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    Circumcision: New Weapon Against AIDS?

    Circumcision Gives Men up to 60% HIV Protection; WHO, UNAIDS Urge Adult Surgery

    Who Will Pay?

    The recommendations have one major drawback: money. Although WHO and UNAIDS say they will provide technical support to any nation that wishes to start a circumcision program, details on funding such programs remain vague.

    The WHO and UNAIDS say only that funding must not come at the expense of funding for other health care programs or HIV prevention programs.

    "Money is going to be the key. If additional resources brought to bear, we can have very substantial effects on the AIDS epidemic in East and Central Africa," Gray says. "These are not cheap resources. There are the costs of training, the costs of equipment and supplies, the costs of all the complexities of providing surgeries and providing postsurgical care and managing any problems that arise."

    If money is not forthcoming, the recommendations may do more harm than good. Men in areas with high HIV prevalence are very much aware of the news that circumcision lowers HIV risk.

    "There is a lot of anecdotal evidence that men already are lining up asking for circumcision," Gray says. "And if we do not provide safe services, they will seek unsafe services."

    The same message comes from Kim Dickson, MD, medical officer at the WHO department of HIV/AIDS.

    "In certain countries we have reports of interest by men for male circumcision services," Dickson said at the news conference. "Yes, if safe services are not in place, then there will be practitioners who will provide unsafe services. The thing that must be done is to set up safe circumcision services with trained practitioners."

    Despite this major obstacle, Gray is highly optimistic.

    "It is doable," he says. "This one-time procedure is likely to confer very long -- perhaps lifelong -- reduction in HIV risk."

    Meanwhile, studies are under way to determine whether male circumcision reduces women's HIV risk and whether circumcision offers protection to homosexual men.

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