Finding Common Ground
Mangochi/Thyolo – The influence of culture and religion on sexual behaviour is complex at both individual and societal levels. In different societies, cultural practices and traditions that were adaptive and fulfilled important functions in the past still exist.
At individual level, many men and women publicly subscribe to strict moral norms of their religions and cultures while at the same time privately behaving totally differently.
Mangochi, Zomba, Thyolo and Mulanje in the southern region of Malawi are some of the districts whose religious and cultural practices prescribe a number of guidelines to promote sexuality and sexual health.
In all these districts, male circumcision, is either imposed by religion or culture, sometimes by both. The practice has been promoted by the cultures and religion for hygienic reasons while it has also been believed to promote sexual vivacity.
According to the Malawi Demographic Health Survey, only 22 percent of men aged 15–49 are circumcised with the majority of them, 87 percent being men of the Yao tribe from Mangochi, Zomba and parts of Mulanje, the majority of them through traditional circumcision.
The study shows that 70 percent of the men were circumcised between the ages of 5 and 13, while 22 percent were circumcised at the age of 14–19 and only 4 percent were aged above 20 years.
However, modern science and medicine suggests that proper removal of the foreskin protects against HIV infection and other STIs by reducing the risk of contracting diseases by half or more.
It is said that in uncircumcised men, smegma or fluids can collect under the foreskin and provide sanctuary to HIV and STI pathogens.
Voluntary Medical Male Circumcision (VMMC) has now become a fairly known method in preventing the spread of HIV in this southern African country with over one million people infected with the virus that causes AIDS.
Unfortunately, VMMC campaigns have been met with mixed reactions from the communities that have previously been practising circumcision for religious or cultural reasons.
Meanwhile, studies reveal that targets of circumcising 250 000 men nationally by 2015 are too modest for the exercise to have significant impact on new HIV infections.
“Circumcising an additional 250 000 men, in addition to the current cultural practices, which maintain male circumcision levels, will increase the percentage of men circumcised to about 27 percent,” says a study titled “Modes of Transmission Analysis”.
The report notes that a significant challenge for the 2011-2016 National Strategic Plan will be to formulate a strategy that could create and sustain the demand required for VMMC to have significant impact on new infections.
Despite launching VMMC campaigns in Mangochi, health reports since the introduction of medical male circumcision at the district hospital in 2011, only one person has so far gone under the knife to have his foreskin removed at the hospital.
Traditional leader, Chief Saidi of the Traditional Authority of Mpondasi in the district, says the reason for the low response to the campaign include low awareness of the need to undergo the process since most males in the district are already circumcised under religious or cultural teachings.
Saidi, who is the chairperson of the Network of Mangochi Traditional Initiators, a grouping of traditional leaders who supervise traditional initiation ceremonies that include cultural male circumcisions, says most people feel the call by government is redundant.
Apart from circumcision, one of the traditional practices in the district includes the cultural demands for freshly initiated boys and girls to have sex as a way of proving their entry into adulthood.
“As a leader, I understand that sometimes the traditional process does not go all the way to remove the whole foreskin leaving part of it vulnerable to contracting HIV,” he says observing that government official have not adequately engaged traditional leaders to understand VMMC.
Researchers and virologists believe that HIV spreads more easily through the special immune receptors known as Langerhans cells, which are highly concentrated in the foreskin and other genital mucosa but largely absent from circumcised male genitalia. The chief says that it is important for government to work with communities and circumcision practitioners to make the operation safer and less traumatic as it has been reported that some traditionally circumcised children have died under the pain of the knife while others have had to painfully live uncomfortably with due to incomplete and unprofessional operations.
“On the other hand, the government should also understand that the practice is a source of income for the initiators, so there is need for a balance on how these people are going to earn their livelihood if the practice is consigned to be done by medical doctors only,” says the chief. He suggests that the government train the initiators on how best to conduct the operations.
However, sub-traditional authority Ngolongoliwa of Thyolo district, while acknowledging that the types of circumcisions performed by people of the Yao tribe, the Lomwes and the medical ones are different.
“The medical [circumcision] is a complete removal of the foreskin, the Yao one leaves part of the viral receptor area while the Lomwe is half way done,” he says. He advises all those who have gone through the traditional types to still go to the hospital to find out if there is need for a complete removal of the viral receptor skin in order to avoid the risk of abrasions of the remaining foreskin during sex, which may provide entry to the HIV target cells.
Ngolongoliwa says despite being circumcised the Lomwe style, he has had to go to the hospital where he received a complete operation.
“As a traditional leader, I am supposed to be a parent and a role model for my subjects,” he says.
Anda Nyondo, Thyolo District Hospital Assistant VMMC coordinator, says VMMC has become one of the major entry points for HIV prevention for males who have slight access to health care services than women.
“We tell our clients that VMMC is not by any means complete protection against contracting HIV or STIs,” she says adding, “They must still practice safer sex all the time”.
Nyondo says that apart from circumcision reducing chances of getting HIV or STIs, “it also reduces the risk of genital ulcer diseases, penile cancer in men and cervical cancer in women”.