The Swazi chief in the center, surrounded by her family and, on the far right, our friend Sonny
I was intrigued by a story I saw in Science News recently about circumcision and its effect on HIV. Africa has been impacted by HIV more than any other continent. In 2007 and 2009, my husband and I were in South Africa and Swaziland, two of the hardest hit countries. We had the priviledge of visiting the chief of a rural village in Swaziland. We were welcomed into her family's small round hut with its earthen floor, along with our friend Sonny who lives and works nearby. I asked the chief, with Sonny as translator, how Swazi life had changed during her lifetime (the chief was an older woman). She wouldn't say much, except how the younger generation won't eat traditional foods any more, wanting junk food instead. But as we were leaving, she stopped us outdoors and asked us to pray for her village. She asked us to pray that someone will find a solution to HIV, which is devastating her village and her country. The sad look of hopelessness on her face haunted me as I read the Science News article last week.
In Swaziland, 22% of adults are infected with HIV. Life expectancy used to be 57 years; now it's 31 years. In the year 2007 alone, 10,000 Swazis died of AIDS. The country has 56,000 AIDS orphans. And so on....you get the picture. In South Africa, the impact of AIDS has been so great that the country's population has stopped the rapid expansion characteristic of most African countries. Life expectancy in 1995 was 64; in 2005 it was 49. See International Data Base (IDB) for more population data.
So what's being done? As far as research, some big strides have been made, and some of that research has to do with protection offered by circumcision.
In humans, the three most common sexually-transmitted viral diseases are HIV, genital herpes, and HPV (human papillomavirus). All three are incurable.
But all three are are less likely to be transmitted when a male is circumcised.
Earlier studies have shown that male circumcision reduces the risk of acquiring HIV by up to 60%.
Another article, published this year in the New England Journal of Medicine, reports that circumcision also provides partial protection against both genital herpes and HPV. This study, funded by Bill & Melinda Gates and the NIAID, involved 3,393 Ugandan males ranging in age from 15 to 49, all of whom wanted to be circumcised and none of whom had herpes. Half the males were circumcised right away, and half had the procedure deferred for two years. After the two years, the earlier-circumcised volunteers were 1/4 less likely to have genital herpes and 1/3 less likely to have a dangerous form of HPV. Because circumcision provided only partial protection, the researchers cautioned that it "should not be considered a full shield."
Even so, the partial protection could have a major public health benefit, says the director of the National Institute of Allergy and Infections Diseases, Dr. Anthony Fauci. Human herpes ulcers make a man more vulnerable to HIV infection. Dr. Fauci says that circumcision not only reduces the incidence of HIV infection outright, but by protecting against genital herpes, circumcision increases the protection against HIV infection. This is a significant finding: in Kenya, where 4/5 of the people infected with HIV are also infected with genital herpes, says Dr. Robert Bailey of the University of Illinois at Chicago.
Although much of the research centers on protection of men, women benefit too. Yet another study in South Africa reports that circumcised men are 1/3 less likely to have a dangerous form of HPV that can cause cervical cancer when transmitted to female partners.
A research team in Kenya is nearing publication of their study of circumcision's effect on STDs. One scientist in the research team has said the results show similar effects to the already published studies.
An Overwhelming Game Changer
Says Dr. Judith Wasserheit of the University of Washington, "I think this trio of trials is certainly a landmark in prevention, not only of HIV but of these other sexually transmited infections. These new data really are a game changer."
Dr. Thomas Quinn of Johns Hopkins University says that the medical evidence of long-term benefits to male circumcision "is now overwhelming."
Good News, But Is It Being Used?
Unfortunately, this information is so far having little effect on the transmission of these diseases in Africa. According to www.avert.org, an international AIDS nonprofit, "only one clinic in South Africa currently offers free male circumcisions, with public facilities only offering the service for medical reasons. The government is reviewing evidence on circumcision, but has yet to issue further guidance on the practice."
One hindrance toward progress in South Africa is the amazing quantity of misinformation among the general public about the transmission of HIV. While in Johannesburg, we read an editorial in the city's major newpaper about the common folklore regarding how a man can determine whether he has HIV or not. If he has sex with a virgin and she does not become infected, then he can assume he is uninfected himself. If he has sex with a virgin, and she does become infected, then she must be a witch. I hate to relay such nonsense about a country I love passionately, but every country has its own damaging dogma. My sympathy in this situation lies with the young girl who's used as meaningless litmus paper, and perhaps paying with her life.
Some of the schools we visited in South Africa showed us herb gardens where they're growing herbs to prevent or treat HIV. Beet root has been a well-known "cure" in the country for years, even promoted as such by the government in earlier years. I'm not aware that any herbs or plants offer protection against this disease.
My hope is that Bill & Melinda Gates or NIAID will invest some of their billions into building free circumcision clinics and distributing information about real-life diagnosis and protection - as well as promoting development and distribution of the promising new vaccine, which appears to offer protection to 1/3 of those who receive it (see NY Times article cited below).
And if you're wondering whether to circumcise your own newborn son, it appears that doing so could offer him some protection against some STDs. Although condoms could most likely provide a higher degree of protection, without the cutting that some object to.
1. Nathan Seppa. "Many benefits to circumcision: Operation in males fends off three common viral STDs." Science News, April 25, 2009.
2. Nathan Seppa "Defense Mechanism: Circumcision averts some HIV infections." Science News, October 29, 2005.
3. Aaron, A.L. et al. "Male Circumcision for the Prevention of HSV-2 nad HPV Infections and Syphilis." New England Journal of Medicine, March 26, 2009.
4. Averting HIV and AIDS. "HIV and AIDS in South Africa." http://www.avert.org/aidssouthafrica.htm
5. Donald G. McNeil Jr. "For First Time, AIDS Vaccine Shows Some Success," New York Times, Sept. 24, 2009. http://www.nytimes.com/2009/09/25/health/research/25aids.html
6. International Data Base. http://www.census.gov
Key words:: circumcision HIV AIDS Africa Swaziland STDs