Pro-Circumcision AIDS Researcher Left S.F. a Pariah, Came Back a Visionary

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AIDS researcher Dr. Daniel Halperin is far from the first person to advocate circumcision.

By Joe Eskenazi

A decade ago, Dr. Daniel Halperin pushed his then-controversial theory that male circumcision drastically reduces the risk of contracting HIV and AIDS at a local scientific conference.

It didn’t go so well.

“They said ‘Get this guy to Langley Porter,’” U.C. San Francisco’s psychiatric hospital, he recalled.

Well, that was then and this is now. Halperin – a top Harvard researcher, former UCSF scientist and Lowell High School graduate who was born and raised in the city – has experienced a reversal of fortune. Trial after trial has shown the theory he and “a cabal, a mafia of nerds” pushed about male circumcision was right on the money.

To say Halperin is a frenetic speaker would be an understatement akin to noting John Wayne occasionally portrayed a cowboy. At a recent speech before UCSF’s top scientists, doctors and medical students (that I crashed) he blasted through a three-hour PowerPoint demonstration on the African AIDS crisis in roughly 70 minutes.

Astoundingly, he managed to be uproariously funny while discussing a continental epidemic – and the frequent missteps the U.S. government and others have taken in combating it.

Why, for instance, while a staggering percentage of African sex workers are HIV positive ... (click for more)

-- 78 percent of prostitutes in Accra, Ghana are infected for example -- is only a pittance of money and resources aimed at this population?

“There’s a disconnect where prevention is and where we should focus ... There’s shiny books and all the kids are dancing and singing ‘We don’t like AIDS, we don’t like AIDS,’” said Halperin, who worked for the U.S. Agency for International Development in Swaziland in 2005 and 2006.

“That’s great and it makes the funders feel really great, but is it really the best thing to do epidemiologically?"

Another longstanding assumption has been that AIDS is a disease of war and poverty. And yet, Halperin pointed out, the statistics do not bear this out.

In the 1980s, scientists predicted the AIDS rate in Kinshasa, Congo (formerly Zaire) would top 50 percent by the year 2000. And yet, even now, in the midst of “more war, rape and genocide” than anywhere else in Africa, the current rate in Kinshasa is 3.8 percent.

Counter-intuitively, AIDS in Africa is often an affliction of the rich; as the Notorious B.I.G put it, “Mo’ money, mo’ problems.” In this case, more money means more sexual partners – and you can figure out where this is going.

Halperin (and his “mafia of nerds”) have long pointed to a potent “lethal cocktail” of African AIDS epidemiology: lack of male circumcision and multiple concurrent sexual partnerships.

The foreskin, incidentally, is teeming with Langerhans cells, which act as virtual magnets for HIV; it is nine times more receptive to the virus than any other region on the genitals (it also frequently experiences small tears during sex, which also opens the bloodstream to the virus).

The practice of open marriages and relationships common to much of Africa is virtually a blueprint of how to spread AIDS. First of all, the HIV virus is most contagious in the first few weeks after it has been contracted -- so if one beds two, three or more partners in that time, there’s an excellent chance of passing on the disease. Secondly, while virtually every man in Africa will wear condoms during sex with a prostitute, virtually no one on the continent wears condoms within relationships, even with multiple partners.

The statistics Halperin presented to make his case are telling. In Botswana, for example, only an estimated 15 percent of men are circumcised and 65 percent of men reported “high-risk” sex with multiple partners. That nation’s AIDS rate among adults is an incomprehensible 25 percent. And yet, in Tanzania, 70 percent of men are circumcised and a comparable 52 percent engage in high-risk sex. And Tanzania’s AIDS rate is 7 percent.

Meanwhile, in Ethiopia, 75 percent of men are circumcised and only 21 percent are swingers, resulting in a 2 percent infection rate.

(You can see this data and a cavalcade of other material from Halperin’s PowerPoint presentation here; scroll down to the bottom and click on the Halperin sections)

Following his San Francisco speech, Halperin told me that serious efforts need to be made to promote circumcision and encourage Africans to reduce their number of sexual partners. The current administration would rather promote abstinence, he noted, but even a slight cutback in sex partners would make a huge difference, and is a more realistic goal -- “I’m not some flag-waving abstinence lover, but if you reduce your number of partners, HIV is going to go down.”

Yet, for a man who has spent 15 years fighting the spread of HIV, Halperin has staked out some counter-intuitive positions. In a Jan.1 New York Times op-ed, he postulated that, perhaps, too much money is being spent on African AIDS prevention.

While infected children are often treated in state-of-the-art facilities with expensive drugs, those suffering from diarrhea, dysentery, malaria and the like are often left to die. Those last three maladies, incidentally, claim far more lives than AIDS. Only a pittance has been spent to provide clean water and prevent these rather preventable conditions.

At his San Francisco speech, Halperin left copies of his Times editorial on the table.

“If all you care about is HIV, don’t take one,” he said with a grin. “If you care about family planning and clean water and stuff like that, take one.”

He paused, and smiled again.

“I’m on death lists now because of stuff like this,” he said.

Presumably, that was a joke.

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