Circumcision makes comeback in AIDS – hit Swaziland

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.


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.


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.”

– Reuters


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