Wall Street Journal - October 12, 2006
Michael M. Phillips, michael.phillips@wsj.com

At a time when scientists are lining up behind the idea that circumcision provides substantial protection against HIV transmission, the U.S. Agency for International Development pulled out of a small, $150,000 program in Swaziland that had circumcised more than 325 men since it was launched in January.

David Snider, a USAID spokesman, said the agency had been wrong to provide its initial funding for the program, which is run by a private non-profit called Family Life Association of Swaziland. U.S. foreign-assistance guidelines allow American money to be used for "formative assessments related to male circumcision but will not support the actual provision of clinical services" until further scientific evidence of its effectiveness is available.

The initial U.S. funding for the FLAS project "should not have occurred, and there will be no further circumcisions performed with U.S. government funds" until the scientific steering committee that guides U.S. aid so recommends, Mr. Snider said in a written response to questions.

"This was the one donor-funded program that was making male circumcision more available anywhere in Africa," said a Western AIDS official who works with Swaziland. "The other donors aren't doing anything to actually provide the services, and people are dying in huge numbers."

Swaziland, a tiny kingdom in southern Africa, has the world's highest HIV prevalence rate, with 33.4% of adults thought to be infected, according to UNAIDS. Almost 39 million people worldwide carry the AIDS virus, 24.5 million of them in sub-Saharan Africa, according to UNAIDS.

At least three major studies have looked at the effect of circumcision on HIV transmission. One study in South Africa concluded that circumcision reduced the risk of HIV infection by 60% to 75%. The other studies are still underway.

Word of the initial findings, however, has spread around Africa, sparking a surge of demand for circumcision.

"The demand will not lose its momentum," predicted Dr. Adam Groeneveld, Swaziland's only urologist, who performs circumcisions at the Government Hospital in the capital city of Mbabane. "That's why FLAS will have to find some other source of money. There will be a temporary dip in the number of circumcisions, and an increase in the waiting list."

Dr. Groeneveld said the FLAS project, while small, provided a substantial increase in circumcision services. Doctors at Government Hospital perform just 10 circumcisions a week, and someone asking to be circumcised today would have to wait until February for the procedure, he said. The hospital is experimenting with the idea of devoting one entire day each weekend exclusively to circumcision procedures, he said.

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