Anti-HIV circumcisions use "dangerous" clamp, say researchers

By Clare Byrne Nov 1, 2010, 13:18 GMT

Johannesburg - South African researchers and unionists on Monday sounded the alarm over the use of a plastic clamp in a government anti-HIV circumcision campaign, which they say causes pain and a higher risk of infection.

In a report circulated by the Congress of South African Trade Unions (COSATU) entitled Money from Mutilation: The Tara Klamp story, the researchers claims the clamp is 'dangerous' and will 'injure thousands of men' in KwaZulu-Natal province.

More than 10,000 men in South Africa's second-most populous province have been circumcised since April under a much-lauded provincial programme to reduce their risk of becoming infected with the deadly HIV virus.

The programme was the idea of Zulu King Goodwill Zwelithini, who called for the revival of circumcision - a rite of initiation to manhood in some African cultures - among Zulu men.

Several studies sugggest men are far less likely to contract HIV and other sexually-transmitted diseases if circumcised.

The KwaZulu-Natal government aims to circumise 2.5 million men by 2014.

But the device used in many of the circumcisions has caused controversy.

The Malaysian-manufactured Tara KLamp works by clamping the foreskin to cut off the blood supply and then waiting between 7 to 10 days for both the foreskin and the clamp to fall off.

The Treatment Action Campaign, a respected Cape Town-based lobby group that campaigns for better HIV prevention and treatment, says a trial of the clamp carried out in South Africa in 2005 showed it caused far more pain and was far more likely to trigger infections than the standard, forceps-guided circumcision technique.

The forceps-guided technique works by pulling the foreskin with a forceps and then cutting it.

In the report endorsed by COSATU, the TAC says the 2005 trial among 69 men in Orange Farm township was stopped after doctors expressed alarm at the results.

A spokesman for COSATU, which represents 2 million workers, said he had 'no reason to doubt COSATU shares the sentiments expressed in the TAC report' which alleges the clamp is being sold by 'shady' businessmen and is calling for it to be withdrawn.

The government of KwaZulu-Natal has, however, defended its use of the device.

Addressing an AIDS conference in Durban last week KwaZulu-Natal premier Zweli Mkhize said: 'To me it does not matter whether you use scissors or forceps as along as it will remove the foreskin safely: halleluiah.'

Provincial health spokesman Chris Maxon said the province was using both the clamp and the forceps-guided technique, and that 'not even a single person (out of those circumcised so far) has had the side effects being alluded to by the Treatment Action Campaign.'

The main advantage of the clamp was that it was much quicker to perform the circumcision - about 10 minutes, compared to 45 minutes for the forceps-guided technique - allowing the province to rapidly scale up the programme, he told the German Press Agency dpa.

The difference in costs between the two methods was minor, he said.

Maxon expressed concern that the allegations against the Tara Klamp would put men off coming forward for circumcision.

South Africa has more people infected with HIV than any other country.

An estimated 5.7 million South Africans, around one in nine, is HIV-positive, with KwaZulu-Natal being one of the worst-affected province.

The World Health Organization says there is 'compelling evidence that male circumcision reduces the risk of heterosexually-acquired HIV infection in men by approximately 60 per cent.'

The WHO, in its 2008 draft manual on how to perform male circumcision using local anaesthesia, recommends three surgical circumcision techniques, requiring varying levels of skill. One is the forceps-guided technique. It makes no mention of the clamp.