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Siyayinqoba Beat It! 2004 Ep. 17 –

Traditional circumcision pt.2

In September 2000 Linda Pindani, a high school learner at the time, was diagnosed as HIV positive. According to Pindani he was likely to have been infected at the age of fifteen at a party, where he and his friends got drunk and slept with multiple girls without using protection. In episode 16 of this series, Pindani, a young man entering into manhood who has also progressed to stage four of the disease, shared his experiences of his traditional Xhosa circumcision ceremony with the viewers. In this episode he discussed his choices and experiences with the support group members.

Jason Wessenaar: Kgotsong re a le amohela ho Siyayinqoba Beat It! Support Group. {Sesotho} [Hi, welcome to the Siyayinqoba Beat It! Support Group.] My name is Jason. In the Siyayinqoba Support Group we are all living positively with HIV. Each week we get together to talk about issues that affects our lives with HIV, from positive living to promoting antiretroviral access in rural areas. USiyayinqoba nguhlelo lakho loku phila kancono ne HIV. Uma uphila ne ngculaza. {IsiZulu} [Siyayinqoba is your guide to better living with HIV. If you are living with the virus] or you have a friend, a family member or a partner who is HIV positive this programme is for you. This week we are talking about traditional male circumcision and initiation into manhood. Recently Chief Matanzima, chairperson of the House of Traditional Leaders in the Eastern Cape referred to the following as unacceptable aspects of initiation ceremonies: botched circumcision, gangrene and amputation of the penis, septic circumcision wounds that spread to other parts of the body, and dehydration. There has been an increasing number of hospitalisation and deaths association with traditional circumcision. We know that about twelve percent of youth between the ages of fifteen and eighteen are living with HIV. Today we ask the question: “What challenges does traditional initiation pose on youth living with HIV? And what advice should we be giving youth in general, and HIV positive youth in particular, going for a traditional initiation?” Last week we followed Linda Pindani on his journey to becoming a man through traditional circumcision.

Traditional Circumcision

Linda Pindani: Ndingu Linda Phindani ndi HIV positive. Ndine minyaka mithathu ndiphila nale tshologwane. Ndize apha ndizobona ugqirha wami malunga ngohambo lam eliya entabeni niyokholuka so ndizeku ngqirha like azindinika I advive ukuba yintoni incebiso angandi nika zona. {IsiXhosa} [I’m Linda Pindani and I’m HIV positive. I’ve been living with HIV for three years. I’m here to see my doctor about my circumcision. I want my doctor to give me advice.]

Linda Pindani: Doctor, I’m going to the bush for traditional circumcision, and I have some difficulties.

Dr Emile Reid (Tygerberg Hospital): I must say I feel very uncomfortable sending you to the bush for obvious reasons that I’ve stipulated. First of all, that CD4 count of 68. It will be very problematic, especially if you develop a secondary infection.

Linda Pindani: Ja, I can’t stay as a boy. I’m going, I want to be a man.

Linda Pindani: When my friends went to the bush, I was so worried because I was alone. It’s only me who’s a boy. All of them are men.

Sheila Nowelcome Pindani: Nimpathe kakhuhle abuye. Halala halala. Nim’ pathe kakhuhle abuye halala a buye umtanam. Hamba Bobosi ubuye, Akhona amapondo ana mampondomise onyavu zotahle undaweni. Bakhona o jola uzimpumlo ezikhulu. {IsiXhosa} [Look after him, he must come back! Go ‘Bobosi’ and come back. There are some Mpondos, Mpondomise. The ancestors will look after you.]

Support Group

Jason Wessenaar: We are joined by Linda, his friend Wandile and Dr Dan Ncayiyana, editor of the SA Medical Journal and Vice Chancellor of the Durban Institute of Technology. Linda, you decided to do your circumcision in hospital, and then went through to do a traditional circumcision. Was this because of your HIV status?

Linda Pindani: Yayi yisi status sami, just because of I CD4 count yami. Yayi low. Kakhulu and then ke nezi friends zami ke I most yazo bezisengamadoda. Bekhundimi yondwa i outie. Ndasiwa for instance I pressure. Ja because I think ku ARV’s kuthiwa sometimes ugqirha ufanele a explaine ukuba ndi fumane I treatment kuqala and the I immune yami I nyuke then sithethele phuzu kwalonto abone ukuba ndithini so ndayiqonda mhalmbe ndingangena ku ARV’s ziphinde zibe resisatance kum zinganifaneli mna. Ndaqonda a better decision is better to go to hospital. {IsiXhosa} [It wasn’t only because of my HIV status. It was just because of my CD4 count. It was low; it was very low. And most of my friends were already men. I was the only boy. That’s why, for instance, mostly pressure. Because I think like, with ARVs, the doctor recommended I start treatment first so that it can boost my immune system, so that we can decide what to do. So I thought I should start with ARVs but I could be resistant to them. So I thought it was better for me to be circumcised at the hospital.]

