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Reuters
Fri Feb 24, 2006 08:36 AM ET
By Rebecca Harrison
MBABANE (Reuters) - 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.
MIXED MESSAGES?
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."
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