Oct 22, 2007 5:51 pm


The finding that circumcision can reduce AIDS infection does not sit well with many activists. But the evidence is overwhelming and, finally, we see some action:

MBABANE, Swaziland -- The young men seated in a cramped waiting room in Swaziland's capital twitched with nerves. Feet tapped. Fingers drummed. The occasional brave joke was delivered with a smirk.

Beyond a wooden door a few feet away, two Israeli doctors donned blue hospital scrubs adorned with faded Hebrew script. Stepping into a modest room where only a dangling sheet separated the operating tables, they prepared to perform the world's oldest surgery.

So began Day 10 of an uncommon experiment in international assistance. Small teams of Israeli surgeons have begun circumcising Swazi men, deploying an ancient ritual in hopes of curbing the terrible modern malady of AIDS.

A series of studies have shown that circumcised men are at least 60 percent less likely to contract HIV. Far less clear is how meager public health systems already overwhelmed by the AIDS epidemic can offer the procedure widely enough to slow the epidemic's ruinous spread.

"For us the major constraint is surgeons, doctors," said Dudu P. Simelane, executive director of the Family Life Association of Swaziland, a nongovernmental group hosting the Israelis. Medical experts in Swaziland, which has fewer than 100 doctors and the world's highest rate of HIV infection, say that over the next five years, they would like to offer the procedure to all 200,000 of this tiny southern African nation's sexually active men, at a rate of roughly 200 a day. That's 20 times faster than the current pace in this country of 1.1 million. . . .

But scientists say that the foreskin has cells unusually receptive to the AIDS virus and that removing it causes the penis head to grow thicker and more resistant to sexually transmitted infections. The World Health Organization said in March that making circumcision widely available, inexpensive and safe could prevent 5.7 million HIV infections over the next 20 years.

So why the foot dragging? Its time for American surgeons to follow their Israeli brethren.

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