How Israel limits African Aids with circumcision

Israeli expertise in ritual helps Africa combat AIDS
Docs trained in adult male circumcisions
By Joel Greenberg | Chicago Tribune correspondent
July 8, 2008
JERUSALEM — Inon Schenker, an AIDS prevention specialist, pulled out a medical logbook from a shelf and opened it to a page filled with handwritten entries.

The notations, from 1993, recorded ritual circumcisions performed on Jewish men from the former Soviet Union at the height of the wave of Immigration to Israel from Russia and neighboring republics.

The entries showed 32 circumcisions by a single doctor in a day's work, an assembly-line rate that Schenker believes shows the potential in Israel for helping combat AIDS in Africa, where recent studies have shown male circumcision to be a significant protective measure against the disease.

In the heyday of Russian Immigration to Israel in the 1990s, about 1,000 adult male circumcisions a month were performed on newcomers in hospitals and clinics, in accordance with Jewish law.



"Israel is the only country with such experience in mass adult-male circumcision, and it can respond to a very important humanitarian challenge," said Schenker, director of Operation Abraham, a project launched last year that dispatched Israeli surgeons to teach circumcision in Africa.



Israel's experience vital
Because it is obligatory under Jewish law, male circumcision is nearly universal in Israel and was stepped up as immigrants from the former Soviet republics sought the procedure to affirm their Judaism and ease their integration in the Jewish state.

The ancient practice is mentioned in the Bible in a passage that describes how the patriarch Abraham circumcised his son at God's command.

Jewish circumcision ordinarily is performed on newborns, but many of the immigrants hadn't been circumcised in their countries of origin for various reasons, such as estrangement from Judaism, restrictions on religious rites in the Soviet era and pressure to assimilate in gentile society.

As the Russian immigrants flooded into Israel—about 1 million since 1989—the demand for adult circumcisions surged, and the country became a world leader in the field, with more than 80,000 procedures performed, according to various estimates.

Schenker, who is with the Jerusalem AIDS Project, a non-governmental group that promotes HIV prevention, is working to marry the experience accumulated in Israel with the urgent need in Africa for effective programs to fight the AIDS epidemic.


50% reduction in risk
A link between circumcision and AIDS prevention was shown in three studies conducted between 2004 and 2006 in South Africa, Uganda and Kenya, which found that the risk of contracting AIDS in heterosexual sex is 50 percent to 60 percent less among men who are circumcised.

The findings led the World Health Organization last year to recommend circumcision as an additional method for prevention of AIDS. WHO's recommendations were endorsed at a gathering of African health ministers.

With the support of the Hadassah Medical Organization, which runs Israel's main university hospital in Jerusalem and has provided most of the budget and equipment, the Jerusalem AIDS Project sent three delegations of surgeons to teach adult circumcision in Swaziland. The southern African nation has the highest prevalence of AIDS in the world — 26 percent in a population of about 1 million.

"This is part of Hadassah's mission: outreach to other places," said Dr. Shlomo Mor-Yosef, director general of the organization.

The Israeli surgeons visited Swaziland twice last year and again in February, training 10 local doctors in adult male circumcision and two others in the procedure on newborns. The Israeli teams included an Israeli Arab doctor with experience in Muslim ritual circumcision.

Prudence Mkhatshwa, chief nurse in male circumcision at the Family Life Association of Swaziland, a non-governmental group that partnered with the Israelis, said the training had helped to significantly raise the weekly rate of adult circumcisions and that the public response is growing. The procedure, conducted under local anesthesia, was first offered in Swaziland in 2006.

"Before, people were scared, but now they see the benefits and they are more willing to do it," Mkhatshwa said from Mbabane, the Swazi capital. She said street billboards are promoting circumcision, in addition to condom use and abstention from casual sex, as methods of preventing AIDS.