Unite tradition and medicine

As a Xhosa male, I grew up cherishing my culture. As a medical professional, as well as a man with a deep respect for tradition and science, I see no contradiction in conducting medical male circumcision procedures in conjunction with traditional initiation rituals.

The unease with which some traditionalists view this is understandable – up to a point.

But as a doctor who took the Hippocratic Oath and as an African man, I see medical male circumcision as a pivotal component of liberating our nation.

We must accept that we won’t have a silver-bullet solution for HIV anytime soon and delaying comprehensive action until a vaccine is developed, costs lives. We must also accept that simply urging men to abstain or even to use condoms does not work.

A recent study in the impoverished township of Kayamandi outside Stellenbosch in the Western Cape found that sexually active men are generally very reluctant to use condoms because of the fallacy that condoms lead to infertility. The HIV infection rate in Kayamandi is three times the national average.

We must accept that failure to act equals moral dereliction: South Africa comprises just 0.7% of the world’s population, but accounts for 16% of HIV cases. There were more than 470?000 new HIV cases in South Africa last year.

If we could do just one thing that could contribute to freeing our country from HIV/Aids, why wouldn’t we do that? Medical male circumcision is a routine, safe, once-off procedure that reduces a man’s lifetime risk of HIV infection by 60% – it also reduces the risk of cervical cancer for women by reducing their contact with the human papilloma virus.

In conjunction with other prevention measures, it’s the closest thing we have to a vaccine.

The closer to their sexual debut that males are circumcised, the greater the benefit of the procedure.

Men circumcised in their 30s have an immediate impact on infection rates because they’re sexually active. By that time, they’ve already increased the number of new HIV cases by 10%. As their level of sexual activity reaches a plateau, so does their impact on infections.

Men circumcised in their early 20s have an impact on the infection rate for longer, reducing it by 22%. But when teens have medical male circumcisions, they reduce new infections by 40% over 50 years.

The 1.3?million men who have already had the procedure will avert 220?000 new infections by 2050.

By medically circumcising 80% of men between the ages of 14 and 40 in eastern and southern Africa by next year, we could avert 3.4?million new infections – 850?000 of these would be in South Africa.

There are also clear humanitarian dividends at an individual level. But at a broader population level, scaling up medical male circumcisions could help South Africa have an Aids-free generation in 20 years.

That potential – to liberate a nation from an incurable disease and the massive costs and tragic consequences of HIV – demands that we act and collaborate.

Medical male circumcisions can be conducted with all the elements of the rite of passage into manhood. It makes perfect sense for modern medicine and traditional culture to collaborate because they share a common denominator – a safe and healthy society.

Middle class families are more fortunate because they can choose where their sons can be initiated. But boys from less well-off families are equally entitled to protection. All role players, including medical professionals, health officials, families and traditional leaders, have a moral duty to ensure that boys are protected from harm during initiation.

Each boy deserves not only the dignity and cultural enrichment that initiation brings, but also a nurturing space for that to take place, with minimised risk. For that to happen, there must be no stigma around medical male circumcision so all males can have access to its benefits, irrespective of their cultural views.

Health Minister Aaron Motsoaledi and his team should be commended for taking the lead on medical male circumcisions.

I am also very encouraged that there is a groundswell of support for medical male circumcisions among my colleagues.

The feedback from the patients and families I talk to is that they received proper counselling and advice beforehand, that the procedure was uneventful and routine, and that they were relieved to have reduced their exposure to HIV.

One should not underestimate the sense of empowerment that such an ostensibly simple act gives to these boys and young men.

Being medically circumcised myself, I know I’m as much a man as any other. The ethical obligation of my profession demands us to reach out to traditional culture not to interfere, but to ensure no parents are left grieving. We can share our expertise, help safeguard culture and ensure no boys are left on the mountain and all can take part in their homecoming ceremonies.

Why should we involve Western practices in our culture to save lives?

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Dr Pupuma is a family physician in private practice in Soweto

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