The Valley of Life or Death
BBC2 9:00pm Thursday 16th November 2000
the heart of the AIDS epidemic in Africa, there is a deadly mystery
that has puzzled scientists for years. There are groups of people
who are four times less likely to get HIV than other people, sometimes
living just yards away, across a single valley - people with apparently
similar behaviour and lifestyle. Scientists realised that if they
could understand why these people are so much less vulnerable to
the HIV virus, it might lead to an answer that could save millions
of lives. And after 15 years of detective work it turns out there
may be a remarkably simple answer: the high risk areas for HIV coincide
with tribes who are uncircumcised. In Africa, it seems a man is
much more likely to get HIV if he is uncircumcised.
In Kaoma, Western Zambia, a young boy is on his way to the sacred
Mukondaa - the tribal circumcision ground. Around him the tribal
elders are gathered, dressed in their ceremonial garb, and vivid
masks. But the young boy himself is an outsider, not from this tribe,
and none of his relatives or ancestors have ever been circumcised.
In fact, his parents are only prepared to break the taboo of their
own tribe because they believe that circumcision could save his
life by protecting him from AIDS. At first sight this belief seems
like the kind of superstition to which desperate people often turn
in times of plague. But now there is scientific evidence that suggests
these people could well be right.
There have now been twenty seven statistical studies that show a
big difference in HIV infection between circumcised and uncircumcised
men. For example, among the uncircumcised people of Kisumu in Western
Kenya, a man is three times as likely to get AIDS than his circumcised
neighbours. Among truck drivers in Mombassa the difference is four-fold.
'Horizon' travels across Africa, tracing the work of scientists
who have unearthed the statistical data behind this correlation.
At the same time microbiologists have been battling to understand
the complex and insidious virus, and their work indicates that the
foreskin may be a key entry point for HIV. The logical conclusion
for these scientists is that if you remove the foreskin, you begin
to protect the man. No-one believes that circumcision can protect
completely - the evidence so far only indicates that it reduces
the risk of infection by HIV, and then only during heterosexual
sex. Unquestionably, condoms are still the best protection. But
in the many countries where the use of condoms is minimal, it seems
that circumcision might help to reduce the spread of AIDS.
In the absence of a vaccine for AIDS, and the lack of condom use
in the developing world, should governments think the unthinkable
and encourage the circumcision of young boys in non-circumcising
tribes as a public policy? Opposing this idea are the voices of
tribal elders who are loath to change tribal traditions that have
existed for generations, and a fierce Western anti-circumcision
lobby which believes that circumcision is a form of mutilation and
violates basic human rights.