Medical male circumcision involves the surgical removal of the foreskin, which is important in HIV transmission because the inner part of the foreskin is highly susceptible to HIV transmission. Since 2007 the World Health Organisation (WHO) reported that Medical Male Circumcision (MMC) can reduce the sexual transmission of the HIV virus from females to males by up to 60 percent.
The WHO and UNAIDS identified South Africa as one of the fourteen priority countries that need to scale up MMC, through encouraging medical circumcision as part of a comprehensive HIV prevention package. In response to this, the South African Government in 2010 has encouraged boys and men (aged 15 to 49) to undertake Voluntary Medical Male Circumcision (VMMC) and has rolled out large-scale MMC service delivery sites across the country. The target for 2016 is to reach 80 percent of eligible HIV negative men.
Like any surgery, MMC does pose risks, but these are mitigated when the procedure is performed by a well-trained healthcare provider and post-operative care is explained thoroughly and the patient follows the post-operative advice (such as abstaining from sex for six weeks after circumcision). Circumcision on its own cannot prevent HIV infection, and only provides partial protection, and thus ordinary prevention methods (such as condom use) continue to be recommended.
The Constitution protects both an individual’s right to health, and their right to practice a culture or tradition of their choice. Traditional male circumcision (TMC) is practiced in a number of South African cultures. TMC represents a rite of passage from boyhood to manhood, without which the adult status of the initiate is not fully recognised. Whilst TMC is of great cultural significance, when not safely undertaken, the risks are great both during initiation and after circumcision takes place.
In ordinary circumstances TMC is not performed by a trained medical practitioner, and as a result non-ideal conditions for circumcision have often occurred. In the past decade, a number of young men have died whilst undergoing TMC from causes such as dehydration, renal failure, botched circumcisions and genital mutilation, or infections as a result of improper dressings of the wound. TMC initiates are rarely tested for HIV before undergoing the practice, increasing the risk of HIV infection in cases where improper sterilization of implements occurs. In many cases the same blade is used on all initiates. In addition, where a circumcision is not fully complete, the remaining damaged foreskin can increase the risk of HIV infection, rather than reduce it.
TMC forms an important part of many South African men’s identity, and as such efforts should be undertaken to facilitate safe circumcision practices in the context of TMC.
JPS Africa collaborates with traditional circumcising communities and traditional leaders to support circumcision practices in a manner conducive to result in safe and effective circumcisions. JPS Africa is already partnering with the Provincial Departments of Health in Mpumalanga, Gauteng, and Limpopo to complement their existing MMC programmes. An important part of this is working with other HIV partners in key districts to ensure that care starts before initiation practices and continues post-operatively. In this way, the medical benefits of MMC can still be felt, without diminishing the cultural importance of TMC practices.
