Sub-Saharan Africa Adopts Circumcision Program

Four years ago, the World Health Organization determined medical circumcision reduces a man's likelihood of contracting HIV by 60 percent. Since then, large-scale circumcision programs have been growing slowly in sub-Saharan Africa. Two-thirds of the world's HIV positive people live there.

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Four years ago, the World Health Organization determined that medical circumcision reduces a man's likelihood of contracting HIV by 60 percent. Since then, large-scale circumcision programs have been growing slowly in sub-Saharan Africa - two-thirds of the world's HIV-positive people live there. Now, one such program is gaining momentum because of the decree of a king. Anders Kelto reports from South Africa.

ANDERS KELTO: Here in Pietermaritzburg, the capital of the eastern South African province of KwaZulu-Natal, the Boom Street Community Health Clinic is bustling. More than a hundred teenage boys are packed into a small room. Many are forced to share their seats. At the front of the room, a nurse holds up a wooden model of the male reproductive organ. She pulls back the foreskin, a brown sock, and explains the procedure the boys are about to receive.

Unidentified Woman #1: (Foreign language spoken)

KELTO: Moneri Tsolo is seventeen and lives across town. He says he's getting circumcised to reduce his chances of getting HIV.

Mr. MONERI TSOLO: I know that, if I do this, it can help me so much. It can help me to protect myself.

KELTO: Since the World Health Organization concluded that circumcision reduces men's likelihood of contracting HIV, and indirectly benefits women by reducing overall infection rates, 13 countries in sub-Saharan Africa have begun to explore circumcision programs.

Cynthia Nhlapo is a project manager for Society for Family Health, the NGO that runs the clinic here in Pietermaritzburg. She says South Africa is still in the early stages of a campaign to have 5.6 million men circumcised by 2015.

Ms. CYNTHIA NHLAPO (Project Manager, Society for Family Health): We're currently embarking on a catch-up phase, where we're trying to get all the men that were not circumcised as babies circumcised.

KELTO: She says the program here in KwaZulu-Natal is now picking up steam. And that's largely thanks to one person: the Zulu king.

Mr. ZAKHE NDIMANDE: (Foreign language spoken)

KELTO: Back in the classroom, Zakhe Ndimande delivers a spirited lecture. He's a traditional Zulu leader, a robust man who looks slightly out of place in a gray pinstripe suit and polished wing tip shoes. He's here at the request of King Goodwill Zwelithini kaBhekuzulu, to talk about Zulu culture and the importance of being circumcised.

Mr. NDIMANDE: I was actually advising these boys in terms of how they should try to behave themselves, as they are actually on their way to manhood. So a man, to be a man, must definitely go through circumcision. It's one of our cultural values and norms and tradition.

KELTO: Circumcision hadn't been practiced by Zulus for nearly 200 years. But last year, the king issued a decree - one that Nhlapo says made a huge difference.

Ms. NHLAPO: The king in KwaZulu-Natal gave a directive last year to say men in KwaZulu-Natal should go forward for male circumcision because he then understood the protective effect of male circumcision for HIV prevention. In KwaZulu-Natal specifically, the king's word is taken seriously and it has urged men old and young to come forward for male circumcision.

KELTO: She says getting the support of cultural leaders is proving equally important in other parts of the continent. And in areas where traditional circumcision, a controversial practice in which the foreskin is removed by often untrained practitioners, some governments are encouraging or requiring cultural groups to use medical professionals.

According to a recent UN report, more than 350,000 men underwent medical circumcision in Africa last year - three-and-a-half times more than the previous year. That number is expected to grow in 2011.

Circumcision is considered a complement to other, more effective forms of prevention, including condoms, abstinence and monogamy. But in many parts of Africa, the procedure is seen as a necessary weapon in the war against HIV.

After the cultural lesson, the boys move to the medical facility, a temporary building with four small operating rooms. They sit in line and wait for their names to be called.

(Soundbite of beeping)

Unidentified Woman #2: Four is ready.

Unidentified Man: OK, you can come...

KELTO: Moneri Tsolo is up next.

Are you nervous?

Mr. TSOLO: No, not at all, but yes. Yes, I'm a little scared.

KELTO: His name is called, and he steps into the operating room to help protect himself from HIV, and to become a Zulu man.

For NPR News, I'm Anders Kelto in Pietermaritzburg, South Africa.

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