry men could start to think
that removing the foreskin is like wearing a "permanent condom,"
destroying the impact of years of safe sex education.

"I am worried about sending mixed messages," said Janet Khumalo, a
counsellor at the FLAS clinic.

Her fears are not unfounded. The South African study showed circumcised men
registered a slightly higher level of sexual behavior immediately after the
operation, although many health officials say the benefits still outweigh the
risks.

FLAS hopes the new trend will push men, usually slow to use reproductive health
services, to come in and talk about safe sex, enabling the promotion of other
services like condoms.

Mills said there was a risk untrained practitioners might start
performing operations on the cheap. Scores of men are killed in South
Africa every year in traditional ceremonies.

But he hopes that if further studies confirm the South African research, donors
will help countries like Swaziland circumcise all male babies and as many young
men as are willing.

"This could be the cheapest and one of the most effective interventions so far
in the fight against HIV," he said.

In some cases, persuading men to give up their foreskins seems to be
easier than getting them to wear a condom and health officials are not sure why,
beyond the obvious fact that circumcision is a one-off event, unlike wearing a
condom.

Recently circumcised Titus Shabangu, a 36-year-old driver in playboy
sunglasses and a smart shirt, had his own theory.

"Swazi men have heard that it is a good thing and when you play with you partner
the sex is good," he told Reuters. "That is why they come."

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[*Thanks to Marge Berer for alerting the forum to this report.]