Medical circumcision and manhood initiation rituals in the Eastern Cape, South Africa: a post intervention evaluation

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Abstract
The objectives of this study were first, to report the adverse events reported following male circumcision performed by medical professionals after a one‐day training workshop; second, to report on the attitudes towards, beliefs surrounding and experiences regarding circumcision and initiation; and third, to assess the HIV‐risk behaviour of young men attending initiation schools post medical circumcision. Initiates who had been medically circumcised by trained healthcare providers were examined and interviewed on the seventh day after circumcision and, in addition, focus‐group discussions were conducted with initiates. Results indicate that of the 78 initiates physically examined on the seventh day after circumcision by a trained clinical nurse, seven (9%) adverse events (complications) were found. Initiates reported mixed attitudes towards combining medical circumcision with traditional initiation. The majority of the initiates (70%) felt that they could be stigmatized as a result of choosing medical rather than traditional circumcision and 20% thought that the relationship between medical and traditionally circumcised men was hostile. Prior to circumcision, most initiates (92%) had been sexually active and had engaged in HIV‐risk behaviour. Focus‐group discussions revealed that sexually active initiates, when asked about sex after circumcision, indicated they wished to abstain for a short period before resuming sexual activities with intended condom use being high. Findings are promising for efforts to up‐scale integrated medical circumcision alongside traditional initiation into manhood.