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From NPR News this is DAY TO DAY.

At the International AIDS Conference this week in Toronto the number one topic, new ways to prevent the spread of HIV, and one of those experts are debating is promoting circumcision in sub-Saharan Africa. That's where rates of HIV are highest. The evidence isn't all in yet, but NPR's Richard Knox reports the debate about circumcision is well underway.

RICHARD KNOX reporting:

Hints that male circumcision, or the lack of it, may have something to do with the spread of HIV have been accumulating for years. Some think it helps explain why East Africa, with low rates of circumcision, has an explosive AIDS epidemic, while West Africa, where circumcision is common, has a less ferocious problem.

Last year results came from a South African study that assigned men to be circumcised or not. The circumcised men were 60 percent less likely to get HIV. Researchers are trying to replicate those results in Kenya and Uganda.

Dr. Helene Gayle is co-chair of the Toronto meeting. Like a lot of public health people, she thinks the pending studies are likely to clinch the case for circumcision.

Dr. HELENE GAYLE (Co-Chair International AIDS Conference): If these trials confirm the earlier results, the world has to act. Sixty percent reduction of HIV risk is something that we have to take seriously.

KNOX: Scientists are presenting dozens of studies on circumcision in Toronto. Some indicate that many African men are eager to get circumcised. Dr. Emanuel Ortaloran(ph) is a Baltimore-based public health expert. He says men lined up in Lusaka, Zambia when a pilot project there offered free circumcisions.

Dr. EMANUEL ORTALORAN (Public Health Expert): At the end of the program we had lots of clients who were on the waiting list who could not undergo the procedure because we just didn't have enough operating time and we didn't have enough staff to cater for all those who showed up.

KNOX: Researchers in Swaziland, with the world's highest HIV rates, had the same experience. They say men there already view circumcision as a kind of surgical vaccine.

Dr. ORTALORAN: So you can imagine what will happen when everybody gets to know that when you undergo circumcision you get a 60 percent reduction of getting HIV infection.

KNOX: Steward Renny, and ethicist at the University of North Carolina, is among those who think enthusiasm for circumcision is premature, although he understands it.

Mr. STEWARD RENNY (University of North Carolina): Within the public health community there is a growing consensus that this is a good thing, against the background of the urgency of the epidemic, the lack of a vaccine and the lack of a cure, and that it would be frankly unethical not to use it.

KNOX: But there's push-back from social scientists like him. They say that public health people aren't taking many sensitive issues into account. Renny says sometimes feelings run strong.

Mr. RENNY: There is a little bit of a feeling of neo-colonialism: we know what's best for you and your traditional practices are not helping the epidemic and need to be reformed.

KNOX: Some argue the cost of circumcisions will steal resources from other priorities, and that the well-off will get safe circumcisions while others get unhygienic operations at the hands of opportunists. The greatest worry is that men who get circumcised will think they're safe and don't need to use condoms anymore.

Mr. RENNY: The people who, like myself, are urging a certain amount of caution, aren't necessarily against the implementation of it. We're just against the hasty implementation before seeing all the possible impacts this intervention could have.

KNOX: Meanwhile, many called for investing more in tried and true methods such as condoms. The United Nations population fund says men in sub-Saharan Africa have access on average to just ten condoms per year.

Richard Knox, NPR News.

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