Sunday Times (Johannesburg) - November 30, 2008
Claire Keeton

South Africa has the world's biggest Aids treatment programme and, like the rest of the world, it has recently adopted a renewed, urgent focus on HIV prevention.

Combination HIV prevention was a key concept at the International Aids Conference in Mexico this year. For World Aids Day tomorrow, the Sunday Times is focusing on new prevention strategies.

Young men are streaming into an air-conditioned circumcision surgery in a Johannesburg township to protect themselves against HIV.

After 30 studies have shown that circumcision halves the risk of contracting HIV for men who have unprotected sex, up to 100 a day are queueing for the snip at the Bophelo Pele male circumcision centre in Orange Farm, south of the city.

Doctors have performed more than 4500 of the procedures since opening the centre in January. The staff said that nearly two-thirds of young women from the area had reported that they preferred sex with circumcised men - and that can't hurt the demand for the procedure.

But according to doctors, the men's main motivation was to reduce the risk of contracting HIV, which has infected about 5.6-million South Africans.

Mkopane Plou, 23, said one of his recently circumcised friends had persuaded him to sign up for the operation.

"It is a good thing for the sake of hygiene and (preventing) disease. This is a reason for every man to do it," he said.

Gideon van Wyk, 15, said he was there because his uncle had told him it reduced his risk of contracting HIV and other diseases. Others agreed, saying their girlfriends also preferred it.

Three years after the first major scientific study in South Africa supporting male circumcision, it has finally been placed high on the prevention agenda.

This week, the South African National Aids Council held a briefing on male circumcision and experts are developing a policy that is expected to be unveiled early next year.

New minister of health Barbara Hogan is backing the move, unlike her predecessor Manto Tshabalala-Msimang.

Before Hogan's appointment in September, Dr Olive Shisana, chief executive and head of HIV at the Human Sciences Research Council, said HIV scientists had recommended that male circumcision be implemented to prevent further infections "and our request fell on deaf ears".

Shisana was among 44 experts who wrote, in the October edition of the Future HIV Therapy journal, that male circumcision was a "lasting and cost-effective strategy for combating HIV in Aids epidemics".

The World Health Organisation and UNAids has also recommended male circumcision. Dr Sibongile Dludlu, a member of the UNAids support team for Eastern and Southern Africa, said countries such as Botswana, Lesotho, Namibia and Swaziland had decided to "scale up" male circumcision as part of their prevention efforts.

But Orange Farm's Bophelo Pele project is the only male circumcision initiative aimed at HIV prevention in South Africa.

It is funded by the French National Agency for Research Against Aids and driven by University of Versailles epidemiology professor Betran Auvert and, locally, Dr Dirk Taljaard.

Field workers from the centre encourage young men to undergo the surgery which is free.

Gift Moatlhodi, 22, was sitting in his yard on Tuesday when he was approached by three centre workers, whom he questioned about the pros and cons of circumcision. Before the operation, volunteers participate in information sessions, which include props and posters of circumcised and uncircumcised penises.

The next stop is a counselling room, where the men are told about the risks of HIV, that they will still need to use condoms and offered HIV tests.

Centre medical manager Dino Rech said 98% of their patients healed quickly, but the remainder had "minor complications like bleeding or infections".

Patients attend follow-up appointments two days after their operations and, after six weeks, they can resume their sex lives.

Traditional circumcisers in Orange Farm want to work with the clinic, said local practitioner David Nqala.

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