July 28, 2009, Updated September 14, 2012

With its vast experience in male circumcision, Israel is leading the training of African doctors in a procedure that could cut the risk of contracting HIV by as much as 65 percent.

It’s a Jewish tradition that started during the time of the Bible, with Abraham. On the eighth day of his life, a newborn Jewish male enters into a covenant or brit with God. A mohel, a man trained for the task, skillfully removes the baby’s foreskin. Then the celebrations begin.

The origins of the ritual may be connected to its health benefits. Modern medical practitioners recommend circumcisions for male babies in the US because those who have undergone the procedure have fewer infections. More recently, professionals fighting HIV-AIDS have understood that if penises are circumcised, the infection rates and spread of the deadly virus can be reduced.

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.

And according to the United Nations, universal male circumcision in sub-Saharan Africa could help prevent about 5.7 million new infections and three million deaths over a span of 20 years.

In a historic first, three doctors from the Muslim community in Senegal came to Israel to learn from the experts how to perform circumcisions. Two health advisors who accompanied them will assist the surgeons in Senegal. The aim is to spread the important message and recruit adult male patients to be circumcised back in Africa, in an effort to prevent the spread of AIDS.

While the custom exists among Muslims, and 13-year-old Muslim males are sometimes circumcised, the practice is not as widespread as it is among Jews, and it is certainly not undergone by Muslims in all the African countries, Dr. Yaron Minz, who heads a unit at the Israel Center for Medical Simulation (MSR) tells ISRAEL21c.

World experts in adult male circumcisions

MSR, a center that provides simulation training for surgical procedures, is a partner in the new training program.

Israel, says Minz, is particularly skilled at performing adult male circumcisions. In recent decades, there was a demand for mass circumcisions from adult male immigrants to the country from Russia and Ethiopia. For whatever reasons, the practice wasn’t followed in their home countries, but upon arriving in their homeland, the new immigrants opted for the surgery.

A few years ago, teams of Israeli surgeons traveled to Swaziland where they trained 10 Swazi doctors and backup staff to perform the operation quickly and safely with limited resources.

It was after this trip that the idea to bring the local doctors from Africa to Israel for training was born. In a hoped-for cascade effect, the doctors from Senegal should return home and teach their newly acquired skills to their colleagues.

In Israel, those cooperating on the project include the Jerusalem AIDS Project, the Chaim Sheba Medical Center at Tel Hashomer Hospital, Hadassah Hospital in Jerusalem, MSR and the Israel Urological Association.

“The idea behind this project is to train the trainers,” says Minz, who accompanied the guests from Senegal as they toured Israeli hospitals for a week to learn the procedure. Their training included attendance at Jewish brit mila celebrations where they could observe professional mohels at work, he tells ISRAEL21c.

Training the trainers

Of all the sub-Saharan African countries, Senegal has the lowest HIV rates, since more than 95% of males are circumcised. These circumcisions are performed under Islamic law. It made sense for Israeli doctors to offer their training to a country where the practice is already accepted.

Another reason for choosing Senegal is that it has become a model of AIDS prevention for the surrounding countries, where HIV rates climb as high as 40 percent. The aim is to provide the Senegalese doctors with the tools to share their expertise with other African nations.

Hard at work on agreements and protocols for this world’s first pilot project, Minz explains that “the next stage is to take younger doctors to go again through a course using [artificial] models.” At the unique medical simulation center where Minz works, surgeons can practice the “clamp” method of circumcision, before trying it out on real patients with local anesthesia.

“We don’t want a surgeon to do it for the first time on a patient. What we want is to train people outside the operating room and to go into aspects of the clinical procedure,” he explains.

Learning the skill of circumcision is only one part of the story, says Minz. The Senegal visitors are also learning the art of communication so they will be able to explain the benefits of circumcision from a health point of view and “sell” the procedure to a community of people – possibly the entire African continent – to help persuade them to agree to it.

AIDS cases can be reduced by 65 percent

The plan is to give doctors in Senegal a “boost,” Minz smiles. Eventually he’d like to see doctors from around the world going to Africa to assist in the procedure. “It’s not like there will be five cases a week. We are working on the masses trying to produce thousands of circumcisions a month.”

“We will start with Senegal and hopefully hook interest from other countries in doing the same thing. I don’t think the relation to, or the origin of faith or religion is the main issue here. It’s AIDS. It’s not only for Muslims or Christians, but a procedure to try and reduce AIDS transmission and dissemination,” says Minz.

According to information from the Chaim Sheba Medical Center, adult male circumcision can reduce the risk of male HIV acquisition heterosexually by 65%. Major international health agencies have issued direct recommendations to at risk countries in Africa for the scaling up of male circumcision efforts to prevent HIV infection.

Minz stresses that the project is not motivated by religious reasons. The Muslim community in Senegal expressed its desire to learn this procedure from Israel, but, he says, its benefits will protect people of all faiths in Africa, be they Muslims, Christians, Zulus or non-believers.

The funding of the Senegal doctors was made possible through private donations and donations from the participating bodies. For information about volunteering in Africa or making financial donations contact the Jerusalem AIDS Project.

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Jason Harris

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