Guest Post: Making the Cut: HIV/AIDS and Male Circumcision in South Africa

Laura Dimon is the Africa Studies intern at the Council on Foreign Relations.  Previously, she worked for the Clinton Health Access Initiative in Pretoria, South Africa.  She has entered the Columbia University School of Journalism.

At the 19^th International AIDS Conference, Secretary Clinton announced that the U.S. will give forty million dollars to South Africa to support a voluntary medical male circumcision program for almost half a million boys and men in the coming year. Why South Africa, and why circumcision?

South Africa has the highest prevalence of HIV/AIDS in the world. There are 34 million people in the world living with HIV/AIDS and 5.38 million of them are in South Africa; 16.6% of people ages 15-49 in South Africa are HIV-positive. Many South Africans are unaware of these staggering statistics.

Further, South Africa’s general public is unlikely to be familiar with circumcision’s role in the prevention of transmission of the disease. But in the words of Dr. Anthony Fauci, circumcision is “stunningly successful” in preventing female-to-male transmission. His views are supported by various studies in Africa which have shown that circumcision cuts transmission risk by about 60%.

Why is this? According to the CDC, the inner mucosa of the foreskin—compared to the dry external skin surface—has a higher density of target cells for HIV infection and higher likelihood of abrasion during intercourse, providing entry points for the virus. Further, the microenvironment of the space created by the unretracted foreskin may be conducive to virus survival. Finally, the higher rates of STDs observed in uncircumcised men may also increase susceptibility to HIV.

Beyond the science, beliefs about circumcision are deeply rooted in cultural practice and tradition and vary greatly between regions and ethnic groups in Africa—and elsewhere (a German court recently banned circumcision of minors.) In South Africa, the Zulu have historically not favored circumcision, but the Xhosa and Sotho view it as a rite of passage into manhood and perform it traditionally, not medically.

As the correlation between circumcision and prevention of the transmission of HIV/AIDS becomes better known, the number of procedures in South Africa is likely to increase, especially where it does not clash with deep-seated religious or ethnic values.