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Sunday Times-South Africa
Orange Farm gives world hope

<p>Katharine Child</p>


July 15, 2013

IT'S an unassuming township: large, sprawling and poor. But it is the origin of the research that showed the world that medical circumcision has reduced the probability of contracting HIV.

The science developed in Orange Farm, south of Johannesburg, has changed the lives of two million Africans.

In the simple Boipelo Clinic, with its amateurishly painted signs, more than 50000 men have been "given the snip" and come to no harm.

Microsoft founder Bill Gates has visited the clinic and acknowledged the research done there by French scientist Bertran Auvert and South Africa's Dr Dirk Taljaard.

More recent research at Orange Farm has shown that removing the foreskin offers up to 76% protection from contracting HIV.

Taljaard said medical circumcision is effective because the foreskin has a high number of the "receptor cells that HIV targets".

In the past six weeks, the staff at Boipelo Clinic have performed about 120 circumcisions a day.

"It's busy season," said Dr Dino Rech, one of the founders of the Centre for HIV and Aids Prevention Studies, which runs the Orange Farm clinic and 24 others.

Winter is circumcision season because it is believed that the penis heals more quickly when it is cold.

Men and boys have been queuing from 5am to be circumcised.

The clinic's doctor, nurses and administration staff look exhausted.

Rech said it was safe to assume that the clinic's doctor, Thabo Mashigo, had done more circumcisions than any other doctor in South Africa.

With 25000 snips under his belt, he has earned his nickname, "Dr Circumcision".

"I don't want to turn men away," said Mashigo, who takes less than six minutes to do the job.

Mashigo has worked with traditional healers in Gauteng to offer medical circumcision to pre-initiates.

The youths then "go to the mountain" for the customary ceremonies after a safe operation.

One of Mashigo's patients, Pheello Komane, a communications student from Sebokeng, arrived for a check-up two days after his operation.

Komane refused to give in to family pressure three years earlier that he have a traditional circumcision.

"I didn't want any regrets," he said. "This way it's safe; it's convenient."

He told his family he was "too weak" to have a traditional circumcision but his uncles were angry.

"You must be blunt with your family. If they love you enough they will support you," Komane said.

"Circumcision is a private thing but I am willing to go public so that people have knowledge."

Komane said he was terrified and thought he would die but nevertheless watched the operation.

"I saw scissors going through my dick and cutting."

Fellow patient 18-year-old Kagiso Motswoenyane said women preferred circumcised men and "there are certain things a woman won't do [in bed] unless you are circumcised".

TIMELINE

  • In 2002 French scientist Bertran Auvert and South African public-health researcher Dirk Taljaard design a study to measure the effectiveness of circumcision in reducing the rate of HIV infection: 1500 men living in Orange Farm are circumcised; another 1500 constitute a control group and are not;
  • By 2004, there are 49 HIV infections in the control group but only 20 in the circumcised group. This translates into the probability of the circumciseded not contracting HIV improving by 61%;
  • The research is stopped when it becomes evident that circumcision is effective in countering HIV but the members of the control group are not being afforded protection;
  • The results are published in the journal Plos in 2005;
  • Almost identical results from similar studies in Rwanda and Kenya soon follow;.
  • In 2007, doctors at the Orange Farm clinic decide to quicken the pace. They design a disposable pack with all the instruments, gloves and medication needed. Nurses are trained to give the preparatory injection and finish the stitching so that the doctor is needed for only six minutes of the procedure. Doctors move from one operation to the next, where a nurse has prepared and anaesthetised another patient;
  • The Orange Farm doctors have changed a 40-minute operation into one done in 20 minutes.
  • World Health Organisation officials adopt the production-line technique as a standard protocol for high-speed, safe circumcisions;
  • In 2010, further research at Orange Farm shows that circumcised men have 76% less chance of contracting HIV than uncircumcised men;
  • Women in Orange Farm are canvassed and 60% say they prefer men who have been circumcised, about 10% prefer uncircumcised men and some have no preference. The overwhelming reason given for preferring a snipped man is cleanliness.


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