AIDS Breakthrough

Scientist links circumcision to halting AIDS spread.

July 31, 2009

Joe Eskenazi
j. the Jewish News Weekly of Northern California

Question: Do you think circumcision should be a required procedure in hospitals everywhere?

What a difference a decade makes.

When Dr. Daniel Halperin first publicly made his case that male circumcision was a huge factor in combating the spread of HIV and AIDS, he was subjected to bitter ridicule.

“Seven years ago, I gave a talk here about this and they said, ‘Get this guy to Langley Porter,’” he said, referring to University of
California San Francisco’s psychiatric hospital.

But at a recent speech at UCSF, when the Harvard researcher, who is Jewish, asked a roomful of top AIDS researchers, doctors and medical students to name the most effective method of curtailing HIV, he was greeted with a unified shout of “male circumcision!”

The San Francisco born-and-raised scientist has been working to fight AIDS in Africa since the 1990s. In that time, his most fervent assertion—that male circumcision is the single largest factor combating the spread of the disease—has been promoted from the outhouse to the penthouse of scientific thought, largely through his efforts and those of a like-minded “cabal, a mafia of nerds obsessed with HIV epidemiology,” he said.

Indeed, the work Dr. Halperin contributed to proving the efficacy of male circumcision was named the top scientific breakthrough of 2007 by Time magazine. The foreskin, research has shown, is the most susceptible part of the body to the HIV virus.

Even the U.S. government has taken notice of the findings. And it’s a good thing, said Dr. Halperin, because the expensive HIV-prevention strategies employed in the United States, Africa and elsewhere have barely made a dent in the epidemic.

So far, efforts have focused on condom use and abstinence. Dr. Halperin, a former longtime UCSF researcher, said that when he was working in Swaziland in 2005 and 2006, condoms were dropped from helicopters, literally blanketing villages with prophylactics. But this alone has not prevented AIDS.

Dr. Halperin spoke of a “lethal cocktail” of uncircumcised males and sexual practices prevalent in stretches of Africa. The result is that the HIV virus—which is most contagious when first contracted—hops through populations like “a hot potato,” he said.

Circumcision can make a critical difference, largely because Africans rarely wear condoms.

In Botswana, for example, only an estimated 15 percent of men are circumcised, while 65 percent report engaging in high-risk sexual practices. The percentage of AIDS infection among Botswana’s adults is 25 percent.

By contrast, in Ethiopia, 75 percent of men are circumcised and only 21 percent report engaging in high-risk practices. There, the nation’s AIDS rate is 2 percent.

It’s problematic for a doctor to tell a patient to “cut back on your risky behavior” rather than “cut out your risky behavior,” said Dr. Halperin, adding that if the population reduced the number of sexual partnerships and used condoms, it would make a huge difference.

It would make an even more potent difference if added to circumcision. Men may forget or ignore a condom, but circumcision offers permanent protection.

In a recent paper, Dr. Halperin and others postulated that male circumcision may be “as good as the HIV vaccine we’ve been waiting for.”

Separate trials have shown that circumcision reduces the risk of heterosexual HIV infection by 60 percent. The minimum threshold for a future vaccine—which isn’t coming anytime soon—is 30 percent, he said.