TORONTO (CP) - A $60 male circumcision could be the key to preventing the spread of HIV-AIDS in Africa, say experts at the International AIDS Conference.
But the half-hour operation is so laden with religious and cultural significance that many doubt it will ever be used to its full potential in the fight against the pandemic.
Studies have shown some African countries with high circumcision rates have lower rates of HIV-AIDS. Trials are underway in Africa to determine more conclusively whether the two are linked.
Kevin De Cock, director of the World Health Organization's HIV-AIDS department, said circumcision removes the foreskin which is both an easy point of entry and full of cells that are targeted by the virus.
While former U.S. president Bill Clinton has said circumcision could have a "staggering effect" on controlling HIV, De Cock said more research must be done before the WHO recommends circumcision as a prevention tool.
"It's injudicious in public health to base major recommendations on the results of one study," De Cock told a news conference at the international AIDS gathering Thursday. "If this is recommended, we must be very, very careful that this doesn't cause harm and it's done safely."
But some say even if circumcision is recommended to prevent the spread of HIV-AIDS, they have grave doubts about touting it as a silver bullet. Catherine Hankins, chief scientific adviser for UNAIDS - the United Nations' AIDS program, said circumcision may give men a false sense of security.
Men may feel they no longer have to use a condom, she said, despite the fact that circumcision doesn't appear to protect women from contracting the disease.
"It is possible that whatever gains may be made against the epidemic through male circumcision, could be wiped out by people letting down their guard," she said.
"HIV will look for any open door - any opportunity that presents itself. Male circumcision may start to close that door but it does not slam it shut."
The procedure is also laden with religious and cultural significance which could stand in the way of any widespread use to prevent HIV-AIDS. In some cultures, if you are circumcised, "you are not a man," Hankins said.
Even in the Western world, circumcision rates have been steadily declining. In Canada, the newborn circumcision rate stands at 14 per cent - down significantly from 48 per cent in 1970.
"It goes to the heart of masculinity," Hankins said.
Carolyn Williams, chief of the AIDS division with the National Institutes of Health, said many resist the operation because it is a religious rite of passage for Muslims and Jews.
"It's difficult to go to communities . . . and tell those who are not Muslim that they should look like Muslim men," she said. "It's difficult to remove (circumcision) from the cultural context in which it grew up."
Still some say it's not impossible.
Dr. Bertrand Auvert - whose 2005 study found circumcision reduced the rate of infection among heterosexual South African men by 65 per cent - said the procedure is a potentially inexpensive way to save lives.
"The cost of adult male circumcision is lower than the cost of treatment of HIV infections that could have been avoided," he said.
A previous study has shown men who were circumcised did not "engage in more risky sexual behaviour," he said. Nor are men adverse to being circumcised if they feel it is hygienic, safe and a way of avoiding HIV-AIDS, Auvert added.
"Practices can be changed," he said.
The International AIDS Conference wraps up Friday.
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[KDR: AIDS scam hits a new low.]
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