Circumcision hailed as way to curb Aids

Bryan Appleyard, March 26, 2000, The Sunday Times, London

New evidence suggests that circumcision of all male babies could help to halt the global Aids epidemic. With 50m living cases and more than 16m deaths, the disease is now the worst human health disaster since the Black Death.

The thesis - laid out in a scientific paper to be published soon - seems likely to create huge controversy as it represents a complete change in accepted ideas about the transmission of Aids.

One of the paper's authors, Roger Short, professor of obstetrics at Melbourne University and a respected scientist with long experience of Aids-ravaged areas, has been told he cannot address the subject at a forthcoming international conference.

Short and his co-author, Dr Robert Szabo, are convinced that a high level of receptors - sites to which invading organisms attach themselves - on the inside of the foreskin make it responsible for transmission.

Short and Szabo noted a sharp difference in the prevalence of HIV infection in the "Aids belt" countries in sub-Saharan Africa. In some areas the infection rates are as high as 25%, in others as low as 1%. The lower infection rates were clearly associated with the practice of male circumcision.

"The presence of an intact foreskin," says the Short-Szabo paper, "has consistently been shown to be the single most significant factor associated with the much higher prevalence of HIV in countries of the Aids belt."

The link is stronger than with more familiar indicators such as promiscuity, other sexually transmitted diseases and multiple marriage.

Even more startling evidence came from a recent study in Uganda, reported in February. This showed that among a large group of "discordant couples" - where one is infected and one not - no circumcised males became infected over 30 months, even though their wives were HIV-positive. Short describes these results as "staggeringly significant".

Outside Africa there is the same pattern. Countries with low circumcision rates, such as Thailand, India and Cambodia, have between 10 and 50 times the rates of infection compared with countries with high circumcision rates, such as the Philippines, Bangladesh and Indonesia.

Once they get ethical clearance in Australia, Short and Szabo intend to test their conclusions by applying live HIV virus to newly removed foreskins to check its rate of uptake. They could have definite results within weeks.

If experimentally confirmed, the implications are radical. Short and Szabo believe that about 80% of male HIV infections in the world happen through the foreskin.

Short is not advocating adult circumcision, a painful and potentially dangerous operation. But future generations could be saved if mass circumcision began now.

Short believes his findings should be spread globally, as rapidly as possible. "There has been insufficient focus on prevention," he said, "and too much emphasis on the search for a vaccine." Despite the billions poured into research, there is still no sign of an Aids vaccine.

The crisis in sub-Saharan Africa - where life expectancy rates at birth as a result of Aids have dropped from 59 to 44 - is out of control.

"The whole of my life's prejudice has been anti-circumcision," said Short. "I've written papers against it. I didn't believe the benefits outweighed the costs. If God had made us the way we were, why remove a sound organ? But I have been totally converted."