Circumcision, HIV
& Population Growth

Broadcast Saturday 9/02/2002

The research of a distinguished Australian physiologist has found that in Islamic countries there is hardly any HIV. He believes that male circumcision more than halves a man's risk of becoming infected with the HIV virus and that this will have and enormous effect on global population growth in the next 50 years.

Robyn Williams: Well, this week the Prime Minister, Mr Howard, has been in Indonesia and the chances are he hasn’t been talking about sex and men’s foreskins. But Roger Short from the University of Melbourne believes he should have been and that the associated risks of population growth, ecological upheaval and refugees ought to be uppermost in the diplomacy of our region.

Professor Short, a distinguished physiologist, has just published a paper warning that paradoxically, protection from AIDS is fundamental to the problem.

Roger Short: Yes, we now know for certain that male circumcision, which of course is used throughout Islam, is a major protective against HIV infection. It more than halves a man’s risk of becoming infected and if you look at a map of Africa you see that the whole of sub Saharan Africa, which on the whole is not Islamic, has got a massive HIV problem. In South Africa 50% of 15 year olds are HIV positive, whereas in supra Sahara in Africa, the bit of Africa on the Mediterranean; Tunisia, Algeria, Morocco, even Egypt, there’s hardly any HIV and we couldn’t, sort of, understand this. And then when you look in Asia, poor old Afghanistan, mercifully hardly any HIV. Pakistan, Bangladesh hardly any HIV. Even Indonesia hardly any HIV. And we’re now certain that this is a reflection of Islam’s neonatal or adolescent male circumcision practice which is actually protecting them. And so one of the countries which will be one of the most numerous in the next 50 years, by 2050, is Pakistan, which is going to be the third most populous nation after India, which will be number one and China number two. Now India, there is virtually no male circumcision and India is rapidly becoming the new epicentre of HIV infection.

Robyn Williams: Is it not possibly the proscriptions that occur under Islam that may be having this effect?

Roger Short: Well, that’s the first thing you think of: since they’ve got such rigorous controls on sexuality is that really what’s accounting for the lower incidents of HIV, and we can sort of control for that, because there are communities in Africa where circumcision is practiced in communities that are not Islamic and they too show the same protection against HIV. So we’re pretty sure that the protection of circumcision is what’s doing it. It’s not the protection of the Islamic faith.

Robyn Williams: Before we come to the policy implications just remind us how it is that circumcision could in any case protect against HIV.

Roger Short: Well, it seems that the inside the foreskin of the penis is where most of the receptors for HIV virus lie. There in the cells called Langerhan cells, which are in the epithelium and most importantly, the inside of the foreskin has very little keratin overlying it so the virus can easily bind onto these Langerhan cells which transport the virus to the regional lymph lode in the groin and hand the virus over to a T4 cell and you become infected with HIV. And if you take the foreskin away you remove, not all but many of the receptor sites for HIV.

Robyn Williams: Well, going back to populations. One of the forecasts you make is that Indonesia for example, with a population of 220 million at the moment will increase its population by 100 million in the next 50 years. That’s extraordinary.

Roger Short: Indonesia is going to have an enormous population increase. That, I think, unquestionably is the major threat to Australia’s future and here’s John Howard in Indonesia talking to Megawati Sukarnoputri and I wonder if he’s talking to her about family planning aid. I bet he isn’t, and yet here’s poor old Indonesia economically crippled with what used to be a fantastic family planning program called BKKBN, which we know is now starved of funds and if Australia could finance a little bit of Indonesia’s family planning program Indonesia’s population growth rate would come tumbling down, because Indonesians we know do not want large families. We’ve done some surveys there. But they’re having large families because they don’t have the wherewithal to control their fertility, and I think that if AusAid, instead of being so mealy mouthed about its family planning assistance and actually refusing to give any money to things like emergency contraception which is a no-no in their eyes, if we actually gave more aid to Indonesia’s family planning programs Australia would save its own bacon in the future.

Robyn Williams: Have you heard of any kind of interaction like this between Australian diplomats and the Indonesian politicians there?

Roger Short: No, not at all.

Robyn Williams: Do you know of any country with whom we have such discussions, for self interested reasons?

Roger Short: Well, it’s extremely difficult I find, as a scientist, to actually get any access to politicians who are prepared to talk about the issue. I don’t know how we feed into political thinking processes.

Robyn Williams: Could it be because it’s too delicate?

Roger Short: I think it is, but I also think it’s probably because our politics is very short term; politicians are really only looking to the next election and they’re not prepared to take a long term view that’s for the next 25 years. But really, if we’re going to deal with population problems we’ve got to take a long term view not a short term.

Robyn Williams: In terms of sexual practice, in terms of family planning, but what about in terms of refugees and the attitudes we have to them?

Roger Short: Again, I think we’re taking a ridiculous approach to the current refugee crisis because we’re just seeing the tip of the iceberg. I mean, we’ve just got a few thousand who have come and we don’t know what to do with them or how to handle them humanely or how to process them. When a recent report from the United Nations shows that what they call ecological refugees or environmental refugees, and there are going to be something like 200 million people in developing countries who are dispossessed because global warming, warfare, desertification, climate change, rising sea level is going to actually force them out of the lands which have previously supported them, and Australia’s going to see quite a bit of that backwash and we’ve given no thought at all as to how we cope with maybe a million refugees who come next year and the issue of global population growth, and the fact that South East Asia is the region with the highest population growth rates in the world is surely of paramount importance to Australia’s long term future political thinking.

Robyn Williams: There is an argument, is there not, that being strict here in the beginning gives us control rather than simply allowing more and more to come through as the populations build up and having the thing perhaps out of control?

Roger Short: Yes, but if we get massive immigration, I mean somebody said to me the other day, well, Indonesia, of course it’s got more than a thousand islands so the number of boats Indonesia’s got is phenomenal and we couldn’t contain massive small scale infiltration of our northern coastline along the whole length of it from Indonesia if Indonesia became a place where Indonesians no longer wanted to live, and already Java is getting pretty overcrowded, and if Indonesia’s population adds another 100 million people they’re going to lose all their tropical rainforest from the spine of Sumatra and what’s left in Java and Irian Jaya, and if you lose the rainforest you’ll get massive topsoil erosion, plus if there’s the sea level rise that everyone’s predicting as a result of global warming they’re going to lose many of their coastal rice paddies. So they’re going to be squeezed from above and below, from a rock and a hard place and they’re going to have to go somewhere else.

Robyn Williams: Well, of course, they’ve just had the experience of the floods but aren’t there echoes to some extent of the worries of the 1950s when it was perfectly commonplace to look north and almost by a sense of gravity feel that those huge populations from Indonesia and elsewhere would come down. Are you saying something like that or something different about our accommodating?

Roger Short: I’m saying that we really need to look upon that as a threat and to try and anticipate it and to collaborate with Indonesia to help Indonesia do what it wants to do and what it can do far more efficiently than Australia has succeeded in doing: keep its population growth in check if only it had the financial assistance for its family planning program, which it lack, and so for a relatively small percentage of our defence budget we could make love not war and we could actually keep Indonesia’s population in check and give ourselves breathing space for the rest of the millennium.

Guests on this program:

Professor Roger V. Short
Departments, Obstetrics &Gynaecology
& Zoology
University of Melbourne
Victoria 3010 Australia

Further information:

'The future fertility of mankind:
effects on world population growth
and migration'