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Video: Africa cuts AIDS

Male circumcision helps Africa fight AIDS, but it isn't the sole solution.

In Kenya, in particular, circumcision is deeply tied up with male identity. The Luo tribe are the third largest ethnic group in Kenya, estimated to make up 13 percent of the country's 39 million people. The Luos do not traditionally circumcise.

In Kenya’s 2007 presidential election a Luo candidate began gaining strength in the polls, only to have some Kenyan newspapers mock his uncircumcised status, asking: How can a nation of men be led by a boy? These barbs go back to colonial times, when British authorities stoked cultural divisions to sow tribal enmity.

When circumcision was first introduced as a way to reduce HIV infections, the Luo Council of Elders balked. AIDS activists countered that circumcision was a medical intervention, not a cultural conversion. Luo parliamentarians joined the pro-circumcision bandwagon, testifying about their own positive experience under the knife. The tribal elders quickly bowed to political pressure from a community apparently ready to throw off tribal custom and join the modern world.

Along Lake Victoria, fishermen contemplating circumcision say that in addition to the health benefits, questions of manhood were very much on their minds. Fishermen said that circumcision had made them "perform better," feel more virile and last longer during sex.

“Some take drugs to have sex, but I just cut the foreskin,” said one 30-year-old fisherman, Julius Soba. “Circumcision is my stimulant!”

Local mobilizers trying to convert as many as possible to circumcision haven’t dissuaded them from this notion. More often they defer to existing cultural associations of circumcision with male potency and prowess. Women also got the message. A study in 2000 showed that 62 percent of Luo women said they preferred sex with a circumcised man. This was years before the pro-circumcision message was officially sanctioned. And since the Luo are uncircumcised, their preference was probably not based on direct experience.

“The truth is that sex is in the mind,” said Dishon Gogi, with the Nyanza Reproductive Health Society. Gogi criss-crosses Lake Victoria in a motorboat he calls the "circumcision boat," ferrying trained surgeons and supplies to the fishing communities. “If a man feels that he is stronger, he is stronger! If he feels he is a lion, he’s a lion! I only ask that they do it safely.”

Gogi’s boss, Dr. Kawango Agot, sounded a note of caution. If circumcision encourages people to have sex with more partners, or riskier sex, she noted, it will negate the benefits of circumcision and speed up the spread of AIDS. “That would be a disaster,” she said.

The genie is already out of the bottle. “It is demand driven!” says Dishon Gogi. He shows me the packed schedule of upcoming site visits for his circumcision boat. “Wherever we’re called we’ll answer. Like the Bible says, ‘wherever we’re called we’ll go.’”

More GlobalPost dispatches about male circumcision in Africa:

Video of circumcision, a Kenyan doctor gives his personal thoughts about circumcision, a South African doctor talks about the drive in southern African countries, a health specialist gives her controversial opinion about the male circumcision campaign.