Academic journal article Gender & Behaviour

Knowledge, Attitudes and Beliefs about Male Circumcision and HIV by Traditional and Medical Providers of Male Circumcision and Traditionally and Medically Circumcised Men in Mpumalanga, South Africa

Academic journal article Gender & Behaviour

Knowledge, Attitudes and Beliefs about Male Circumcision and HIV by Traditional and Medical Providers of Male Circumcision and Traditionally and Medically Circumcised Men in Mpumalanga, South Africa

Article excerpt

The aims of this study in Mpumalanga, South Africa, are to assess (1) the current behavioural risk reduction messages and HIV/AIDS education provided by medical and traditional providers of male circumcision to men undergoing medical and traditional circumcision and (2) the risk-related behavioural beliefs regarding circumcision, HIV/AIDS risks, condoms and gender attitudes among men who have undergone elective medical circumcision and men who have been circumcised in traditional initiation schools in the past 18 months. The sample included 13 male traditional providers and 13 male medical providers of male circumcision, and 15 traditionally and 15 medically recently circumcised men, all of an Ndebele cultural background. Qualitative analysis identified seven themes: (1) HIV/AIDS denial among men, (2) social influence of male circumcision including community norms and peer pressure, manhood initiation, perceived attitudes of women and traditional versus medical circumcision, (3) male circumcision is protective from HIV and sexually transmitted infections (STI), (4) HIV and other risk from male (in particular traditional) circumcision, (5) male circumcision lowers sexual inhibition (abstinence, multiple partners, inconsistent condom use, increase in sexual desire and pleasure), (6) HIV/STI education and counselling and male circumcision, and (7) promotion of male circumcision. The implications of these findings for the development of effective male circumcision HIV/AIDS prevention programmes are discussed.

Key words: Traditional circumcision, medical circumcision, HIV risk, knowledge, attitudes, practices, HIV prevention, South Africa

Introduction

HLV/ ALDS in South Africa

In the past decade, the numbers of HIV infections and deaths associated with AIDS have dramatically risen in South Africa. According to UNAIDS (2008), South Africa has the largest proportion of people living with HIV in the world. UNAIDS estimated in 2007 that there were 5.7 million people living with HIV in South Africa, including 3.2 million women and 280 000 children. It is currently estimated that each day there are 1500 new HIV infections and 600 AIDS-related deaths in South Africa. The South African National seroprevalence study estimates that the overall HIV prevalence in the South African population is 10.6%. It is estimated that there were 5.2 million people living with HIV in 2008. The national HIV prevalence among those aged 15-49 is 16.9% (Shisana et al., 2009).

HIV prevalence among women is 13% and for men is 9%. Among youth (aged 15 to 24), double the number of females (12%) are infected as males (6%). According to Shisana et al. (2009) HIV prevalence remains disproportionately high for females compared to males in the 25-29 age group, where 32.7% were found to be HIV positive. HIV prevalence among males aged 20-24 is more than twice as high as that of males aged 25-29. In terms of race, HIV prevalence among indigenous Africans is 13% compared to 6% of Whites.

At present, South Africa is experiencing negative population growth and this devastating trend is attributed to HIV/ AIDS. The South African National 2008 noted that HIV prevalence is heterogeneous in South Africa's provinces, with the highest prevalence in 2008 being found in KwaZulu-Natal (15.8%) and Mpumalanga (15.4%) (Shisana etal., 2009).

Traditional and medical male circumcision in South Africa

Connolly, Simbayi, Shammugam and Nqeketo (2008) found in a national survey in South Africa in 2002 that of 1067 men of 15 years and older who had been circumcised, the majority (57.2%) had been circumcised traditionally and 42.8% medically. The vast majority of Whites (97.8%), Indians (92.8%) and Coloureds (87.4%) were circumcised medically, compared to only 21.8% of black Africans. The median age of circumcision for black Africans was 18 years compared to 10 years for Coloureds, 2 years for Whites and 1 year for Indians.

The prevalence of traditional male circumcision among men was found to be 24. …

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