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HIV prevention done right

Local control is vital to the success of anti-AIDS efforts in other countries.

July 24, 2012|Daniel Halperin | Daniel Halperin is an HIV prevention and public health researcher based at the University of North Carolina and is the coauthor, with Craig Timberg, of "How the West Sparked the AIDS Epidemic and How the World Can Finally Overcome It."

Fortunately, there are better models in Africa. For years, foreign researchers, such as Robert Bailey of the University of Illinois at Chicago, have collaborated with Kenyans to study why HIV rates were so much higher in Nyanza province, the only part of the country where most men weren't traditionally circumcised. They worked closely with Kenyan counterparts to establish a vigorous national program. Over the last three years, there have been about 400,000 circumcisions in Nyanza, boosting the proportion of men circumcised from 17% in 2007 to about 60% now.

In the neighboring East African country of Tanzania, more than 100,000 circumcisions have been performed in less than two years. And though progress continues to be disappointing in much of southern Africa, there are some promising initiatives, in Zimbabwe and Lesotho, for example. It is estimated that by 2025 about 300,000 HIV infections (about half of those in women), as well as many cases of cervical cancer and other sexually transmitted diseases, will have been averted by these and other new circumcision programs in Africa, and millions more in the decades thereafter.

As Bailey emphasized in an email this month from Kenya: "So much of success is about local ownership and branding. Here, Voluntary Medical Male Circumcision is a Kenyan program, owned and run by the Kenyan government ... but what I've seen in other countries is that the program is run by American contractors. They slap their logo all over everything ... and present the program as theirs."

For The Record
Los Angeles Times Wednesday, July 25, 2012 Home Edition Main News Part A Page 13 Editorial Desk 1 inches; 36 words Type of Material: Correction
HIV: In a July 24 Op-Ed article, the title of Daniel Halperin and Craig Timberg's book was incomplete. It is "Tinderbox: How the West Sparked the AIDS Epidemic and How the World Can Finally Overcome It."

In addition to local ownership, some experts have observed something else that's crucial: Programs are likely to be more effective if they are presented to local communities as part of integrated health services rather than being overly linked to AIDS. But as Bailey also noted, "It's hard to turn the supertanker around" after the emphasis in recent years has been, understandably, so focused on the HIV prevention potential of this ancient and recently revived medical practice.

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