HIV circumcision faces challenge

2009-09-22 12:17

Promoters of male circumcision as a weapon against HIV will have to

reckon with a Zulu belief that partial circumcision means better sex, according

to researchers.

An article in the latest issue of the South African Medical Journal

reports that interviews in a rural community in KwaZulu-Natal revealed “rich

traditional understandings” of male circumcision. People had strong negative

views on circumcision that involved removal of the foreskin.

“These perceptions seem to originate in historical tensions between

Zulus and the Xhosas regarding male circumcision,” they said.

“In contrast to the Xhosa practice of full circumcision, Zulus

traditionally promoted partial circumcision (ukugweda).

“Here, the foreskin is not removed, but an elastic band of tissue

under the penis glans is cut, allowing the foreskin to move easily back and


The researchers, from the Human Sciences Research Council and the

University of California, said men and women taking part in the interviews

understood the difference between full and partial circumcision, but preferred


They felt it helped prevent infections, and helped avoid

sensitivity and pain during sex.

“Participants felt that if the tissue under the penis glans is

uncut, the foreskin is not able to move back and forth easily, which interferes

with erection and causes the penis to bend downward painfully.

“A partial cut is believed to allow sperm to move freely and to

enhance pleasure for men and women.”

The researchers said male circumcision was being widely promoted on

the assumption that the term was unambiguous.

However, their study showed a widely-held alternative meaning in

the rural community where they conducted their interviews.

They said there was a need to distinguish between medical male

circumcision, and its benefits, and ukugweda, whose HIV benefits were


“For successful uptake in these contexts, strategies to overcome

historically negative cultural perceptions of male circumcision among Zulus, as

well as positive associations of partial circumcision with enhanced sexual

pleasure, are required,” they said.

Trials in South Africa, Uganda and Kenya have shown that full

circumcision has a dramatic effect in reducing HIV transmission.

The World Health Organisation said in 2007 that there was

“compelling evidence” that circumcision reduced heterosexually acquired HIV

infection in men by about 60%.

It said male circumcision should be considered “an efficacious


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