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During the first year of life, an uncircumcised boy is 10 times as likely to develop a kidney infection as is a circumcised infant. These serious infections are caused by fecal bacteria binding to the moist undersurface of the foreskin and moving up the urinary tract. The predominance of kidney infections in uncircumcised infants was first described in the 1980’s coincident with an increasing move from cloth, to paper-lined to super-absorbent polymer diapers. Leakage of loose stools, common with cloth and paper-lined diapers, is prevented by the new polymer diapers.

Superior fluid absorption means that the diapers remain dry longer, necessitating less frequent diaper changes. Infective fecal bacteria are thus kept closely in contact with the foreskin for a longer period, increasing the chance of infection. Kidney infections in uncircumcised infants below the age of 1 year can result in kidney scarring and abnormal kidney and hormonal function. Further, the infection can spread to the bloodstream and have fatal consequences, particularly in babies below the age of 2 months.

The health risk of efficient absorption of body fluids was pointed out over 20 years ago, following an outbreak of “toxic shock syndrome”, a severe often fatal infection. It was noted that this disease followed the introduction of super-absorbent vaginal tampons, which promoted longer retention of the tampon in the vagina. Pathological bacteria were given more time to grow and produce dangerous toxins, resulting in shock, and death in some cases. The super-absorbent tampons were recalled from the market.

There is evidence that the risk of kidney infections in uncircumcised infants is increasing. In the 1980’s it was found that about 1% of uncircumcised infants developed kidney infection. Recent studies from California and Sweden indicate that this has risen to 2% of uncircumcised infants. Can this disturbing trend be tied to the increasing use of super-absorbent polymer diapers? Answering this question may prove to be difficult, given the continued efforts of the multibillion-dollar disposable diaper industry to develop increasingly absorbent diapers (New Yorker magazine, November 26, 2001) and the current absence of relevant research studies on this issue.

Ignoring an Important Weapon Against AIDS

Since 1987, when it was first reported in leading scientific journals that circumcision protects against HIV/AIDS , many studies have confirmed that uncircumcised men are from 3-7 times more likely to acquire HIV infection following heterosexual exposure than are circumcised men. The most recent research from a study in India ,starting in 1993, found an 8-fold increased risk in uncircumcised men . A report from the U.S Agency for International Development (USAID) this year reviewed 28 studies relating the HIV/Circumcision connection and found that sexually -exposed circumcised men are half as likely to get HIV as are uncircumcised men. A spokesperson for USAID stated that there is “an incredible preponderance of evidence” of the protective effect of circumcision.

The reason for this protection has been found by Dr Roger Short and his group at Melbourne University in Australia.. The virus in HIV was found to enter the body by sticking to the moist undersurface of the foreskin , where there are specialized cells with HIV” receptors”. The rest of the penis has cells with a keratin covering which keeps the virus out.Dr Short stated in a recent meeting that “if you take the foreskin away you remove most of the receptor sites for HIV, you drastically reduce risk” of getting HIV infection.

Edward Green, an HIV researcher at Harvard, estimated that if all males in Africa were circumcised the rate of HIV could be reduced from 20% to under 5%. AIDS is responsible for over 20 million deaths in Sub-Saharan Africa and millions are infected every year. Dr Malcolm Potts from the University of California earlier estimated that 8 million African deaths from AIDS could have been prevented by circumcision. In view of the enormity of the epidemic , it is difficult to understand why this simple, low risk procedure has been largely ignored by international health and diplomatic organizations to help fight HIV.Would this attitude be different if the AIDS epidemic occured in more developed countries?

Currently over 46 million people are infected with the HIV virus worldwide, the majority in sub-Saharan Africa , and 3 million deaths are expected this year alone. Tens of millions have already died. In the past
15 years many published studies have shown that circumcision helps protect against HIV infection, by eliminating the specialized receptor cells in the foreskin that bind to the virus. A recent statement from the U.S Agency for International Development (USAID) referred to “an incredible preponderance of evidence ” of the protective effect of circumcision . But would circumcision be acceptable to Africans as an intervention against HIV?

Two recent surveys, one in Botswana and the other in South Africa , examined the question.Both countries have a high prevalence of HIV. The South African study took place in the Westonaria area where most of the men were uncircumcised.Of 374 uncircumcised men 70% stated that they would want to be circumcised if the procedure were proved to protect against sexually transmitted diseases. It was concluded that circumcision was perceived positively in this area where the level of circumcision is low.
In the Botswana survey 605 men and women (52% men ) were interviewed and 68% stated that they would definitely or probably circumcise a male child, if circumcision were offered free of charge in a hospital setting. Of 238 uncircumcised men, 145 (61%) said they would agree to circumcision under the same circumstances.The investigators felt that the option for safe circumcision should be made available to parents in Botswana , since the procedure seems to be highly acceptable.

Why aren’t medical and diplomatic agencies encouraging the use of circumcision as an intervention against the devastating HIV epidemic in view of the evidence of benefit and the acceptability by the people at risk