In S. Africa, a deadly rite of passage

Tradition: HIV is adding to the health concerns over ritual circumcision.

July 06, 2005|By Scott Calvert | Scott Calvert,SUN FOREIGN STAFF

ELANDSKRAAL, South Africa - Jackson Khobane can pinpoint the instant he became a man. It was seven years ago, when he was 17. A traditional surgeon, with the flick of a wrist, used a razor-sharp knife but no anesthetic to circumcise him outside this rural village.

"You can't cry - maybe the others will laugh at you," Khobane recalls. "It was hurting, my friend, very much. I didn't like it. You have to be tough. You're feeling this pain, but you need to be a strong man."

The importance of circumcision for many of South Africa's young men traditionally rests on the belief that real men can endure pain - of the blade, of the cold, of physical deprivation. But the deaths and maiming of hundreds of boys have led physicians and provincial health officials to criticize the practice, and the criticism is becoming louder, now that the circumcision season is under way with the start of winter.

Traditional leaders blame incompetent surgeons for the problems and resist what they see as modern society's encroachment on a significant rite of passage.

Since the annual circumcision season began last month, 12 boys have died and dozens have been hospitalized in Eastern Cape province, in the southeast. In Limpopo province, in the northeast, 15 boys are being treated for serious infections. Since 1995, health officials say, about 300 boys have died in Eastern Cape and more than 70 have undergone genital amputation.

Some experts say the tradition poses even graver health consequences today because of HIV. Doctors fear that HIV, which afflicts one in five adults here, may be spreading among young men undergoing circumcision through repeated use of unsterilized blades.

"We can imagine in some communities about 20 percent of boys going off to the bush will be HIV-positive," says Dr. Graeme Meintjes, an AIDS specialist in Cape Town and author of a book on ritual circumcision. "It's an extremely high risk."

Circumcisions that are properly performed might bring significant health benefits. South African researchers have tentatively concluded that it reduced men's risk of contracting HIV through intercourse with infected women by 70 percent.

Dr. Ronald Gray, an AIDS researcher at the Johns Hopkins Bloomberg School of Public Health, is conducting a similar study in Uganda and is familiar with the still-unpublished findings of the researchers here.

"If male circumcision can reduce the rate of HIV transmission, it gives us the potential for a very important intervention in a lot of African cultures where circumcision is not traditionally practiced," he said.

Dr. Thabo Rangaka, the South African Medical Association's spokesman on circumcision, advocates having all boys undergo circumcision - the removal of the foreskin of the penis - at a clinic or hospital before going into the countryside for the rest of their ceremonial transformation to men.

"The problem is the contention by chiefs, or so-called cultural leaders, that it is their area, and we as physicians must not interfere," he says. "They want to include an element of trauma."

Traditional leaders reject his criticisms, leading Rangaka to conclude that only two people in the country have the moral power to bring about a change: former President Nelson Mandela and retired Archbishop Desmond Tutu.

The National House of Traditional Leaders, which advises the national government on tribal culture, has called for a task force to look into the recent deaths that it says were caused by "bogus" operators.

The group says medical experts can help by screening young men about to undergo circumcision, monitoring their recovery and training practitioners. But it wants only tribal councils to license traditional surgeons to practice in the customary way.

"This is not really a health issue at all. It involves culture," says spokesman Sibusiso Nkosi.

The traditions have already been altered, says Meintjes, whose 1998 book, Manhood at a Price, focused on practices among South Africa's Xhosa, the country's second largest tribal group.

"In traditional society, there was a subtle and unspoken attempt to make it safe," he says. "Fathers would go into the bush and monitor things; elderly men who no longer had to prove themselves as men would just keep an eye on things. That has completely vanished."

Fewer families have fathers present, Meintjes says. And many young men have less respect for elders, who are seen by some as having been too servile under the white apartheid government. As a result, he says, more circumcision schools are being led by inept practitioners who are motivated largely by the money the young men pay them.

That trend has made it harder for the provinces. Eastern Cape, which licenses 2,600 initiation schools, uses four-wheel-drive trucks and helicopters to track down illegal operations. From 2001 through last year, 42 unlicensed traditional surgeons and nurses were arrested; 18 were convicted.

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