King of Tiny African Nation to Subjects: Get Circumcised to Prevent HIV

The King of Swaziland has told the men of his country to get circumcised in a bid to combat the rising tide of HIV infections in the African country, the AFP reported on July 15.

Calling HIV a "terrorist," King Mswati III framed his call for the males in Swaziland to undergo to procedure in martial terms.

"It seems fitting that our men and young boys should be given an initiative that will help them fight this disease," Mswati said in an appearance in the village of Mankayane. "This virus I shall liken to a terrorist. It is here to finish off our people."

Swaziland is a landlocked country almost totally surrounded by, and dependent on, South Africa. It is also one of Africa's poorest and the most decimated country in the world by the AIDS epidemic. The king rules with almost total control over his impoverished people.

The AFP story said that studies have indicated a drastic drop in HIV transmission for circumcised men, in theory because the foreskin can act as a point of entry for HIV.

But while the U.S. is funding the push, men here are pushing back against the procedure. Moreover, at least one study shows that circumcision would not do much to prevent the spread of HIV in the United States.

In a nation of just over one million, where the rate of HIV is one in four adults, any means to stem the tide seems worth taking -- even scaling back the tough talk that Mswati had engaged in previously, when he called for violent measures such as branding and sterilization to be used against people living with HIV.

Health advocates have long warned that nations that criminalize and persecute gays and men who have sex with men (MSM) court making the pandemic worse. Their argument is that in oppressive political climates, gays and MSMs do not seek testing and treatment. People living with HIV are much less likely to pass the virus along to others if they are in a regimen of medication to fight the disease.

In his speech at Mankayane, Mswati encouraged his subjects to "stay away from activities that could give you the disease," but did not demonize any particular group.

The new circumcision program is backed by $30 million in funding from the United States, the article said, and is intended to move quickly. The goal is to circumcise 80 percent of Swaziland's males between the ages of 14 - 49, the AFP article said.

But going has been slow. The program started six months ago, and far fewer men than hoped have subjected themselves to circumcision -- a mere 3,000. Mswati's direct involvement is seen as a means to jumpstart the mass circumcision movement.

In the United States, circumcision has excited controversy and political activism. So-called "intactivists" gathered enough signatures to put a ban on the practice of circumcising infants and boys under 18 before voters in San Francisco later this year. The ban does not offer any religious exemptions, and its constitutionality has been questioned.

Legal counsel for the city of San Francisco says that there's no way for the proposed ban on male infant circumcision can answer both state law requirements and constitutional muster.

A coalition of opponents to the proposed ban have filed suit to take the measure off ballots this coming November. The plaintiffs in the suit said that the measure threatens religious freedoms and parental rights, and also violates state law, since California does not permit local governments to restrict medical procedures.

"It's a measure that would basically infringe upon my rights as a Muslim to practice here," one plaintiff, Leticia Preza, a 31-year-old mother of two, told the AP. "It would also take away my rights as a parent to choose what's a good procedure for my child."

But a partial removal of the measure's language would not be acceptable, either. The city's lawyers pointed out that to avoid breaking state law, the ballot initiative would have to exempt doctors. But the ballot measure would then be reduced to targeting religious rites alone, rather than a blanket ban on circumcision carried out by doctors as well as by clerics.

Banning the practice by clerics but allowing it for medical personnel would mean violating the United States Constitution, the city's lawyers said. The First Amendment protects freedom of religion, and circumcision is a long-held rite for both Jews and Muslims.

Anti-circumcision activists say that the procedure is medically unnecessary and amounts to genital mutilation performed on an individual who is too young to consent. The ballot measure would criminalize circumcisions performed in the city on anyone under the age of 18. No religious exemption is offered in the ballot measure's language.

Although studies in Africa have indicated that circumcision might help reduce the spread of HIV in straight men by removing foreskin cells that are vulnerable to the virus, another study -- which focuses on gay American men -- does not arrive at the same conclusion, in part because circumcision is already so prevalent in the U.S. Moreover, only a very small minority of men surveyed for the study said that they would undergo circumcision even if it were proven to reduce their risk of contracting HIV.

"Our study indicates that any potential benefit may likely be too small to justify implementing circumcision programs as an intervention for HIV prevention," said Chongyi Wei, a post-doc with University of Pittsburgh Graduate School of Public Health, which carried out the study. Wei is also an author of the paper on the results, which was presented at last summer's International AIDS Conference in Vienna.

Previous studies have also indicated that gay men do not benefit from circumcision the way heterosexuals seem to when it comes to HIV transmission. One study by the U.S. Centers of Disease Control and Prevention showed that circumcision seemed to make no difference in HIV transmission rates when it came to anal sex.

Uncertainties about the procedure's effectiveness aside, other issues compete with HIV prevention for the attention of King Mswati's subjects, the AFP article indicated -- namely, the country's economic problems.

"I love the king but 90 percent of youth are not working. Only those close to the king get jobs," said one 21-year-old man. The man said that he did intend to get circumcised.

"The king has a lot of money in the bank but he can't help us. He has many women and a luxurious life. His children get an overseas education. He doesn't care about Swazis," another man complained.

Mswati has 13 wives, the article noted, and some say that he should be monogamous in order to encourage his countrymen to do the same and help slow the rate of new infections.

The article also took note of the fact the Mswati has not declared that he will undergo the procedure.