Law puts HIV prevention at risk

Belinda Beresford

South African researchers and doctors are worried that a new law intended to protect young men from death or mutilation as the result of circumcision may weaken the potential use of circumcision to curb the spread of HIV.

This month President Thabo Mbeki signed into law the Children’s Act, one of whose clauses bans circumcision of male children under the age of 16 except when “performed for religious purposes in accordance with the practices of the religion concerned”, or “for medical reasons on the recommendation of a medical practitioner”.

HIV/Aids experts are concerned that the latter qualification is too narrowly defined and may not allow parents to choose to have their sons circumcised on health grounds to reduce chances of HIV infection when the child becomes sexually active.

Some have also questioned why circumcision is not regulated as a medical procedure and allowed as long as certain minimum sanitary and safety guidelines are followed.

Legal experts have also expressed concern that by allowing circumcision on religious grounds, the Act unfairly discriminates against people who are not religious. One expert pointed out this could mean that agnostics would have to get medical permission to circumcise their children, whereas Jewish and Muslim parents would not.

CEO of the Human Rights Commission Tseliso Thipanyane said his organisation had lobbied for greater regulation of circumcision because of the young men who died or were mutilated because of botched or unhygienic circumcisions in some traditional initiation schools.

By last week 16 young men were reported to have died as the result of circumcisions in “initiation schools” in the Eastern Cape region.

Michael Masutha, a member of Parliament’s social development committee, which oversaw the legislation, said the Children’s Act would not take full effect until at least 2008, after the implementing regulations were framed by the relevant government department.

Masutha said the regulations would clarify how broadly the phrase “medical grounds” should be read. There was no intention to ban circumcision, only to regulate it more effectively.

The provinces currently have different rules on male circumcision — the Eastern Cape, for example, bans the circumcision of children under the age of 18.

However, Jonathan Berger of the Aids Law Project said that while “medical grounds” could be interpreted to allow circumcision on hygienic grounds, “it is not a good idea to have such uncertainty in the law and to wait for the matter to be resolved in court. Either medical reasons should be defined or the clause should be amended to allow for general health reasons”.

Last year, research at Orange Farm in the Vaal area found that circumcision of adult men appeared to reduce their risk of contracting HIV by up to 70%. Research in Uganda has suggested that HIV-negative women are 30% less likely to catch the virus from their HIV-infected partners if the latter have been circumcised.

Trials similar to those in Orange Farm are under way in Kenya and Uganda. If they replicate the South African findings, it would intensify pressure on governments to add circumcision to the list of prevention strategies.

The Botswana government recently mandated counselling of all mothers of newborn boys on the potential health benefits of circumcision.

Circumcision is a highly emotive issue, with some lobby groups likening it to female genital mutilation. The Children’s Act bans the latter outright.