South Africa's health minister took another controversial foray into the AIDS debate Thursday by questioning international medical studies that say circumcision helps reduce HIV infections in men.
Manto Tshabalala-Msimang, who frequently clashes with foreign experts on how to deal with this nation's world-worst AIDS epidemic, said there wasn't "enough information" to justify the government running roughshod over some local communities whose traditions frown on circumcision.
Her comments were the latest in a string of positions that have earned Tshabalala-Msimang sharp criticism from AIDS activists, leading one expert to say the statement showed she is "addicted to folly."
Tshabalala-Msimang voiced doubts about the circumcision studies on the sidelines of a meeting of South African traditional leaders. Many of those leaders portrayed the advice on circumcision as a Western attempt to force foreign values and solutions on Africans.
South Africa has an estimated 5.4 million people infected with the AIDS virus — the most of any nation.
The United Nations says there is compelling evidence circumcision reduces the risk of men contracting the AIDS virus by up to 60 percent. The World Health Organization and UNAIDS last March endorsed male circumcision as an "additional important intervention."
The advice was issued following three extensive trials in South Africa, Kenya and Uganda that showed circumcision dramatically reduced men's susceptibility to HIV infection because the cells in the foreskin of the penis are especially vulnerable to the virus.
One study projected that in the next decade, male circumcision could prevent 2 million AIDS infections and 300,000 deaths.
Tshabalala-Msimang said she was not convinced, noting South Africa's Xhosa ethnic communities suffer high AIDS infection rates even though nearly all Xhosa men are circumcised. However, the infection rate is even higher for Zulus, for whom circumcision is taboo.
The health minister also said male circumcision offers no protection for women, who bear the brunt of the AIDS infections in sub-Saharan Africa.
"I can't say to people they must get circumcised when the process (of research) is ongoing," she said. "I can't go and say things to people which I can't guarantee."
Stephen Lewis, the former U.N. AIDS envoy for Africa and a strong critic of Tshabalala-Msimang, said the comments were typical of an official who has espoused garlic and lemon as a remedy for AIDS and openly mistrusts anti-retroviral medicines used to treat infections.
"She remains a minister who is addicted to folly," Lewis said in an interview from Canada. "There is overwhelming scientific evidence that male circumcision is one of the important ways of preventing transmission of the virus. This is proven beyond a shadow of a doubt."
Rwanda, Uganda, Zambia and Swaziland are among the African countries incorporating male circumcision as part of government AIDS prevention strategies. The United States and big donors like the Bill and Melinda Gates Foundation have said they are willing to fund such programs.
Swaziland, where an estimated one-third of the population is infected, has set up a circumcision task force even though Swazi culture is similar to that of Zulus, who fear circumcision will undermine their warrior traditions.
Twelve Swazi doctors, a tenth of the country's total, are being trained to perform the operation. The country's rate of circumcisions has increased from a couple a week to more than 10 a day, said Inon Schenker, head of an Israeli training mission in Swaziland.
"I meet almost everyone who comes into the operating room," Schenker said in a telephone interview. "I ask them, `Why did you come?' and 90-plus percent say, `This is going to allow us to be healthy.'"
He said every Swazi man who undergoes circumcision is counseled that the medical procedure alone does not offer complete protection against the AIDS virus and continued condom use is essential. They are also told they must wait until the wound heals before having sex.