November 26, 2008
African AIDS fight uses Israeli circumcision skills
In a clinic in Swaziland, Israeli doctors have been training their counterparts in male circumcision, hoping expertise in the ancient technique will help in the battle against the modern scourge of AIDS.
The United Nations announced last year that the procedure could reduce the rate of HIV transmission by up to 60 percent. It was in Israel, with its experience performing adult male circumcision on a wide scale, that the international medical community found an unlikely partner in the global fight against AIDS.
"Israeli medicine and public health are positioned as a real asset in African countries," said Dr. Inon Schenker, a director of Operation Abraham, the consortium that sent the doctors to Swaziland and plans to send more training teams to Africa. "They recognize the expertise and experience gained in Israel over the past decade, where close to 100,000 [adult] male circumcisions have been conducted."
Israel's accidental expertise in conducting large-scale numbers of adult male circumcisions came with the mass wave of immigration from the former Soviet Union, which brought with it a dramatic rise in men requesting the procedure.
To meet the demand, Israeli hospitals set up special circumcision clinics in five hospitals throughout the country. In turn, Israeli doctors gained unique experience in performing a high number of procedures efficiently.
It's a model organization, such as the World Health Organization (WHO), and the United Nations would like to see it replicated in Africa as a tool for helping combat the spread of HIV.
Answering the call has been Operation Abraham, a team of Israeli doctors and AIDS educators -- Jews, Muslims and Christians -- who this year made three training trips to Swaziland, in what is considered a pilot program that they hope is just the start of their work. The organization has had requests to do a similar training program in Uganda, Lesotho, Namibia, Kenya and South Africa.
Their work is sponsored by the Jerusalem AIDS project and the Hadassah Medical Center, and they hope to recruit surgeons from abroad.
Dr. Eitan Gross, a pediatric surgeon at the Hadassah hospital in Ein Kerem, who was in Swaziland and is the medical director of Operation Abraham, said he was surprised initially to hear that surgery could play a role in preventing the spread of AIDS.
Research has shown that male circumcision reduces the chance of HIV infection. Experts say the scientific evidence has shown that specific cells on the penis foreskin appear to be targeted by the virus. It also has been found that an unremoved foreskin can trap the virus on the skin, making infection more likely.
Gross said he was moved by his time in Swaziland, which has one of the highest rates of HIV infection in the world. The average life expectancy in the country has plummeted to 31 years.
"People came of their own free will," he said. "There was no publicity to draw them.... When we spoke to the men who came, many of them in their 20s and 30s, they told us about living amid the epidemic and what it's like to see so many people die."
Although nearly 30 percent of the world's men are circumcised, the practice is quite rare in many southern African countries, where AIDS has become pandemic.
Dr. Jamal Garah, an Israeli Arab pediatrician, was among the Israeli doctors in Swaziland. He has experience in performing male circumcisions, usually on babies or young children in Israel's Muslim community.
"It's fitting that our project is named after Abraham," he said. "It symbolizes a measure of unity to give the message to other people that we can work together."
Officials from the WHO traveled to Jerusalem in 2006 to gather information on Israel's expertise in the field.
"The circumstances in which adult male circumcision are done in some institutions in Israel are generally of a high standard with few complications," said Dr. Tim Hargreave, a leading British urological surgeon and WHO technical adviser, explaining the organization's interest in Israel's experience.
Drawing in part on Israeli methodology, Hargreave helped author the WHO manual on male circumcision, which along with a teaching course, is being used as part of government male circumcision programs in several African countries.
Dr. Kiron Koshy was one of the doctors working in Swaziland who was trained by the Israeli team. He now conducts as many as 15 male circumcisions a week at a Catholic mission hospital near the Mozambique border -- more than twice the rate he was performing previously.
"I have now learned the technique, and I can work faster," Koshy said in a phone interview from Swaziland. "There are a lot of people coming in for the operation, and I think the numbers are only going to increase."
Meanwhile, in San Francisco, Don Abramson, a former chairman of American Jewish World Service who has been advocating for the project, said he hopes it will help galvanize Diaspora Jewry to fight one of the world's biggest problems. One of his ideas is to encourage Jews around the world to donate money to Operation Abraham whenever they attend a bris.
"My message to Jewish families is that a bris affirms the Divine covenant relationship with the child, but also demonstrates that their friends and family who care about the child celebrate that the child is healthy enough to have a bris," Abramson said. "A contribution to Project Abraham demonstrates a desire for others to be alive and healthy, as well, and could be a life-saving act."