Jason Wessenaar: Did it work for you that you went through to hospital instead of going through to the bush first?

Linda Pindani: Ja, because I came back form the bush, it did work for me.

Wandile Mtikrakra: And the other thing, anye into ndingase ndithi like ukoluka kwa Linda ne, sebe zifriends sikhula sonke and uLinda, so siyeyaluka thina so kwabe kushiyeke yena and not ukuba besingahambi naye noba besihambe naye ne but kunezinto bekungakwazi ukuzazi or xa sinzenza besingakwazi ukuziyenza naye because baka yikwekwe not because of isi status sakhe and even though u Linda e HIV positive thina sizi friend zakhe uLinda into wayenzayo wasithatha wasisa kwa TAC for i- information what is HIV. So we acceptaned uLinda as i chomi yethu no matter i status sakhe sithini. So ukoluka kwakhe besiyazi before ayokolukwa fane aqale andibane no gqirha because I zinto ze CD4 count siyazazi and xa u Linda a hambile ayokuluka nantoni ingayezeka yabona and we couldn’t just anything to happen ku Linda because of sifuna ukuba abe yindoda, so besi funa i- information kugqirha qala. Athi u gqirha no u Linda I CD4 count ithi ngoku anga kwazi a khululeke a hambe ayoluka. {IsiXhosa} [Linda and I are good friends because we grew up together. The rest of us went for initiation and he was left behind. Even though we were doing things together, there were things he was not supposed to know, because he was a boy, not because of his HIV status. Even though he’s HIV positive, he involved his friends. He took us to TAC, we had information about what is HIV. So we accepted Linda as our friend, regardless of his HIV status. We knew that before Linda can be circumcised, he had to see a doctor. We are aware of CD4 counts and if Linda goes to the bush, anything can happen, and we couldn’t just let anything happen to Linda. We wanted him to be a man but we needed the doctor’s confirmation. The doctor should say Linda’s CD4 count is good enough for him to go to the bush.]

Busisiwe Maqungo: After a lukhile esibhedlela iyeyayenza ntoni lento leyo, I luyenzile utshitsho niye namu involve ngoku fully kuthwezenu zobudoda. Okanye still kukhona azinto angaka zenzi because yena a lukele esibhedlela or something? {IsiXhosa} [After he was circumcised at the hospital, did you involve him in manhood activities? Are there things they can’t do because he was circumcised at the hospital?]

Wandile Mtikrakra: Okhokuqala ne, uLinda since besiyazi i-situation yakhe which is thina sizi friend zakhe. We wanted what’s best for him. Wo lukelaphi?wenza ntoni as long ukuba u Linda ehambile wayokulukha njengoba u hambile wabuya ne, So besibulela lonto ukuba uhambile wabuya because ukuba uyaqaphela I number yabantwana baswelekayo bavele basukhe umntu ayokuluka engasazi isi status sakhe, engeyazi iphilo yakhe. Asukhe aluke asweleke. {IsiXhosa} [Firstly, we knew Linda’s situation. As his friends we wanted what was best for him. It does not matter where he got circumcised, as long as he came back. We were happy that he was circumcised. For instance, a large number of boys who go for circumcision don’t know their HIV status, get there and they die.]

Jason Wessenaar: Do you consider him a man, or do you consider him a boy? It would be a waste that he goes through all of that and then he’s still considered a boy.

Wandile Mtikrakra: Ja, actually, I do regard him as a man, even though we’ve spent maybe two or three days together since he came back, and I do regard him as a man. And I was so glad to see my friend, first of all, after all this time, and that no matter of what happened, nê, I do understand why it went like that. But, in my case, I do regard him as a man, but somebody else, I don’t know.

Anthony Fernandes: But we know we all have different cultures, and it goes way back in time. If circumcision is such a big part of manhood, and becoming a man, I would think that if he’s gone through the process, he’s a man, end of story. However, as young Xhosa men, isn’t it up to you guys to change the future and to discuss these things and to say: “Isn’t there a different way of doing it?” and challenging that old tradition? Surely you can’t walk around your entire life thinking, “Am I a boy? Am I a man?” It’s you at the end of the day that’s gonna decide if you’re a man or a boy, and nobody else.

