Page 195 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 5 of 6 Original Research

HIV. How it is or the specifications, am not sure … (Participant 4, children increased to 89% after the session. This study sought
male, single) to establish the knowledge regarding MC or MCC as an HIV
prevention strategy. Our study found that there were still
One participant revealed that he had heard of the link, but gaps in the knowledge of immigrants from east and southern
could not believe it was possible and showed scepticism: Africa. Male circumcision is still largely looked at in the light
… We have heard always in media but specifically I have not yet of culture (five participants) and religion (five participants),
believed. (Participant 5, male, married) rather than HIV prevention.
One participant did not have any idea that MC or MCC had Regarding culture, other studies have also tried to explain
any link to HIV prevention: how culture informs health choices and behaviour. Shweder
… Well I don’t know what exactly the link is. I only know studies suggested that MC often seems to be a social phenomenon,
that have looked at the link between HIV and circumcision. … I propelled by the need for individuals to fulfil cultural norms
don’t know if there is any proof exactly how it could prevent and practices, that enables males to acquire the traits of
HIV … (Participant 8, male, single) masculinity. Such cultures are embedded in African societies
23
like the Gisu and Bakonjo in Uganda, Kikuyu of Kenya, Masai
To achieve objective 2, participants were also asked what of Kenya and Tanzania. In the modern era, the cultural aspect
they thought were the disadvantages or dangers of MC of MC remains in regions such as east and southern Africa.
or MMC. However, in the majority of these areas, most of the rites that
used to accompany such ceremonies are no more. In many
Pain came up prominently as one of the barriers to cases, the procedure is now performed in private, for example
circumcision, as was mentioned by five participants: one-on-one, in a hospital or doctor’s surgery. Local pain relief
… First and foremost, I would say to human beings, pain is is often used in such settings. However, this modification is
24
something that is not easy to persevere so perhaps I do think not acceptable to all tribes. The antagonists of modernisation
they would fear the pain … (Participant 5, male, married) insist on circumcision within a group ceremony, without
anaesthesia, and as a test of courage at the banks of a river.
This study found that people do not only fear to face the This traditional approach is common among the Meru and
knife, but also fear possible complications that may arise out Kissi tribes of Kenya. Despite the loss of the traditional
24
of the procedure, especially if it is done traditionally: appeal of circumcision, the physical effects are crucial to
… Hmm I would like to believe that circumcision is a surgical personal identity, pride and acceptance in society.
and there is bound to be complications especially traditionally. If Uncircumcised men in such communities risk being banished,
you are undergoing through circumcision and then there are and subject to ridicule as if they were boys. There have been
complications that could be a disadvantage … (Participant 3, many reported cases of forced circumcision of men from such
male, married) communities, who are discovered to have escaped the ritual.
Culture as the primary reason for MC in this study is largely
Lastly, some participants believed that circumcision of males explained by the fact that the participants came from countries
can actually lead to HIV infection instead of protecting where some cultures continue to practise circumcision.
against it, especially when done traditionally:
… understanding is that they just use the same instrument to cut The findings showed that there was uncertainty regarding
all the boys. And there is no sterilising of instruments. Because of MC or MCC as an HIV prevention strategy. Even after
that I think those are the disadvantages … (Participant 1, male, in concerted efforts by the WHO to promote this, 2,25 this study
a relationship)
suggests that many individuals do not agree. The findings
26
concur with Naidoo et al., who suggested that even among
Responses presented show that although there is some educated people such knowledge is limited. The latter
awareness of MC or MCC as an HIV prevention strategy, study assessed university students in Kwazulu-Natal,
most people still view the procedure from a cultural and a South Africa.
social point of view. Even among the people who are aware
of the positive relevance of MC in HIV prevention, there is Based on the findings, it is evident that although there has
limited knowledge of how effective the strategy is, resulting been increased information, especially through the media
in scepticism.
and peer groups about MMC, little has been done to help
Discussion people understand how MC protects against HIV. As a
result, scepticism about the appropriateness of the
The efficacy of any health strategy relies on how the target procedure remains. This explains why educated people
population is aware of the strategy and the benefits it can seem to be more likely to accept MC as an HIV prevention
provide. This was made evident in a study carried out in strategy (participant 1). This was demonstrated in a study
22
27
Botswana, where before the informational session, 68% of carried out in Uganda and Kenya, where it was found
28
respondents were willing to circumcise their male children, that levels of awareness were higher among educated
but the percentage of those willing to circumcise their adults in rural areas.
http://www.sajhivmed.org.za 188 Open Access