KIGALI, Rwanda - His friends were doing it. His high school biology teacher recommended it, for health reasons. Finally, his girlfriend insisted on it. So one morning about a year ago, Guillaume Gatera, 19, walked into a busy private hospital in Kigali, Rwanda's capital, plunked down about $40 and was circumcised.
"It was less painful than I expected," the lanky student recalled recently, nursing a mango juice at a terrace cafe and exhibiting not a trace of squeamishness. "Actually, I felt proud. After I did it, three or four of my friends went and did it too."
It may seem an unlikely trend, but more and more men in Rwanda and other African countries are being circumcised, spurred by new medical research showing that it greatly reduces the risk of contracting HIV.
On a continent ravaged by AIDS, the health imperative is overturning centuries-old beliefs about circumcision, which most traditional African cultures practice as a male rite of passage but many societies do not. Only 1 in 5 African men are thought to be circumcised. In Rwanda, an overwhelmingly Christian nation, the local word for the practice is "gusilamula," which means to make oneself a Muslim.
With experts worldwide now touting it as a simple and proven method of fighting HIV - though far from guaranteed - Rwandan health officials plan to launch a nationwide campaign this year to dispel myths and encourage men to be circumcised. The country's health minister, Innocent Nyaruhirira, said recently that the voluntary campaign would begin with soldiers, police officers and university students.
In a country where some 20,000 people die of AIDS every year, many young men aren't waiting, however. One nurse, Justin Gatete, said he'd done more than 1,000 circumcisions at a Kigali clinic last year alone.
"When it's something to do with life and death," Gatera said, "you ignore the cultural aspect."
For years, epidemiologists have observed that HIV is more prevalent in pockets of the world, such as southern and parts of east Africa, where men tend not to be circumcised. But it was only last March - after studies in Kenya, Uganda and South Africa found that men who were medically circumcised were 60 percent less likely to acquire HIV during heterosexual sex - that the U.N. World Health Organization endorsed it "as an additional important intervention" against AIDS.
The findings had immediate implications for Africa, home to two-thirds of the 33 million people worldwide living with HIV. Unlike in the United States, AIDS in Africa has spread primarily through sex between men and women. Despite the growing availability of lifesaving drugs, the U.N. estimates that 1.6 million people on the continent died of AIDS-related illnesses last year.
Researchers think that cells in the foreskin of the penis are especially vulnerable to HIV. Surgically removing the foreskin through circumcision also thickens the skin on the penis head, helping to resist infection. U.N. experts think that widespread circumcision in Africa could prevent 5.7 million HIV cases and save 3 million lives over the next 20 years.
"It's the most effective prevention method we know about for heterosexual guys, if it's done properly," said Robert Bailey, an epidemiologist from the University of Illinois at Chicago who led the studies in Kenya and Uganda.
The Bush administration has pledged money from its mammoth, $15 billion global AIDS program to help make circumcision more widely and safely available in countries that want it. Already, Kenya, Swaziland and Zambia have decided to make the service available in public clinics.
In Rwanda, a tiny nation in the forested hills of central Africa, American government experts are helping the government formulate its campaign. Rwandan officials want to slash the cost of the procedure - as high as $55 at private hospitals and clinics, well out of reach of most people - and ensure that basic medical insurance covers it.
"We're not going to wake up one morning and have all men be circumcised. We need to see how best to implement this," said Anita Asiimwe, the director of the government's Treatment and Research AIDS Center.
Rwanda has made strides against AIDS thanks to a huge influx of money from the United States and other donors. Six years ago, the U.N. estimated that 8.9 percent of Rwandan adults were living with HIV; by last year that had fallen to 3 percent.
But Rwanda still has one of the poorest health-care systems in the world, with 400 doctors and about 3,600 nurses serving a population of more than 8 million. Experts warn that circumcisions that aren't performed by trained medics using modern equipment could have no benefit, and may even raise the risk of infection.
Gatete, the Kigali nurse, said that he saw dozens of cases of botched circumcisions every year, often done by ritual healers.
"There are infections, and I have to treat the wounds," Gatete said. "They don't do it the way you're supposed to. You can't trust those ceremonial methods."
Medical professionals also worry that men will engage in unsafe sex if they think that being circumcised is a cure-all. The U.S. Agency for International Development has said that "it is essential for countries that are considering incorporating male-circumcision delivery to place it within a comprehensive HIV-prevention package" that includes promoting condom use and other behaviors.
Health Minister Nyaruhirira has warned circumcised men not to think they have a "green light for promiscuity."
There's growing awareness of circumcision's benefits and limitations among the young and educated in Kigali. Science teachers tell their students that it's hygienic, and counsel them to have it done during Christmas or Easter holidays so they have a few days to heal.
Ebenezer Ntabwoba, 24, said high school friends had mocked him when they learned that he wasn't circumcised, calling him unclean. Before he went off to college last year, he went to a hospital and had it done.
He urges his friends and relatives to follow suit. Peer pressure among young men is a powerful force, he said, but there's another reason why guys are doing it.
"Girls don't like a guy unless he's been cut," Ntabwoba said. "They ask, `Why are you like that?' That's a strong motivator."
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