Dr Daniel Ncayiyana (Editor, SA Medical Journal): You asked a very critical question, and that question can only be answered by Linda. You went to the hospital for you circumcision, and then you went to the mountain to fulfill your tradition. Were your wishes fulfilled? Do you feel like a man now?

Linda Pindani: Ja, I feel like a man. Because I know how to defend myself, you see, because they did give me that initiation school. Besides that thing of being circumcised, there is a school that we have been given there, in the bush. So I know how to, like, how to protect myself.

Dr Daniel Ncayiyana: [U yakwazi ukukhuluma nje nge ndoda manje] {IsiZulu} Yes, I am able to speak like a man.

Jason Wessenaar: With circumcision itself, is it risky? Is it risky for someone who isn’t infected? Is it also risky for someone who’s infected and how is it risky?

Wandile Mtikrakra: Any person that uses the same blade and cut himself and let me, even like needle-sticking, it can infect a person. So we do know that in order to contract HIV, it’s in the blood, it’s in the fluids, but in some fluids you cannot contract it because it has to be certain amount, you do understand. But in the blood it has to be just a piece, like a drop of blood. So I would say that it is very risky, and there are ways that can be prevented; only if there was enough education, not just in the cities, also in rural areas. We need to have such educations, let people understand what is at risk.

Dr Daniel Ncayiyana: But we had lots of deaths as a result of circumcisions. How much horror has that actually brought to the community? Vuyani might be able to explain this. Has it brought sufficient horror that the communities themselves have said: “We need to change the way we do these things?” Or is it just is the attitude simply that, the spirits will see to it, and we’ll just do it the way we did it three hundred years ago. I mean, I’ve wondered about that.

Vuyani Jacobs: People abalukayo {IsiXhosa} [circumcisions] who goes through circumcisions need to promote better things of it. I’m not judging you by having this kind of discussions in regard to going to hospital. I promote the situation where there’s going to glove, I promote the situation where there’s going to be a lot of knives, I promote the situation where there’s going to be doctors. But I don’t want to promote a horror, and say that HIV status and CD4 count leads to lots of deaths, because I don’t see that going hand-in-hand. We must never come up to the conclusion.

Anthony Fernandes: Vuyani, if you’re HIV positive, and you’re a young boy and you wanna become a man, you’re gonna become a man regardless. What are you gonna do?

Vuyani Jacobs: That’s what I’m saying: gloves, a regulation on it. But what I’m saying is that the whole statement that gives HIV to the most deaths in circumcision is incorrect. Not every young boy who goes through circumcision is having HIV.

Dr Daniel Ncayiyana: You are saying that the deaths cannot be attributed to HIV status, not only, you are absolutely right. Not only, maybe even not the majority. But you are willing to concede that if this young man here, Linda, had gone to circumcision school being HIV positive, and the knife used to circumcise him was used to circumcise ten or fifteen other boys, he would in fact have caused a mini-explosion of infection. So the risk is not just that the person who is HIV positive is gonna die, but it’s the fact that he’s gonna cause death of other people, five, ten years from now.

Jason Wessenaar: We will continue our talk with Linda and Dr Daniel Ncayiyana about HIV and traditional circumcision after this break.

Jason Wessenaar: Welcome back to Siyayinqoba Beat It! The programme for everyone infected and affected by HIV/AIDS. We are with Linda Pindani and Dr Daniel Ncayiyana and we are talking about traditional circumcision in the age of HIV and AIDS.

Traditional Circumcision

Lungisa Pindani (Linda’s ikhankatha): With our custom, it is very risky, very, very, very risky, the iceba [piece] auto cut there is blood you know, which is people who are dealing with abakwete’s [initiates] are taking a very high risk.

Linda Pindani: East London’s circumcision season is only in its second week, and two initiates have died while 35 are in hospital in Transkei. The first initiate died at an initiation school near Queenstown last week and the second died in Mount Frere on Monday. Traditional experts are concerned that the province could experience another circumcision Beat It CMScarnage season.

Linda Pindani: My parents and my uncle, they said that if I want to go to the bush, I must go to hospital first you see. But, it was not my aim to go to hospital you see.

Nqaba Busuku Clinic Supervisor, HIV/AIDS & Circumcision: Everybody wants to go, no matter what. And everybody wants to go there and come from there, not from hospital. That’s why some of them would rather die there than go to the hospital, because they want to maintain their integrity and status. You see, that enjoyed, they are men.

