GuardianBill Clinton called for the world to prepare to tackle the cultural taboos surrounding circumcision yesterday if, as many expect, trials show that it protects men and the women they sleep with from Aids.
In a speech to the International Aids conference in Toronto, Canada, Mr Clinton said that if the trials had good results, there would be a major job of persuasion ahead. "Should this be shown to be effective, we will have another means to prevent the spread of the disease and to save lives, and we will have a big job to do," he said. "It is important that as we leave here we all be prepared for a green light that could have a staggering impact on the male population but that will be frankly a lot of trouble to get done."
The problems would be most obvious in India where Muslims are circumcised but Hindus are not, and the difference is associated with religious identity. During sectarian violence, men have been known to pull down each other's trousers as a means of identifying friend from enemy.
In Africa studies have shown that men are willing to be circumcised if it can be shown to be protective against HIV.
There is excitement about the potential for circumcision in preventing Aids. Last year researchers from South Africa and France announced that in a trial of 3,274 men from near Johannesburg randomly chosen either to be circumcised or not, those who underwent the procedure had a 60% lower risk of acquiring HIV afterwards than those who did not.
Three further studies are under way in Kenya and Uganda, according to a report published yesterday at the conference by the Global HIV Prevention Working Group. They are looking at different age groups of men and ways of carrying out the circumcision operation. One of the trials is following 7,000 women in Uganda to see whether they are less likely to get HIV if their partners have been circumcised. The results are expected next year.
The potential for preventing HIV through circumcision was one of the interventions spoken of with most hope in Toronto this week. Mr Clinton also backed opt-out schemes for HIV testing, such as that being introduced in Lesotho. "If it is done right, Lesotho's infection will plummet and more people will live," he said.
He understood the fear of discrimination, which existed when a friend of his died of Aids in the 1980s, "but there is a different equation today".
Some human rights groups are anxious that pressure could be exerted on people to be tested without help and treatment being available. The knowledge to stop the pandemic exists, Mr Clinton said, and must be used.
More than 15 million children in sub-Saharan Africa will have lost one or both parents to Aids by 2010, according to the UN which says the world has failed youngsters. At the launch of a report entitled Children Affected by Aids in Toronto, Michel Sidibe of UNAids said children were "the missing face" of the pandemic.