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Mention adult male circumcision in conversation in Canada, and the response from most men is a wince, maybe even an involuntary protective hand movement toward the midsection. But there's a six-month waiting list for the operation in Swaziland today — because there, in the country with the world's highest rate of HIV infection, men have heard that having their foreskins removed may protect them from the virus.

Other countries could soon have Swazi-style waiting lists: circumcision was the hot topic of the day at the international AIDS conferences yesterday, when a variety of researchers and even former U.S. president Bill Clinton endorsed it as an effective way to stop the spread of the disease.

No question, the numbers seem to suggest it's worth doing. AIDS experts have speculated about this for years, noting that the rates of HIV infection are much lower in places where all men are routinely circumcised.

The first definitive proof came a year ago when a randomized trial in the South African township of Orange Farm was halted early because the data showed that circumcision gave men who had the procedure a 61 per cent protection rate for infection, compared to men who didn't. Researchers said they couldn't in good conscience keep the trial going without giving the uncircumcised men the chance to get the operation and get protected.

New data presented yesterday compared nearly 2,000 men in Kenya, some circumcised and some not, and found the rate of new HIV infection to be roughly two-thirds higher among the uncircumcised men. Another study found that if 20 per cent of adult men in the South African township of Soweto were persuaded to have the surgery, it would prevent 53,000 new HIV infections over 20 years.

“Even modest programs can convey substantial health benefits and should be implemented immediately,” epidemiologist Kyeen Mesesan said.

Now all eyes are on trials underway in Kenya and Uganda, from which data will be available next year. Should they show results similar to those in Orange Farm, the United Nations may begin to recommend male circumcision as a crucial health intervention much like polio vaccination.

Circumcision lowers the risk of HIV infection because the skin that is removed contains more of the cells to which HIV easily attaches — it cuts off the sticky bits, essentially.

The problem is that adopting male circumcision as a public health measure to stop HIV infection brings with it a great, swampy mess of problems — and those got short shrift in the fervent discussions about the science yesterday.

Circumcision is, of course, much more than a medical procedure. For Muslims and Jews, it's a religious rite. For many of the cultures of east and southern Africa, it's a hugely important marker of boys' transition into manhood. But in cultures that don't circumcise males, that decision is often equally sacrosanct.

How is the World Health Organization, or national governments, going to persuade people to, first, start doing it, if culturally they are non-circumcising people? (Roughly half of African societies routinely circumcise at some point in a man's life.) Second, how do you persuade a society with an elaborate ritual for 17-year-old boys to instead start circumcising infants, on whom it's a much easier operation with far fewer possible complications? Another big concern is that, once circumcised, men will believe their level of risk is so low they won't use condoms (when of course the operation offers no such total immunity) or that youth, hearing about the practice, will get the mistaken impression that they do not need to take precautions, although a study from Kenya presented yesterday found that essentially there was no increase in risky sex among men who were circumcised.

“Is this going to take resources from other known HIV-prevention interventions — will it be taking resources that maybe could be employed in better condom promotion or education?” mused Tim Farley, who heads the sexually transmitted infection control team for the World Health Organization.

The Swazi waiting lists suggest that it's not necessarily difficult to persuade adult men to get the operation. But other acceptability studies in Africa have shown that less than half of men are willing.