Debate over male circumcision

Male circumcision as a method to the reduce risk of HIV infection is being hotly debated this week after a prominent politician announced that his four sons had been circumcised, contrary to Swazi tradition. "All male children should be circumcised. To show my seriousness, I have taken all my sons for circumcision," MP and former House Speaker, Marwick Khumalo, told his constituents at Lobamba, 20 km east of the capital, Mbabane. Khumalo said he wondered why circumcision, despite the evidence of its effectiveness, was not being stressed as a way to reduce HIV infection. Dr Alan Brody, national director of the UN Children's Fund, who supports male circumcision as one precaution against HIV infection, said studies on the effectiveness of the procedure have produced differing statistics. "Depending on the report you read, the possibility of infection is reduced by 25 percent to 50 percent in the circumcised male. This is significant. The male child is best circumcised at an early age, preferably in infancy," Brody said. But traditionalists in this conservative country frown upon the procedure, because it is not a Swazi custom. Some of Khumalo's constituents at Lobamba, a stronghold of tradition that was the royal village of King Mswati's long-reigning father, King Sobhuza, reacted negatively to the idea of male circumcision. "That is a custom of the EmaXhosa (an ethnic group in neighbouring South Africa). They do it as a manhood ritual. Swazi men do not need to prove themselves in that way," said Jason Simelane, a 55-year-old father of three sons. Simelane said he was unswayed by the medical argument in favour of circumcision. "First, they say we must use a condom to stop AIDS, even though a condom is unknown to Swazis. Now they say we must cut off our foreskins. They should just leave our penises alone, and invent an injection to stop AIDS." The Ministry of Health has no policy on the promotion of male circumcision (female circumcision is unknown in Swaziland) in a country where close to 40 percent of adults are estimated to be HIV-positive. However, most NGOs dealing with AIDS and health issues support the procedure, and the health ministry intends to seek data on the prevalence of circumcision in a Demographic and Health Survey, soon to be conducted nationwide. "We debated whether to include circumcision in the health data. The survey looks into issues of family planning, HIV and AIDS, and sexually transmitted infections," Rudolph Maziya, national director for the Alliance of Mayors Initiative on Community Action on AIDS at the Local Level (AMICAALL), told PlusNews. "We decided to ask families whether they have circumcised children, to establish baseline data. The anecdotal evidence is that more and more parents are asking for circumcision. They learned of it from South Africa, which is our neighbouring state and has a large influence here," Maziya said. Hannie Dlamini, president of the Swaziland AIDS Support Organisation (SASO), a counselling and treatment centre for Swazis who are HIV-positive or have AIDS, told PlusNews, "We support circumcision as public health policy. It is just one part of what is needed to reduce risk, but it is not a substitute for using a condom, remaining faithful to a single sexual partner, and taking other precautions." Member of Parliament Hlobsile Ndlovu, who is also the communications director for PSI Swaziland, an NGO which distributes condoms, is strongly opposed to circumcision. "Circumcision must not be promoted, because HIV infections will increase, and AIDS will spread. People will stop using condoms. Unfortunately, there is a tendency for people to listen to only half of a story, and they will believe that because a man is circumcised, he cannot get infected." She added: "[Swazi men] don't like using condoms, and they will also use circumcision as a way to avoid them."