In the past year, 60,000 men have been circumcised in a singleCA

In the past year, 60,000 men have been circumcised in a single province in Kenya, raising hopes that an effective and still underutilized tool for fighting AIDS could gain acceptance across sub-Saharan Africa, where 22.4 million people are HIV-positive.

Michael Stalker, deputy director of the Male Circumcision Consortium, is encouraged. "Without this effort," he says, "you would have an estimated 15,000 more people with HIV in this one province in Kenya."

The consortium was formed after randomized controlled trials in Kenya, Uganda and South Africa revealed that male circumcision reduces the risk of heterosexually acquired HIV infection in men by 60 percent. With an $18.5 million grant from the Bill and Melinda Gates Foundation, the consortium is mounting a "full-court press" to train clinical officers and nurses to supplement the supply of doctors now performing circumcisions in the western Kenyan province of Nyanza on the shores of Lake Victoria.

Michael Stalker

Male patients are circumcised at a clinic in Kenya.

Dr. Wycliffe Omondi, who performs about two dozen circumcisions a day there, personally reflects the delicate ethnic and cultural issues surrounding male circumcision. The program's prime target is the Luo tribe, which traditionally does not circumcise and which has an HIV rate roughly double the national average. Omondi, who is Luo, was voluntarily circumcised while in college. The Kikuyu, Kenya's most populous tribe, circumcises its teenage boys during the traditional rite of passage to manhood.

The bloody violence that swept Kenya after the disputed 2007 election brought this cultural divide into stark view, with Luo and Kikuyu trading vicious insults about who was civilized and who was not, as the country plunged into violence.

"Now that (the circumcision program) has become public, men are coming openly," Omondi said in a published report, noting that he has circumcised males ranging in age from 8 to 85. "They are coming in large numbers."

Moreover, AIDS has been bumped

Moreover, AIDS has been bumped out of the medical limelight by the H1N1 flu virus. But the "swine flu" has killed fewer than 6,100 people, according to the CDC; 14,000 AIDS patients die annually.

Yanzhong Huang, director of the Center for Global Health Studies at Seton Hall University in New Jersey, said the public may ignore the AIDS issue because people feel they aren't at risk for getting the disease. AIDS can be managed with drug treatment, he said, but "still, it kills people."

Oldham said too many younger people aren't taking precautions to prevent getting the disease because they don't remember the horrors of the early years of the epidemic in the 1980s. Oldham was living in New York City when he was diagnosed 20 years ago and started a sad cycle of attending friends' funerals.

"My entire circle of friends was dying," he said. Many were dead within 30 to 90 days of diagnosis. As they wasted away, he said, some hospital personnel were too afraid of the new disease to even bring the patients their meals.

Now, he points out, HIV patients can live 20 to 25 years after diagnosis, many with treatment from anti-retroviral drugs. And new medicines are so recent that it's unclear how long they will prolong the lives of infected people but could give them close to a normal life span, said Judith Feinberg, professor of medicine at the University of Cincinnati and an AIDS researcher for 25 years. "This is not an automatic death sentence anymore," she said.

But that rosier picture has led to some complacency in following safe-sex practices, Oldham noted.

AIDS is the No. 1 cause of death among African-American women ages 25 to 35, he said. Their rate of infection is 15 times that of white women, according to the CDC.