Many health activists back male circumcision -- saying it could reduce the infection rate by almost two-thirds in Africa. But some say it provides a false sense of security, and does nothing to stem the behaviour that spreads the disease. Danstan Kaunda has more in this report from Lusaka, Zambia.
Two UN agencies, the World Health Organisation and UN/AIDS, recommend male circumcision in regions like southen Africa where a tradition of multiple partners is helping the spread of HIV and AIDS.
Kampala-based urologist Dr Kasonde Bowa explains the science behind his support for the practice. He notes that in an uncircumcized man, the foreskin of the penis is very thin, and an easy entry point for the virus during intercourse." But once a person is circumcised," he said, "it is like developing a wall, a barrier. " He said the thicker skin also reduces the chance of contracting other infections as well.
According to recent findings, uncircumcised men are more than twice as likely to be infected as circumcised men -- though there is no evidence yet as to whether circumcision has any impact on the risk of infection for their partners..
In Zambia, many men agree to be circumcised if it free, and done safely. This is a challenge due to a shortage of surgeons and urologists.
In Kampala, the main public health institution, the University Teaching Hospital, has began offering the service. More than 400 men have requested the procedure -- far more than can be accomodated. Professor Kumar Baboo is a public health specialist there. He said there's a human resource crisis in the country, due to the brain drain of skilled health workers to other countries.
Some activists disagree with the emphasis put on male circumcision. They say the focus should be on changing the behavior of youths. They note that in much of the so-called AIDS belt that cuts across southern Africa, there is a tradition of multiple sexual partners – an issue that increases the likelihood of infection.
Professor Nkandu Luo, a renowned HIV/AIDS consultant in Lusaka, said though the trend now is to promote circumcision, "go to the compounds (townships) and see what happens there. Every other house is [bar], every other house is a beer-hall. Young people as young as nine years of age are (there) dancing while others are having sex. And so, what [good is circumcision]?"
But those who support circumcision say the practice should be added to the arsenal of other HIV interventions like the use of condoms, abstinence campaign massages, and the distribution of anti-retroviral drugs to pregnant women.
Already, circumcision is often coupled with counselling in order to prevent people from developing a false sense of security.
Sub-Sahara Africa has the highest rate in the world of HIV and AIDS. Over 70 percent of adult men acquired HIV/AIDS infection through vaginal intercourse.