Facing the Knife No Longer Egoistic, Male Circumcision Fights HIV/Aids in Africa

To most African communities, facing the knife is akin to being a “real man”. Male circumcision is an important rite of passage that moves the young man that undergoes it a notch higher towards marriage and earns him a respectable position in society. But to a few African tribes, like the Zulu warrior nation in South Africa and the Luo in Kenya, male circumcision is not in the books. But this may soon change.

Recent extensive medical research and studies on the prevalence of HIV/Aids in Africa indicate that male circumcision could help reduce the spread of the disease on the continent and elsewhere. A massive roll out of free male circumcision programs in Swaziland, Rwanda, Zambia and Kenya is underway and experts hope results will reflect the 60% reduction in new infection rates documented in the studies.

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Circumcision is the surgical removal of part or the entire foreskin that covers the tip of the penis. Male circumcisions are traditionally carried out for a number of reasons - social, cultural, religious (mainly for Muslims and Jewish communities). Medical reasons may now compel most males worldwide to go for the knife.

In the US, the National Health and Nutrition Examination Surveys (NHANES) found that between 1999 and 2004, 79% of men reported being circumcised, including 88% of non-Hispanic white men, 73% of non-Hispanic black men, 42% of Mexican American men, and 50% of men of other races/ ethnicities. These figures showed a remarkable reduction on the rate of circumcision in recent years, from about 85% of all newborn males in the 1970s.

Reports indicate that a study in Kenya prompted the World Health Organization (WHO) to include circumcision in its prevention policies a year ago, and which compelled the Kenyan government to form a task force to promote voluntary, medically safe operations.

The trial in Kisumu, Kenya, of 2,784 HIV-negative men showed a 53 percent reduction of HIV acquisition in circumcised men relative to uncircumcised men, while a trial of 4,996 HIV-negative men in Rakai, Uganda, showed that HIV acquisition was reduced by 48 percent in circumcised men.

“Many studies have suggested that male circumcision plays a role in protecting against HIV acquisition, we now have confirmation—from large, carefully controlled, randomized clinical trials—showing definitively that medically performed circumcision can significantly lower the risk of adult males contracting HIV through heterosexual intercourse. While the initial benefit will be fewer HIV infections in men, ultimately adult male circumcision could lead to fewer infections in women in those areas of the world where HIV is spread primarily through heterosexual intercourse,” noted US National Institute of Allergy and Infectious Diseases (NIAID) Director Anthony S. Fauci, M.D.

Male Circumcision Considerations for the United States
A Centers for Disease Control (CDC) document, Male Circumcision and Risk for HIV Transmission: Implications for the United States, says: A number of important differences from sub-Saharan African settings where the three male circumcision trials were conducted must be considered in determining the possible role for male circumcision in HIV prevention in the United States. Notably, the overall risk of HIV infection is considerably lower in the United States, changing risk-benefit and cost-effectiveness considerations.

Also, studies to date have demonstrated efficacy only for penile-vaginal sex, the predominant mode of HIV transmission in Africa, whereas the predominant mode of sexual HIV transmission in the United States is by penile-anal sex among MSM. There are as yet no convincing data to help determine whether male circumcision will have any effect on HIV risk for men who engage in anal sex with either a female or male partner, as either the insertive or receptive partner. Receptive anal sex is associated with a substantially greater risk of HIV acquisition than is insertive anal sex.

But the African roll out programs may face cultural and traditional setbacks as acceptability of male circumcision will be an important factor that cannot be ignored. The Meru tribe in Kenya for instance differentiates between circumcisions in a modern hospital environment with the traditional communal knife by special “cut surgeons”.

The traditional one is of course more painful as it is done under no local anesthesia and also less hygienic as the knife is always shared among the candidates in a pompous, beer fest cutting ceremony. A “real” Meru man is one who has undergone the traditional cut.

Image Credit: Babasteve at Flickr under a Creative Commons license

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