Circumcision touted as HIV defense

TORONTO -- Tens of thousands of HIV infections could be avoided in a single South African township with even a small increase in circumcision among adult men, according to a study made public yesterday. At just $55 per procedure, circumcision would potentially save millions of dollars in AIDS treatment expenses, another study found.

Struggling to find novel ways of slowing the spread of HIV, scientists have increasingly focused their attention on the circumcision of adult men, a relatively risk-free procedure that removes the foreskin, where cells are particularly susceptible to the AIDS virus. One lab study showed that foreskin is nine times more likely to be infected by HIV than cervical tissue. But as these findings were being presented yesterday at the 16th International AIDS Conference, social scientists here complained that social and ethical considerations were being given short shrift.

``The cultural meaning of this act is much more profound than this kind of research can take account of," said Gary Dowsett, an Australian sociologist.

In an interview, Dowsett charged that ``social scientists have been deliberately excluded from this field because they know we'll mess up the field."

But Robert C. Bailey, a researcher engaged in an ongoing circumcision study in Kenya, disputed Dowsett's assessment.

Bailey, of the University of Illinois at Chicago, said his research team included social scientists who conducted extensive interviews with Kenyans to gauge their beliefs about circumcision before embarking on the medical trial. Bailey's study is one of two continuing in Africa -- the other is in Uganda -- with the potential to change global health policy.

The World Health Organization said the studies in Kenya and Uganda, in which half of the men are given circumcisions and half are not, would prove pivotal in helping to determine whether male circumcision should be promoted as a prevention method.

The skin of circumcised men is thicker and less prone to penetration by the virus, research has found. In some parts of Africa, circumcision rates are comparable to those in the United States -- at least 70 percent of the men -- while on other parts of the continent, rates are much lower. AIDS specialists have long noticed that infection rates are highest in areas of Africa where circumcision rates are lowest.

But scientists concede that circumcision is not a panacea. They fear that if men are circumcised, they might, for example, think they can for go condoms.

``When we think about circumcision, we're not talking about it as a stand-alone prevention strategy," said Kawango Agot, a Kenyan researcher.