HIV This Week

Peltzer K, Kanta X. Medical circumcision and manhood initiation rituals in the Eastern Cape, South Africa: a post intervention evaluation. Cult Health Sex. 2009;11(1):83-97.

The objectives of this study were first, to report the adverse events reported following male circumcision performed by medical professionals after a one-day training workshop; second, to report on the attitudes towards, beliefs surrounding and experiences regarding circumcision and initiation; and third, to assess the HIV-risk behaviour of young men attending initiation schools post medical circumcision. Initiates who had been medically circumcised by trained healthcare providers were examined and interviewed on the seventh day after circumcision and, in addition, focus-group discussions were conducted with initiates. Results indicate that of the 78 initiates physically examined on the seventh day after circumcision by a trained clinical nurse, seven (9%) adverse events (complications) were found. Initiates reported mixed attitudes towards combining medical circumcision with traditional initiation. The majority of the initiates (70%) felt that they could be stigmatized as a result of choosing medical rather than traditional circumcision and 20% thought that the relationship between medical and traditionally circumcised men was hostile. Prior to circumcision, most initiates (92%) had been sexually active and had engaged in HIV-risk behaviour. Focus-group discussions revealed that sexually active initiates, when asked about sex after circumcision, indicated they wished to abstain for a short period before resuming sexual activities with intended condom use being high. Findings are promising for efforts to up-scale integrated medical circumcision alongside traditional initiation into manhood.

Editors' note: As discussions with traditional leaders in some settings are showing, traditions are not static and synergies can be constructed between traditional and clinic-based systems for male circumcision. Traditional circumcision teaching can be adapted to include reproductive health and life skills. These would be added to the traditional community mobilisation and emotional, social, and philosophical aspects of the preparation for circumcision and for relations with women. Community discussions can highlight the improved safety of clinic-based circumcision and pre-screening for sexually transmitted infections (30% of the study participants had a sexually transmitted disease diagnosed in the previous 12 months) while exploring the extent to which participant perceptions of possible stigma would actually reflect current and evolving realities in traditionally circumcising communities.