Health & Beauty | August 2008
|In Fight Against AIDS, Agencies Consider Male Circumcision|
Ioan Grillo - Catholic News Service
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Mexico City - When French scientist Bertran Auvert was studying male circumcision in South Africa, he made a curious discovery: About 85 percent of the young men who believed they had been circumcised in tribal rituals were not. They just had just gone through painful ceremonies.
|Male circumcision is one of the worlds oldest surgical practices; carvings depicting circumcisions have been found in ancient Egyptian temples dating as far back as 2300 BC.|
However, after he offered the young men real circumcision, he made a second find, with much wider implications. The circumcised men were 60 percent less likely to contract HIV when having sex with women. While some scientists had speculated about such an effect, it had never been proven, and the results were one of the most important medical breakthroughs since the AIDS epidemic first exploded in the 1980s.
The so-called Orange Farm trials of 2005 have since been confirmed in three more tests across Africa, causing some of the biggest buzz at the XVII International AIDS Conference in Mexico City Aug. 3-8. Scientists, government officials and aid workers were all discussing how effective a campaign of mass male circumcision in Africa would be in curbing the epidemic.
Catholic aid workers were also examining how much they should become involved with such a drive. The U.S. bishops' Catholic Relief Services, one of the leading agencies in HIV treatment worldwide, has drawn up a policy position that circumcision is a reasonable prevention method when combined with other measures. However, their workers are still cautious about collaborating in what could be one of biggest campaigns of mass surgery in medical history.
"We are still learning about circumcision and how much we should focus on it," said Dr. Carl Stecker, senior technical adviser for HIV and AIDS for Catholic Relief Services. "The evidence is overwhelming that it reduces the risk of HIV infection. And we have examined theological texts and found no opposition to it. But we are a little unsure how the church would react to such a huge campaign."
One concern is that an emphasis on circumcision could take away from the church's traditional position on changing sexual behavior. Church officials say their messages of sexual abstinence and faithfulness in marriage have significantly helped to fight HIV in countries such as Uganda, where infection rates have decreased dramatically since the 1990s. The worry is that focusing on circumcision could make people feel that they have become vaccinated against the disease and ignore safer sexual practices.
"We have to make sure people understand that this is no magic bullet. Abstinence and faithfulness are still the only sure ways to protect against this virus," said U.S. Msgr. Robert J. Vitillo, the Geneva-based special adviser for HIV and AIDS for Caritas Internationalis, an umbrella agency for Catholic aid groups.
However, scientists working with the United Nations on the issue say there is no evidence that circumcision would lead to more dangerous sexual practices. Studies they have conducted show that a program of mass circumcision in Africa would lower HIV rates even if there were a subsequent reduced use of condoms.
"I don't see any reason that people should throw away their condoms if they were circumcised," said Dr. Nicolai Lohse of UNAIDS, the U.N. agency that coordinates the global campaign against AIDS. "But the evidence is that HIV infections would drop sharply whatever they did."
UNAIDS has concluded that male circumcision - at the estimated price of about $51 per patient - would be a cost-effective way to fight AIDS.
A second concern is how male circumcision would fit in with the other messages that Christians have spread in Africa over the centuries. Some early missionaries discouraged the tribal traditions of circumcision as a pagan practice. Later, when Christians rallied against female genital mutilation, they used the argument that people should leave the body the way God made it.
"It can be difficult to get the message to some tribes that they should abandon their practice of circumcising females but they should start a new practice of circumcising males," said Sylvester Tuach, who runs a hostel for children with HIV in southern Sudan.
Furthermore, in some communities, circumcision is a sign of identity, marking whether men are Christians or Muslims. The Muslim communities generally have lower HIV infection rates, which has been attributed to circumcision as well as safer sexual practices, but some Christian men could be resistant to undertaking something that breaks with their tradition.
A campaign would also have to overcome some fears that circumcision could damage men's sexual prowess. This argument has been disqualified in several studies, such as one presented at the AIDS conference by John Krieger of the University of Washington.
However, the greatest concerns about male circumcision have not come from inside the church but from secular activists who have formed the International Coalition for Genital Integrity. Calling the issue "a dangerous distraction" in the fight against HIV, the group questions the studies that circumcision reduces HIV infections, claiming the issue is more complicated. It also argues that coercing adults to be circumcised is unethical.
"The church is opposed to condoms so circumcision is appealing," said coalition activist Georganne Chapin. "But cutting off people's body parts is a far worse tactic."
Such arguments hold little sway with aid workers in the field who see the devastation caused by HIV.
Doris Odera, director of the Catholic Medical Mission Board for Kenya, said she has been working with male circumcision for some time and people are very open to the practice.
"We have to use all the weapons at our disposal," Odera said. "If there is a chance that circumcision will stop this virus destroying someone's life, then it needs to be available."