John Vollenhoven: Would you recommend other young men, like yourself, with HIV to go to the circumcision school?

Linda Pindani: It depends to a person. Andinguquli isikho lakaXhosa. Amasikho wamaxhosa mawalandelwe ngowakha xhosa, because amasikho for instance abeSotho akukho into esiyaziyo ukuba uqubekha ntoni kusikho labeSotho, so izinto zakaXhosa banziyenzwe habakhaxhosa. Mna into bendiyiyenza bendi protector mna only. {IsiXhosa} [It depends to a person. I’m not trying to change Xhosa culture. The Xhosa culture must go the way it’s supposed to go. For instance, we don’t know how Sotho culture works. Xhosa culture should go the way it’s supposed to. All I was doing was to protect my life.]

Lihle Dlamini: [Would you say it is okay for a person to go to the hospital and be circumcised, Then go to etabeni ayofundiswa ke ngobudoda ke. Kunga sebenziswa mela etabeni afundiswe nje ngobudoda just to get that education. {Isi Zulu} [then go to the mountain and to be taught about manhood, without the use of knives but just getting the education?]

Linda Pindani: If he’s not HIV positive, this discussion is not well organised. Here, there are womans, and there are guys who are whites, and they are guys who are Zulu. You can’t speak the secret. Sinezinto esingakwazi ukuzithetha. {IsiXhosa} [There are things we cannot talk about.]

Dr Danial Ncayiyana: We don’t want you to reveal your secrets.

Linda Pindani: There are things we cannot talk about.

Jason Wessenaar: But I think these issues affect women, they affect white men they affect black men, in all sorts of ways. But I think the whole point of this show is to say that there are some risks, to come to some agreement that there are some risks for somebody who’s infected who goes to the bush, and also for someone who’s not infected who goes to the bush. We don’t necessarily want to know the details of what happens, our discussion was around issues of prevention of HIV to people who are not HIV positive, but then also to make sure that people who are HIV positive are protected. And you took the decision to go to hospital, because your life would have been at risk if you had not done that. That was the core of the discussion.

Busisiwe Maqungo: Okay if yena, andizum’bamba but mna xa kufika ixesha umtanami makeluke as an HIV positive mother unomtana ongekho HIV positive and ndiyazi kukho a risk, there is a risk etabeni, not unless he brings he’s own weapon and icebe izosebenzisa I weapon ibonwe ezenayo. Until abe uzasebenzisa la weapon andinam vumela betele a hambe aye sibhedlela nxa angavumelanga aza nesi spear sakhe ndinga yosikhetha. {IsiXhosa} [When the time comes for my son to be circumcised as an HIV positive mother with a child who is not HIV positive, knowing there are risks in the mountain. The boy must bring his own weapon and the guy must use it. If they don’t want to use the weapon, then he must be circumcised at the hospital.]

Jason Wessenaar: Is that allowed?

Dr Daniel Ncayiyana: You saw the guy on the video who was shaving, shaving with a razor blade, and he was told to use gloves, and he was mumbling under his breath: “Why am I wasting my time? I’m okay. There’s nothing wrong”, which means that the surgeon who does circumcisions must undergo training so that he has the understanding of why it is necessary to have a fresh knife for every circumcision; why it is necessary to use gloves. Because if you just supply the materials and there’s no understanding, people are going to disregard it.

Busisiwe Maqungo: La tata unemikhonto emithathu. Uthi usukha kuyo luka kwenye ilali, ngalomuzuzu amephaya ndi sikha uyokoluka abakwekwe ayisix ngalemikhonto emithathu because lemikhonto endiyiphetheyo I sharp both sides. That means three knives are enough for six boys. Andazi ndiyive ndidwendwa na. Yena he thinks that he understands and he doesn’t. {IsiXhosa} [The man had three knives and he had just circumcised six boys and he said that his knives were sharp on both sides. That means three knives are enough for six boys.]

Dr Daniel Ncayiyana: That’s precisely the problem. He’s got three knives and he says on the video: “I’ve just done six circumcisions. How could I do that? Look at this knife, that’s number one, that’s number two.”

Busisiwe Maqungo: Same knife for two boys.

Dr Daniel Ncayiyana: But I mean he doesn’t understand that having used number one, the whole knife is contaminated.

Jason Wassenaar: Resaya papatsong. {SeSotho} [We are going to the break.]We will be back after the short break.

