When a Muslim and a Jewish surgeon travel to KwaZulu Natal later this month to help local healthcare teams develop high-volume adult male circumcision programmes, they are expecting considerable interest. Operation Abraham, an Israel-based group, has tapped into the traditional experience of two faiths in circumcision to offer guidance in a region where the practice was long in abeyance but recently resumed. “Young men are proving very receptive,” says Inon Schenker, who led a first training team in August dubbed Shesha (Zulu for swift), based on earlier pilot schemes in Swaziland.
South Africa has long been at the epicentre of the HIV epidemic, and a venue for innovation in tackling the disease. Now, the change in political leadership is allowing some of the findings to be put into practice, albeit more slowly than many advocates would like. Two decades after anecdotal and observational data highlighted lower HIV rates in circumcised men, it was in Orange Farm, near Johannesburg, that Bertran Auvert, a French researcher, conducted a systematic clinical trial proving that the procedure could reduce infection by 60 percent.
In South Africa’s private sector, the findings soon began to have an impact. “As soon as we saw the data, we made sure adult male circumcision would become a funded benefit,” says Jonathan Broomberg, head of Discovery Health, a large health insurance company that has also helped fund Shesha philanthropically. Yet if scientific, logistical, procedural and financial hurdles have helped explain the modest overall progress thus far in many countries, South Africa had a particular political challeng rooted in the ambivalence of Thabo Mbeki, the former president, towards tackling AIDS.