KHOPOTSO: The trial started in 2002 and ended last year. It involved more than 3000 men who were all uncircumcised. Two arms of research, each with equal numbers of men, were formed from that sample. These were called the intervention and control groups. Men in the intervention group were circumcised upon entering the study. The others were circumcised only at the close of the study. Dirk Taljaard, of research and consultancy firm, Progressus, explains the rationale.

DIRK TALJAARD: The control group – we didn’€™t do any intervention. So, they were not circumcised. But we followed them in exactly the same way as those from the intervention group ‘€“ those that were circumcised… We had to make sure that the two processes were exactly the same so that at the end the only thing that is different between the two groups is that one is circumcised and the other one is not’€¦ In that way it’€™s the only way we can then compare the impact of the actual circumcision and we can be sure that the differences we are looking at is not because of some other variable that interfered.            

KHOPOTSO: After a 21-month follow-up period with the two groups, the following was found.

DIRK TALJAARD: Of the 3374 people that were recruited during the trial, 69 of those sero-converted. So, 69 participants turned HIV positive. Twenty were from the  intervention group that were circumcised at the beginning of the trial, got infected. And 49 were from the control group that were not circumcised at the beginning of the trial, but were circumcised at the end of the trial, got infected through the duration of the trial. So, you can see that there’€™s a huge difference between the number of people from the intervention group and the control group that was infected. And that’€™s what we call the protective effect. Circumcision protected those people.      

KHOPOTSO: According to Taljaard, in effect, the study shows this:

DIRK TALJAARD: To be circumcised has a 60% protective effect’€¦ Your chance of getting infected with HIV is 60% less if you are circumcised’€¦ A protective effect of 60% is enormous. It could really make a huge difference.

KHOPOTSO: Epidemiological studies also suggest that in eastern, central and western Africa ‘€“ where tradition and religion require men to circumcise ‘€“ the prevalence of HIV infection is significantly smaller, compared to southern Africa’€™s epidemic where large-scale male circumcision occurs only in selected communities.

For instance, Swaziland probably has the lowest rate of circumcised men in Africa ‘€“ estimated to be between 5% – 10%. The HIV prevalence rate in that country is an enormous 38%. But as the benefits of male circumcision become apparent, it’€™s reported that many Swazi men are flocking to hospitals demanding circumcision operations. Daniel Halperin is the regional HIV/AIDS Programme advisor for the United States AIDS agency and is based in the capital, Mbabane.

DANIEL HALPERIN: Hospitals that used to do relatively fewer of these procedures are now, in some cases, being over-run ‘€“ that’€™s what the practitioners are saying – by men seeking circumcision. The wait(ing) list at the public hospital in Mbabane’€¦ is now about 7 or 8 months long and they are getting way more men coming in than they can possibly do. We’€™re seeing a similar situation with the private practitioners as well.          

KHOPOTSO: Halperin recognises the benefits of circumcision, but cautions against its   wide-scale promotion as a tool against HIV infection.

DANIEL HALPERIN: If a microbicide is developed there will be some women who may believe that now they are protected when, in fact, microbicides are only partially effective. If a vaccine is ever invented ‘€“ that works ‘€“ it’€™s almost definitely going to be partially effective. So, I have the same kind of issue. Even with condoms, in a way, because condoms are not 100% effective’€¦ So, any of these prevention mechanisms can have that problem of dis-inhibition, where people feel that they can do anything they want now because they’€™ve got this. We’€™ll have the same problem with circumcision. That’€™s why it’€™s so important to keep on telling people over and over again: ‘€œThis is definitely not 100% effective. It may reduce your risk, but it certainly doesn’€™t eliminate it’€.                  

KHOPOTSO: Two more studies looking at the link between male circumcision and protection against HIV are being conducted in Kenya and Uganda. The United Nations’€™ AIDS agency is awaiting the final results from the two studies, which are due in 2007, before it can make a policy that embraces universal circumcision in the fight against HIV. Tomas Lundstrom is the regional advisor for UNAIDS in eastern and southern Africa.

TOMAS LUNDSTROM: I think the findings from Orange Farm and some other findings are quite good. They’€™re positive’€¦ We will have results of two other trials (that are)

on-going now’€¦ If they come out positive – in the sense that it can really show scientifically that they prevent HIV – this is crucial for HIV prevention. Condoms must still be pursued’€¦ as one package. But, of course, if men want to circumcise, let’€™s make it possible.