Friday, August 26, 2011
Israeli circumcision skills saving Zulu men
Dr. Inon Shenkar of the Jerusalem AIDS Project and Operation Abraham with Zulu King Goodwill Zwelethini in South Africa.
An ancient Jewish religious rite turns out to be a critical weapon in the war against the spread of the HIV virus in South Africa.
While San Francisco politicians debate the necessity of the male foreskin removal rite, citing human rights concerns, Zulu King Goodwill Zwelethini of KwaZulu-Natal nods his head. The tribal leader of KwaZulu-Natal, a province of 10 million people in South Africa, recently rescinded a 200-year-old ban on the age-old practice of male circumcision, still conducted in many regions in Africa, after seeing the evidence on the spread of AIDS.
Some estimates suggest than more than half of all HIV infections could be stopped if men are circumcised. Very conservative estimates are one in 10.
"Circumcision is one of the interventions that reduce the risk of transmission," says Maureen Malowany, a medical historian grounded in evidence-based medicine. The Canadian-Israeli woman has started volunteering for the Jerusalem AIDS Project (JAIP), and since March, as the NGO's country coordinator for South Africa, has traveled there twice to help train Zulu medical personnel in the practice of male medical circumcision.
So compelling is the evidence of circumcision as a protection against AIDS that physicians there are all but competing to remove the highest number of foreskins per day, Malowany tells ISRAEL21c. Learning the age-old practice from top-notch Israeli surgeons and nurses, some 100 trained doctors and nurses in South Africa have so far taken their skills back to their own hospitals. Up to 50 circumcision operations can be performed per surgeon, per day, according to the protocol.
"The evidence," says Malowany "is always about context and good science. KwaZulu-Natal has a huge HIV/AIDS challenge. If the government and the king are willing to stand up and say that ‘our men need to be circumcised,' then that's a pretty good argument for delivering male adult circumcision."
Ancient practice meets modern need
Among Jews, baby boys are circumcised on the eighth day of life, in accordance with a biblical commandment. Muslims circumcise their sons by age six, also in keeping with religious tradition. But as a medical practice, removing the foreskin has been found to dramatically reduce HIV transmission based on scientific studies, including three controlled trials in Uganda, Kenya and South Africa in 2007.
(Male circumcision is not to be confused with female circumcision, which mutilates the female genitalia by removing the clitoris partly or entirely. Jewish Israeli doctors are against this practice, although it is still reportedly done in some Bedouin communities in Israel.)
Working in Africa by invitation only, volunteer doctors and nurses under the Israeli umbrella group Operation Abraham, as part of the JAIP project, have twice traveled to Saint Mary's Hospital in KwaZulu-Natal to teach high-volume male circumcision. The team at the clinic in the region of Durban includes Zulus, Muslims and Hindus, making it an extraordinary experience, Malowany relates.
More than two decades of education
The impact factor of JAIP is in the millions. In Latin America, Israeli HIV/AIDS education has become part of the school curriculum in some countries. The all-volunteer JAIP has set a model for educating citizens of developing nations on how to stay protected from the deadly HIV virus.
Since its early beginnings in 1986, the NGO has worked locally in Jerusalem, nationally in Israel and internationally through materials utilized in about 30 countries, in coordination with groups such as the World Health Organization and UNAIDS. JAIP was commended by the United Nations in 2006 for its approach.
Not long ago, founder Dr. Inon Shenkar returned from Myanmar, where he trained AIDS educators. It's his mission, he tells ISRAEL21c, to show that Israel is much more than a country in conflict.
One of the special projects he has helped developed employs icon-based flashcards carried by backpackers wherever they roam. When they encounter villagers on their travels, they show the cards and explain via smiles and images how the virus spreads, and how to prevent contracting it.
In Africa, JAIP is active in Swaziland, Ethiopia, Senegal, Uganda and South Africa.
More funds are being sought to continue circumcision training in KwaZulu-Natal. The group also has invitations from Uganda and Swaziland, where JAIP ran pilot training sessions in 2007 to 2008.
"If 100 doctors could circumcise 1,000 men every month, for every 10 we could avert one case of HIV," says Malowany. "For conservative estimates, that is 5,000 people in KwaZulu-Natal."