By Kurt Shillinger The Boston Globe
JOHANNESBURG - Male circumcision reduces the risk of HIV infection by at least 50 percent and may explain the vast discrepancies in the prevalence of the AIDS virus from one region to another across Africa, according to assessments of nearly 40 individual studies in Africa over the past decade. That should be good news on a continent where more than 2 million people die each year from AIDS. In Africa, the disease is largely spread by heterosexual contact and transmission from mother to child.
But African governments remain skeptical about high-cost interventions like anti-retroviral drugs. From country to country, 20 percent to 80 percent of African men are not circumcised.
The procedure represents one of the most promising, low-cost ways of reducing the swift rate by which the epidemic is moving across the continent.
International organizations and health workers have been reluctant to push the procedure partly out of cultural sensitivities, though that reticence may be unfounded. While those ethnic groups that do circumcise males often attach deep significance to the practice, experts say, the same does not apply to those that do not circumcise their men.
''The evidence is not 100 percent consistent, but more and more studies are out, and they show that men who are not circumcised are at least two times more at risk of infection than men who are circumcised,'' said Stephen Moses at the University of Manitoba in Canada.
The physiology is fairly simple. The foreskin is susceptible to tearing and bleeding during sexual contact and traps fluids and discharges that are potentially harmful.
The first study on the increased risk of HIV infection among uncircumcised men was published a decade ago. Since then, 37 scientific inquires have been conducted.
Among those, according to Robert Bailey, an epidemiologist at the University of Illinois at Chicago who has just completed a comparative analysis of existing studies, 27 papers from eight countries found a significant link between HIV infection and lack of male circumcision.
Despite this mass of evidence, Dr. Bailey said, research supporting an association between HIV infection and male circumcision has been met with resistance or silence.
''No one wants to be first to come out with a statement in support of male circumcision,'' Dr. Bailey said. ''In the U.S. and Europe there are big anti-circumcision movements now, so people don't want to promote something in Africa that is discouraged here.''