Aids experts have called for a mass circumcision programme in South Africa, condemning the "deafening silence" from policymakers since studies revealed the procedure sharply cut infection rates.
As scientists this week questioned a lack of movement on using male circumcision as a preventative method, delegates at South Africa's Aids conference called for a mass circumcision programme.
This year the World Health Organisation (WHO) recommended the procedure after three studies in Africa showed it reduced chances of contracting HIV by up to 60percent.
But though countries such as Kenya, Malawi, Swaziland, Zimbabwe, Mozambique and Tanzania have drawn up plans for widespread circumcision, the South African government has done nothing to date.
"I think by now I would support people starting to think about a mass circumcision campaign," said Neil Martinson of the perinatal HIV-Aids research unit.
Martinson said concerns over whether South Africans thought it was a culturally acceptable practice that would lead to risky sexual behaviour were not proven to be valid.
"In South Africa, high proportions of men and women find it acceptable to be circumcised, people [in the studies] weren't going around and sleeping around more because they didn't have a foreskin."
With an Aids vaccine years away, the focus has turned to HIV prevention and the conference aims to build consensus about ways to do this.
"I am surprised there is no action on male circumcision. Where are the male activists? Studies show a 60 percent reduction [in risk] but there is silence," Glenda Gray, who will oversee the first HIV-vaccine trials run in the country, said.
The primary investigator into the first circumcision trial held in South Africa, Bertran Auvert of the French Institute of Health and Medical Research, said it was time for implementation.
"It's not even my opinion. It's now a WHO recommendation."
In some cultures in South Africa circumcision is seen as a rite of passage into adulthood, and boys go to initiation schools where they are circumcised with a spear-like instrument.
Critics of the mass use of male circumcision to combat HIV, like Tim Quinlan from the University of KwaZulu-Natal's Health Economics and HIV-Aids Research Division (Heard), said there was a danger of jumping to use male circumcision without it forming part of a larger package of measures.
He questioned the fact that circumcision only protected men, and not women who were at a greater risk of contracting the virus.
But Professor Alan Whiteside, also based at Heard, called for the "routine offer of circumcision for every male child born in a public hospital. It is so blindingly obvious that there are real reasons for circumcision. What we need is informed advocacy and communication." - Sapa-AFP