Culture and traditionas key factors in voluntary medical malecircumcision (VMMC) decision-making

in Gauteng, South AfricaAuthors & a� liations:

Frade, S.1; Nieuwoudt, S.2; Rech, D.1; Spyrelis, A.1; Taljaard, D.1

1. Centre for HIV and AIDS Prevention Studies (CHAPS) 2. Division of Social and Behaviour Change Communication, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand

Results:

Male participants stated that VMMC is safer than traditional circumcision, and were aware of the bene� ts of VMMC.

However, culture remains an important factor in decision-making processes, particularly for those with rural roots.

Xhosas and Sothos described themselves as being culturally circumcising, while Zulus still tended to de� ne themselves as non-circumcising despite King Goodwill’s support of circumcision.

Ancestral FearsMany Xhosa and Sotho participants cited fear of their ancestors if VMMC was done.

“[Why we don’t] go Is the beliefs as well the myths you get from your parents that if you go [to the clinic] you will go insane, or you

will have problems with your ancestors.”(Uncircumcised, OF, 25+)

Family PressureParticipants described feeling forced to circumcise traditionally due to family pressures and restrictions.

“At home we are the Zulus and we normally discuss things before can be decided. You can’t just wake up and go for circumcision

without telling the parents anything. So, there’ve a huge challenge to balance the peer pressure and the culture in the family.”

(Uncircumcised, OF, 25+)

ReligionIn the context of the Christian faith, one perspective was that God created men with foreskins, which should therefore not be removed.

“My point of view is that if God was not wise, He was going to create us all without the foreskins. He gave us all the penises with a

foreskin but you want to go and cut it. For me, it doesn’t work.” (Uncircumcised, Zola, <25)

LocationFor Xhosa and Sotho males with strong cultural identities, the decision to circumcise was about location: clinic or “the mountain” (a term used to describe going to an initiation school for circumcision). Some believed that they could still adhere to the family’s (Xhosa) culture of circumcision without getting circumcised in a traditional setting:

“As a Xhosa speaking person... I took a decision to have my circumcision clinically at Nelgate*… This was based on the safety

and organization of the whole procedure…Some initiates die in the bush and I chose the safer option.”

(Circumcised, OF, <25)

*Nelgate is a VMMC clinic

Figure 1. This map fi rst appeared in a 1996 issue of Scientifi c American magazine. Since then the link between high HIV prevalence and low circumcision rates has been further clarifi ed.

Photograph.A South African Traditional Initiation Ceremony

Figure 2. Tomb artwork

in Egypt is thought to

be the oldest documented

evidence of circumcision

Contact: Sasha FradeCentre for HIV/AIDSPrevention Studies (CHAPS)email: sasha@chaps.org.za

Introduction:VMMC plays an essential role in HIV prevention in countries with a generalised epidemic. However, the role of tradition and culture in the decision-making process has not been well explored even though its in� uence is widely acknowledged. This is especially the case in South Africa, which is home to communities that both circumcise as part of a right-of-passage, as well as communities that traditionally do not circumcise.

Objectives:The purpose of this study was to explore VMMC decision-making in the context of existing outreach e� orts in Gauteng.

Methods:Twelve focus group discussions with circumcised and uncircumcised males and six in-depth interviews with female partners of circumcised men were conducted in the peri-urban areas of Orange Farm and Soweto, for a qualitative exploratory study.

Deductive and inductive codes were developed and categorised by theme, using a grounded theory approach.

Conclusions:Culture remains an important factor in the decision to circumcise, as well as where to circumcise and how, for many males. Tradition and culture should be taken into account in demand creation messaging on the scale-up of VMMC in South Africa.

Presented at the 6th South African AIDS Conference