Israeli surgeons and Swazi doctors are working together to curb the world’s highest HIV infection rate by increasing the number of male circumcisions. (Photo: Inon Schenker – Jerusalem Aids Project)A three-member Israeli medical delegation is in Swaziland to teach local African surgeons to perform circumcisions on men to reduce their risk of contracting AIDS, the first of three such missions to Africa. Swaziland was chosen to begin the campaign because it has a million residents, a very low male circumcision rate and among the world’s highest rates of HIV carriers (40 percent).
Last March, based on “compelling evidence,” the World Health Organization (WHO) and UNAIDS accepted expert recommendations that adult male circumcision be recognized as an “additional important intervention” to reduce the risk of HIV transmission.
A few months prior to this decision, a UNAIDS delegation came to Israel to learn how best to perform adult male circumcision, given this country’s great experience in the ritual procedure for voluntary conversion of new immigrants.
Israeli experts advised infant circumcision as well, even though it would take years until the infants reached sexual maturity.
Studies suggest that male circumcision in sub-Saharan Africa could prevent 5.7 million new cases of HIV infection and three million deaths over 20 years, or up to 60% of infected males.
The WHO said that scaling up male circumcision in such countries will result in immediate benefit to individuals. However, it will take a number of years before we can expect to see an impact on the epidemic from such investment. Currently, an estimated 665 million men, or 30% of men worldwide, are circumcised.
Nevertheless, the Israeli experts advised that counselling of men and their sexual partners was necessary to prevent them from developing a false sense of security and engaging in high-risk behaviors that could undermine the partial protection provided by male circumcision.
Dr. Inon Schenker, a Jerusalem AIDS Project public health educator, HIV/AIDS prevention specialist and head of the Israel Multi-Center Research Group on Male Circumcision, is a member of the Israeli team in Swaziland. The Jerusalem AIDS Project has received several requests for Israeli support to African countries in this area.
The two surgeons in the delegation, who will be there for two weeks, are Dr. Eitan Gross, a pediatric surgeon at Hadassah-University Medical Center in Jerusalem, and Dr. Moshe Weistreich, chief of plastic surgery at Assaf Harofeh Medical Center in Tzrifin and a Health Ministry representative in the committee that supervises ritual circumcision.
There are several biological explanations of why circumcision reduces the risk of infection. Removal of the foreskin minimizes the ability of the AIDS virus to penetrate the skin of the penis. In addition, Langerhans cells and other special immunological bodies are located on the underside of the foreskin, and these are targeted by the virus. It may also be that tiny lacerations in the inner surface of the foreskin during sex may allow easier entry for HIV.
The two surgeons will perform a few hundred circumcisions on Swazi men and teach 15 local surgeons. Schenker will educate public health personnel on the link between circumcisions and lower rates of HIV infection. The campaign is supported by a grant from the Hadassah Medical Organization, by private donations and by Tuttnauer, leaders in sterilization and infection control.