EPISODE 8 - Circumcision

"If I was supposed to be circumcised I would have been born like that," is the reaction of Bheka Msomi and his friends when asked what they thought of being circumcised. But that is before they heard all the facts.

Mondli and Ian, young men from Mgungundlovu in KZN, have no doubts about circumcision. "I think it's important for men to be circumcised" says Mondli. Ian explains:  "If you haven't been circumcised and you have sex with an HIV positive women the foreskin stores the infection. A person who has been circumcised is at less risk of contracting infections".  Armed with this knowledge, Mondli and Ian were circumcised at Northdale Hospital. "It's a government hospital, they don't charge" says Ian - and "it's not sore" he says with a shy laugh.  "It doesn't mean that because you are circumcised you can have sex without a condom, you still have to use a condom" adds Mondli.

That circumcision reduces the risk of HIV has been confirmed by by three scientific studies undertaken in South Africa, Kenya and Uganda that all came to the same conclusion: that male circumcision reduces the risk of HIV infection by up to 60%.

The news of this research has travelled fast. In Orange Farm, one of the sites of the original research, Dr Thabo Masego of the Bophelo Pele Circumcision Centre has performed about 13 000 circumcisions since 2008. Lebohang and Thabang are two teens in the waiting room at Bophelo Pele. They want to be circumcised because they heard it reduces the risk of getting HIV.  Another teen, Martin,  says he is "happy and nervous.  I want to do this." In the waiting room another young man encourages them: "I've just come from the operation, 5 minutes ago, it's not painful, it's fine."

One of the biggest worries of HIV experts is that men will stop using condoms if they think that circumcision protects them from HIV infection.  It seems that the message about using condoms after circumcision is getting through. Asked if he will stop using condoms now that he is going to be circumcised, Thabang responds: "if circumcision gives 60% protection then it means there is still 40% chance that you might get infected."  He is sure he will go on using condoms after circumcision - "using condoms will make it 100% safe!" he says.  After the operation, Lebohang and Thabong are both fine and feeling more confident about the future "because we know we are going to be fine!"

One of the questions that most people have about circumcision is that surely we should see a lower rate of infection in places like the Eastern Cape where 44% of men are circumcised. In fact the HIV infection rate in the Eastern Cape is 15%, 7% lower than the 22% in KwaZulu Natal where only 27% of men are circumcised. It's quite possible that this difference is partly due to higher rates of circumcision in the Eastern Cape. The question remains:  why are we not seeing the promised big reduction in infections? There may be many reasons, including the number of men having more than one partner. But part of the explanation may be that traditional circumcision does not always remove the whole foreskin, leaving behind some of those cells that provide an easy entry point for HIV. Lunga Mlumbi is a traditional surgeon in Roxeni, near Alice in the Eastern Cape. He has been trained in the importance of reducing the risk of HIV infection during traditional initiation. The training, he says, improves the lives of everybody, the surgeon, the initiates, the traditional nurses and the whole community. He strongly supports the use of gloves and using a separate blade for each boy to prevent them being infected with HIV.  He makes sure the blades are sterilized as well. He is emphatic that these innovations are not changing the ritual.