JOHANNESBURG - South Africa remains plagued by AIDS despite massive government and NGO efforts on prevention and life-sustaining Anti-Retro-Viral programs.

The country has the highest number of new HIV infection worldwide and 15 to 20 percent of the adult population is HIV positive. But it has opened up another front to reduce new HIV infections: promoting circumcision.

Each day, dozens of men pass through the doors of this circumcision clinic in southern Johannesburg. But before any surgery, all patients attend a counseling session to be briefed on the protective impact of circumcision.

Abel, 17 years old, came with his brother.

“My mother said I must come, for safety. They say it protects from AIDS,” Abel said.

It does, to a certain extent. Studies show that male circumcision reduces the risk of contracting HIV. Yet the clinic’s medical staff counsels these men to also use condoms.

Clinical trials

The protective effect of circumcision was confirmed through clinical trials about 10 years ago, prompting the World Health Organization and local governments to launch massive circumcision programs in 14 priority countries in Africa, which represent 50 percent of all AIDS cases.

After counseling at the clinic, men are offered an HIV test because UNAIDS estimates more than half the people living with HIV are not aware of their status.

The next step is the surgery, which lasts 5 to 7 minutes and is pain free, said general practitioner Dumisani Mhlambi.

"All they are scared of, all they are thinking of, is pain: Is there gonna be pain inflicted more than anything else," Mhlambi said, adding that most surgeries are pain free.

The Bophelo Pele clinic in Orange Farm was the first circumcision center to open in South Africa in 2007.

Awareness campaigns seem to be working in this neighborhood, where more than 80 percent of men are circumcised, compared with less than 20 percent seven years ago. Dozens of other centers have since opened across the country.

Male nurse Mandisi Mfazwe said social norms have shifted over the years.

“It has now become a norm in Orange Farm. Now if you're not circumcised, some guys will laugh at you. So people come also because of peer pressure. Not only because of the HIV/AIDS reason, but it is beneficial for them at the end of the day,” Mfazwe said.

Impact of circumcisions studied

CHAPS, the Center for HIV and AIDS Prevention Studies, which manages the clinics, continues to study the impact of circumcisions.

CEO Dirk Taljaard said new data suggests circumcision benefits women, too.

"We saw a protective effect for women. If you had women in the community that have only had circumcised partners, the risk was reduced already by 20 percent for 15- to 25-years-old women,” Taljaard said.

Some studies estimate that, in South Africa, for every four circumcisions, one HIV infection is avoided. Since 2007, more than 1.5 million circumcisions have been performed in the country, suggesting close to 400,000 new infections may have been avoided.