Michael Stalker, deputy director of the Male Circumcision Consortium, is encouraged. "Without this effort," he says, "you would have an estimated 15,000 more people with HIV in this one province in Kenya."
The consortium was formed after randomized controlled trials in Kenya, Uganda and South Africa revealed that male circumcision reduces the risk of heterosexually acquired HIV infection in men by 60 percent. With an $18.5 million grant from the Bill and Melinda Gates Foundation, the consortium is mounting a "full-court press" to train clinical officers and nurses to supplement the supply of doctors now performing circumcisions in the western Kenyan province of Nyanza on the shores of Lake Victoria.
Michael Stalker
Male patients are circumcised at a clinic in Kenya.
Dr. Wycliffe Omondi, who performs about two dozen circumcisions a day there, personally reflects the delicate ethnic and cultural issues surrounding male circumcision. The program's prime target is the Luo tribe, which traditionally does not circumcise and which has an HIV rate roughly double the national average. Omondi, who is Luo, was voluntarily circumcised while in college. The Kikuyu, Kenya's most populous tribe, circumcises its teenage boys during the traditional rite of passage to manhood.
The bloody violence that swept Kenya after the disputed 2007 election brought this cultural divide into stark view, with Luo and Kikuyu trading vicious insults about who was civilized and who was not, as the country plunged into violence.
"Now that (the circumcision program) has become public, men are coming openly," Omondi said in a published report, noting that he has circumcised males ranging in age from 8 to 85. "They are coming in large numbers."
Adds Stalker, "They're seeing impressive numbers of adolescent males asking for the procedure. There seems to be an incredible amount of interest from mothers who will do anything to protect their sons from HIV."
Stalker said a "tipping point" in the campaign to gain public acceptance came last fall when Prime Minister Raila Odinga, who is Luo, came out in support of circumcision.
The consortium, like the World Health Organization and the joint U.N. Program on HIV/AIDS, stresses that circumcision is no silver bullet. The United Nations considers it just one of a package of measures including "HIV testing and counseling services, treatment for sexually transmitted infections, the promotion of safer sex practices, and the provision of condoms and promotion of their correct and consistent use."
That broader approach reflects concerns that men will get circumcised and then use the somewhat mitigated risk to pressure women into having sex without a condom. Which brings up the importance of education.
Asked to describe the top challenges facing the male circumcision campaign, Dr. Dino Rech of Population Service International/Society for Family Health, says, "Disseminating the correct message so that men understand it would probably be right up there with the problem of resources."
To help get the right message out, independent filmmaker Kim Best has just completed a 15-minute film for the consortium that touts the potential benefits of male circumcision -- provided the program is woven into existing counter-HIV measures.
"This is a real breakthrough," Dr. David Okello, the WHO representative for Kenya, says on the film. "Over a dozen biomedical interventions to prevent the sexual transmission of HIV have been studied --- from vaccines to vaginal gels --- but this was the first that was shown to be highly effective."
The film will soon be shown to Kenyan government officials and policymakers. "But anybody could watch it," Best says, "and we'd like to use it for the general public in Kenya. It's a very controversial subject, and there's a lot of information here that a layman could understand."
In Kenya, Zambia, South Africa and several other African countries, circumcision is beginning to win acceptance as a valuable new weapon in the fight against AIDS.
"People at the World Health Organization, the Gates Foundation, the Centers for Disease Control, the President's Emergency Plan for AIDS Relief --- people paying attention to male circumcision are impressed and very happy to see this much support from the government of Kenya and to see the number we've reached in the first year," Stalker said.
"Giddy might be a stretch, but people are pretty excited."
