HARARE, Zimbabwe – The U.S. ranks high on President Robert Mugabe's enemies list, but at ground level it is leading a war on AIDS that may help save the life of 32-year-old Tineyi Marokwe and hundreds of thousands of other Zimbabweans.
The weapon is cheap and simple: male circumcision, considered a significant reducer of AIDS transmission.
In a 10-minute surgical operation, Marokwe recently became one of more than a million Zimbabwean men in the most sexually active age group who are being targeted for circumcision during the next seven years.
Dr. Bill Jansen, a senior American adviser with the U.S. Agency for International Development in Zimbabwe, says trials and circumcision pilot programs in South Africa and East Africa have shown a reduction in HIV infection by 60 percent.
The Zimbabwe program, begun in May 2009, has carried out 12,000 circumcisions. The U.S. spent $6.6 million on it in the first year and more money is promised as the program scales up.
It makes a quiet counterpoint to the stridency of Mugabe's confrontation with the West, primarily the United States and former colonial ruler Britain, over the sanctions imposed on his government because of its human rights record.
So vilified are Western nations by Mugabe that few Zimbabweans realize their continuing aid programs are the mainstay of humanitarian assistance to the troubled nation.
The U.S. is Zimbabwe's biggest aid donor — more than $1 billion since 2002 — and the biggest contributor to nationwide modern AIDS clinics that have tested and counseled 2 million people. This month it pledged another $50 million to its wider AIDS programs that include supplies of AIDS drugs.
While Mugabe has done nothing to hinder the program, some volunteers assigned to explain sexual health issues to the poor have been accused by Mugabe's supporters of abetting a U.S. political agenda and working for the opposition in next year's election.
Marokwe says he was afraid to go to the clinic in western Harare, the capital.
"I was worried, but when I came here I learned this could save my life," the unemployed laborer told The Associated Press.
Nurses unpacked one of 60,000 single-use circumcision kits allocated by USAID — forceps, disposable scalpels, needles and gauze — and administered local anesthesia while surgeon Shame Dendere exchanged cheerful banter with Marokwe.
He was told to expect minor pain after the anesthetic had worn off, to abstain from sex for six weeks and to come back three times for follow-up treatment.
The procedure complete, Marokwe dressed and headed to a bus stop to ride home, saying "I'm going to tell all my friends."
The clinic conducts more than 40 procedures a day and expects demand to grow to as many as 180 a day as word spreads.
If the program can circumcise 1.2 million Zimbabwean men by 2017, 750,000 new HIV infections can be averted, Jansen said. The organizers envisage a future stage for the program with circumcision at birth. At present more than 10 percent of Zimbabwean men are circumcised, mainly in tribal ceremonies during early childhood.
While condoms and fidelity remain essential, circumcision helps because the foreskin is more vulnerable to the AIDS virus.
According to Population Services International, an independent family planning and sexual health organization, Zimbabwe's infection rate is about 13 percent of the population, but rises above 20 percent in the 13-30 age group.
The circumcision is free, with USAID picking up most of the cost, helped by the international Population Services group and health care charities, but a nominal fee is being considered because "when something is free, there is a tendency for people not to attach any value to it," said Roy Dhlamini, a PSI social worker.
He said when the U.S. government provided free condoms, many Zimbabweans shunned them. That changed when they were priced at a token 10 U.S. cents.
Besides performing circumcisions, the doctors must cope with misinformation: that foreskins are used in healing rituals and witchcraft, in skin grafts or skin lotions.
"We've seen this in the media and heard it in our interaction with communities," Jansen said.
Fred Togara, 36, a brick maker and father of two, said he knew little about circumcision other than from verses he read in the Old Testament.
He said that after a policeman friend who got circumcised told him about the U.S. program, "I wanted to do this process for hygiene and put safety first."v