What is the place of circumcision in fight against HIV/AIDS in South Sudan?

Health & HIV/AIDS
Typography

With evidence that circumcision can reduce HIV risks for men engaged in vaginal sex by up to 60%, the drive for voluntary medical male circumcision (VMMC) in adult men has taken on a new urgency. New ethical challenges are arising, beyond voluntarism and informed consent.

With evidence that circumcision can reduce HIV risks for men engaged in vaginal sex by up to 60%, the drive for voluntary medical male circumcision (VMMC) in adult men has taken on a new urgency. New ethical challenges are arising, beyond voluntarism and informed consent.

 

How do we respect the principle of beneficence, ensuring procedures and programmes are good, not just for the person, but for society as a whole? This question was raised by Pierre Brouard, director of the Centre for the Study of AIDS at the University of Pretoria in South Africa.

 

To him, circumcision is more than surgery – it is a personal, social and political marker.

 

Media reports unpack meanings and impact of medical male circumcision campaigns in Africa.

 

Circumcision is more than just a biomedical procedure – it is a personal, social and political marker. It connotes difference or similarity. It can signify belonging to a particular religion, ethnicity, cultural group or power bloc in a country or region.

History is full of examples of circumcision being used as a tool of inclusion, exclusion and even marking for killing in times of conflict. Have we anticipated the impact of changes in identity that circumcision can signify?

 

Current VMMC drives have failed to adequately engage with masculinity, tradition and traditional circumcision, possibly blurring intentions and outcomes.

 

Take the case of Swaziland, not traditionally a circumcising country. It had set ambitious targets for VMMC for HIV prevention but, by 2011, the country had only met about 12% of its target.

 

Research showed that the reason behind is that men feared reduced sexual pleasure and possible adverse effects, like wounds and swelling, and said the procedure threatened their notions of manhood.

 

Where manhood was defined as someone who has a wife and children and therefore is “sexually functional”, medical circumcision introduced a threat to this.

 

In South Sudan, circumcision of both sexes is traditionally done. In the knowledge of traditionalists, this circumcision has nothing to do with HIV. It has just been known to few educated men and women that this circumcision will reduce HIV risks.

 

In South Africa, traditional circumcision (with its rituals, messages and meanings) is regarded as a non-negotiable rite of passage into acceptable masculinity for some groups, perhaps precisely because there is some risk. Mutilation, amputation and death do occur.

 

Here, VMMC has been met with some suspicion, a reluctance to accept a clinic circumcision as an acceptable test of manhood, among concerns that “culture” is being diluted.

 

Given that a clinic circumcision would maximize the HIV benefits of the cutting, because sufficient foreskin is removed, VMMC campaigns have to manage this tension between a desirable health outcome (medical circumcision) and an acceptable social identity (traditional circumcision).

 

Despite the fact male circumcision could reduce HIV infection, investigative report on Juba sex workers this year revealed that men who are circumcised refuse to use a condom, believing they have sufficient HIV protection from circumcision. Some women have reported more difficult condom negotiations.

 

On a large scale, VMMC could thus impact on gender relations, especially in contexts where gender violence and rigid masculinities dominate.

 

Illiteracy and lack of awareness or knowledge about HIV/AIDS are major challenges civil society, activists and media, including NGOs concerned with health, should address.

 

As we celebrating World Aids Day, there is need to launch civic education on medical male circumcision in South Sudan.

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