HIV Prevention: Medical Male Circumcision in South Africa

This 29-page formative research report was produced to inform medical male circumcision (MMC) components of The Soul City Institute of Health and Development OneLove campaign. According to the report, there is compelling evidence that male circumcision reduces the risk of HIV infection in men by approximately 60%. The study found that there is general support for men to be circumcised and that there is some, though limited, knowledge about male circumcision.

The study used qualitative research methods and was conducted from August to October 2010. Twenty-six focus group discussions were performed in the nine provinces of South Africa. The research participants were from a mix of urban, rural, informal settlement, and rural-informal residential areas.

The key findings are as follows:

• Knowledge of male circumcision (MC) was high. Most participants knew what MC is, many from their experience with traditional practices.
• Age of circumcision was debated, varying from support for neonatal circumcision to boys only above 18 years old.
• Benefits of circumcision cited by respondents were: health, hygiene, and sexual pleasure. Most participants thought that MC is beneficial.
• The key barrier to MC mentioned is pain.
• There was a lot of discussion about medical versus traditional circumcision, and about the issues involved in becoming a man.
• The foreskin was labelled with many derogatory names.
• Disadvantages of having a foreskin were discussed in detail.
• HIV/AIDS awareness seemed relatively high.
• Male and female perspectives of MC were similar.
• Most people didn’t see a role for women in MC, though some mentioned supporting partners and staying away from them until they had healed.
• Medical MC was considered safe because it is performed by trained personnel, who also check for other diseases.
• Some cultural practices around MC were discussed and criticised; some were supported.
• Most participants felt that medical MC and traditional practices can exist side by side.

The research suggests that there are many similarities among all the groups. The research participants talked openly about their experiences, perceptions, beliefs, and attitudes around male circumcision. There were debates about the merits of both types of circumcision. Generally, there was a strong belief that men should undergo circumcision because participants believed there are more benefits than challenges to male circumcision. Many participants said that they accept that male circumcision should be performed medically at the health services, and some said that as long as the health workers are professionals they would not mind whether they are male or female doctors. Nonetheless, there were more men who felt that if circumcision happens at the medical centres, it should be male doctors or male nurses who perform the operation. Other men spoke of the cultural belief, without explaining it, that women are not allowed near circumcised men. Even those who think that there is a need to involve medical doctors in the traditional schools insisted that those doctors should be male and that older men should guarantee that the doctors don’t have sex the night before going to the initiation schools, as this would cause all the wounds not to heal.

Women, unlike men, talked strongly against some bad practices and conditions around traditional circumcision, and mentioned deaths and penis amputation as a result. There were also many problems emanating from boys going to the bush that women discussed. They talked about boys coming back from the bush drinking and smoking, which they had been taught to do by the elders. Young women did not feel comfortable talking about MC, and they did not have a lot to say about it, though they talked about hygiene and sexual pleasure with circumcised men. All participants shared similar views that men should be circumcised, since it brings about many benefits.

The report concludes that some people are well informed about MMC, largely those in areas around MMC projects. Many have learned about MC through the media. For further education on HIV prevention, this research also highlights the need to position MC in existing traditional and health contexts within communities where it is practised regularly. There is a need to reduce tensions between the medical and traditional male circumcision practices; concerns from both perspectives need to be addressed in order to reach common ground. In addition, there needs to be a process for ensuring the participation and involvement of women in MCC.