Jason Wassenaar: Welcome back to Siyayinqoba Beat It! the programme for everyone affected and infected by HIV and AIDS. We are with Linda Phindani and Dr Dan Ncayiyana and we are talking about traditional circumcision in the age of HIV and AIDS.

Dr Daniel Ncayiyana: I lived in Mtata for many years, I was at the university there and I was there for more than ten years. And the HIV problem came up right during those years. And what I noticed was that among the people in Transkei there is general acceptance that is absolutely essential in order for one to attain manhood. But you’ve got traditionalists, it’s like ultra-orthodox traditionalists, and then you’ve got the average attitude. And the ultra-traditional view is that, unless you do it the way it was done three hundred years ago, it’s not valid. And yet I found among my colleagues, that is the doctors, the nurses and so on, that there was general acceptance that until and unless the procedures within the traditional schools are brought up to the present day, and there’s no tradition, by the way, no rite of passage, which has survived history, which can not keep up with the times. But unless it keeps up with the times, it’s gonna die, because people faced with the choice between death and life are gonna choose life. And so I just think that, we have to regard hospital circumcisions, or circumcisions outside the school, as an acceptable way to go, until the procedures within the schools are safe, and people don’t risk losing their lives.

Busisiwe Maqungo: Into esithetha ngayo zi medical conditions, abantu babenazo zibanyanzelisa into yokuba mabahambe bayoqala esibhedlela. Lonto leyo asilotyala akhuno puthwa ubomi bomuntu e risking ngexayoba kuzobuya kuthwe hayi asiyododa. Betunana nolobudoda kuqala kuya dlwengula nabatwana kungaboni lubudoda bungenaphi. {IsiXhosa} [We are talking about medical conditions that force people to be circumcised in hospitals. It isn’t a crime because people are not going to put their lives at risk for the sake of manhood. Some of the men end up raping children and still think they are men.]

Dr Daniel Ncayiyana: You are absolutely right. First choice is that the operation must occur at the circumcision school, that’s first choice; and if the school is safe enough for it to be first choice. But, having said that, there are people who are diabetics, there are people who are hypertensives, there are people who have certain heart conditions, there are people with all sorts of medical conditions, who would not survive if you subjected them to the rigours of circumcision at the school. I think those people should not now be condemned to be boys for the rest of their live. They should have an opportunity to have a circumcision at school, in a hospital as an exception, and then go and gain the wisdom and the knowledge that the school offers.

Jason Wessenaar: Are there any ideas to train or to educate people?

Dr Daniel Ncayiyana: The traditional surgeon must be trained, must undergo training and be licensed on the basis of training, so that he understands that the safety measures he undertakes are necessary. The second thing is that I believe that circumcision schools must be licensed, because the places that these circumcisions occur are atrocious. Their ablution facilities are non-existent, and there’s no cooking facilities and food and everything else like that is totally inadequate for the purpose for which these things are done. There’s a good question about whether HIV and AIDS contributes to the number of deaths that happen. Twelve percent of all youths who normally go to circumcision schools are HIV positive. The moment that you have HIV, you have a level of compromise of your immune system and therefore, wounds and infections that may occur in youths today that did occur also in the old days are more likely to result in people getting sick now because our diet has changed as Africans. We don’t have the same level of immunity. There’s a lot more poverty now than there was in the old days and we know that poverty undermines immunity. And therefore nutrition, hydration, proper procedures and so on in terms of universal precautions to prevent spreading AIDS either to yourself or to the other people. And the training of the traditional surgeon, and the licensing of the school, I think all of those matters will ensure and will guarantee that this wonderful tradition survives into coming generations. But I’m afraid that the tolerance for death amongst people who have been circumcised, is gonna get less and less. And if we keep losing people who go to traditional circumcision, we’re also gonna see a growing loss of interest among parents for their children to be exposed to such risks.

Jason Wessenaar: Things to remember are:

1. Consult your doctor before you go to an initiation school and traditional circumcision.
2. Make sure your initiation school is safe. The traditional surgeon should use a single knife for each cut and wear gloves.
3. You can have your circumcision done in hospital and attend the traditional initiation afterwards.

Jason Wessenaar: We hope that you have enjoyed the show and are feeling the Siyayinqoba Spirit that together we can Beat It! If you have and questions, please contact us on the number s on the screenrigth now. Join us again next week in the Siyayinqoba Beat It Support group. Till then, stay healthy and stay positive. Goodbye.

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