A research report submitted to the Faculty of Humanities, School of Social Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Arts in the field of Demography and Population Studies. November 2016. / Introduction: South African men practice both traditional and voluntary medical male circumcision. Voluntary Medical Male Circumcision (VMMC) was introduced as a health intervention strategy against HIV/AIDS. On the other hand, traditional male circumcision (TMC) is a ritual that marks the rite of passage into manhood. TMC has been identified as a public health hazard associated with high numbers of complications and even deaths. The South African government has launched and promotes the VMMC programme. The programme aims to reach a target of 80% coverage in order to effectively reduce HIV infections in the country. However, TMC remains a popular practice. In 2009, the National HIV Community Survey reported that 67% of men were traditionally circumcised, while 33% had been circumcised medically. This study aims to identify factors associated with VMMC, in order to inform the current programme. Furthermore, this study will add to the body of knowledge regarding VMMC and TMC, as previous literature has focused on identifying factors associated with circumcision status rather than the choice of circumcision type (VMMC vs TMC). Objective: The aim of this study was to the identify levels of circumcision status and circumcision types (VMMC vs TMC). Furthermore, this study aimed to examine the relationship between demographic, socio-economic, cognitive and environmental factors associated with VMMC and TMC in South Africa. Methodology: The study used data from the Third National HIV Communication Survey, 2012. The study sample is 6 828 473 males aged 16-55 years who underwent VMMC or TMC. The first step of the analysis was descriptive, using cross tabulations and graphs. Finally, multivariate analysis was employed using binary logistic to examine the relationship between VMMC and TMC with demographic, socio-economic, cognitive and environmental factors. Results Fifty-one percent (51%) of circumcised males were circumcised medically, while 49% were traditionally circumcised. As expected; ethnic groups known to practice TMC were less likely to choose VMMC. In terms of socioeconomic variables, education was significantly associated with whether males were medically circumcised (p<0.05; CI1.66=5.11). Availability of VMMC at the health facility significantly influenced the males choice of selecting VMMC as the type of circumcision to undergo (p<0.05; CI 0.43=0.79). / GR2017

A dissertation submitted in fulfillment of the requirements for the award of the Degree of Master of Social Sciences in the Department of Anthropology Faculty of Humanities University of the Witwatersrand March 2016 / This is a study of the material culture associated with male circumcision rituals among Hlubi people in the Matatiele region of South Africa’s Eastern Cape Province. In recent years social scientists and public commentators have paid increasing attention to male circumcision in the context of controversies around ‘botched’ circumcisions, on the one hand, and the growing evidence, on the other hand, that male circumcision plays a role in restricting the spread of HIV. Much less attention has been paid, however, to a vital issue that underpins all these concerns: what materials give male circumcision its distinctive qualities as a cultural process, and how do various kinds of participants and observers think about those materials in relation to other domains of material culture, e.g. medical circumcision. This study will approach the topic through unstructured interviews conducted with various groups of informants / MT2017

Thesis (MPhil)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Traditional male circumcision (TMC) is non-therapeutic ritual removal of the penile foreskin of a male person undertaken as part of a rite of passage from childhood into adulthood and manhood. The practice of TMC has received increased attention in recent years as a result primarily of complications that have led to hospitalization, penile amputations, and death of initiates. This study is a literature review and philosophical-ethical reflection with the following objectives: • To explain the current problems that beset TMC in South Africa • To explore the socio-cultural context in which TMC takes place in South Africa • To engage in ethical deliberation on the harms and benefits of TMC and determine whether, in its current form, the practice constitutes a net harm or benefit • To establish the ethical basis on which society ought to intervene in TMC, and to explore the modes of intervention proposed. Kepe (2010:729-730) identifies three concurrent crises that beset TMC in South Africa- the crisis of disease, injuries, and death suffered by some initiates, the crisis of the tension between the government and traditional leaders with regards to government intervention in TMC, and the crisis of the uncontrolled and negative way in which societal changes have impacted on the practice of traditional male circumcision. Male circumcision is the most widely accepted cultural practice among the Xhosa-speaking people of South Africa, and it is considered to be the only manner in which a boy can attain manhood and adulthood (Vincent, 2008). In view of the ongoing, unambiguous and preventable harm associated with TMC as it is currently practised, I think that it ought not to be allowed to continue in its current format. But I also think that the defect in TMC is remediable. I therefore feel sufficiently warranted to advocate for intervention to make the practice safer for all concerned. Intervention in TMC may be justified on public health, socio-cultural, autonomy, and beneficence grounds. / AFRIKAANSE OPSOMMING: Tradisionele manlike besnyding (TMB) is die nie-terapeutiese, rituele verwydering van die peniele voorhuid van ’n manspersoon. Dit word gedoen as deel van ’n seremonie van oorgang vanaf kinderjare na volwassenheid en manlikheid. Die praktyk van TMB het die afgelope jare toenemende aandag geniet, hoofsaaklik as gevolg van komplikasies van die prosedure wat gelei het tot hospitalisasie, peniele amputasies en dood van die persone wat geïnisieer is. Hierdie studie is ’n literatuuroorsig en filosofies-etiese refleksie met die volgende doelwitte: • Om die huidige probleme met TMB in Suid-Afrika te verduidelik • Om die sosio-kulturele konteks waarin TMB in Suid-Afrika plaasvind, te ondersoek • Om vanuit etiese oorweging te verduidelik wat die nadele en voordele van TMB is en te bepaal of die praktyk, in die huidige vorm, suiwer nadelig of voordelig is • Om die etiese basis waarop die gemeenskap in TMB behoort in te tree, asook die voorgestelde metode van intervensie, te ondersoek. Kepe (2010:729-730) identifiseer drie samevallende krisisse wat TMB in Suid- Afrika insluit – die probleem van siekte, beserings en dood ondervind deur sommige inisiandi, spanning tussen die regering en tradisionele leiers met betrekking tot regerings-intervensie in TMB, en die ongekontroleerde en negatiewe wyse waarin samelewingsveranderinge ’n impak het op die praktyk van tradisionele manlike besnyding. Manlike besnyding is die mees algemene aanvaarde kulturele praktyk in die Xhosa-sprekende mense van Suid-Afrika. Dit word beskou as die enigste manier waarop ‘n seun manlikheid en volwassenheid kan bereik (Vincent, 2008). In die lig van die voortdurende, ondubbelsinnige en voorkomende nadele wat geassosieer word met TMB soos dit tans beoefen word, dink ek dit behoort nie toegelaat te word in die huidige formaat nie. Maar ek dink ook dat die gebrek in TMB herstelbaar is. Daarom voel ek genoegsaam verseker om intervensie te verdedig om die praktyk veiliger te maak vir almal betrokke. Intervensie in TMB mag geregverdig word op grond van publieke , sosiaalkulturele en outonomiese voordele.

Three recent Randomised Controlled Trials (RCTs) have been able to deduce that Medical Male Circumcision (MMC) can reduce a heterosexual man’s chances of acquiring HIV through vaginal sexual intercourse by approximately 60% (Auvert et al. 2005; Gray et al. 2007; Bailey et al. 2007). In 2010, based on WHO recommendations, South Africa commenced a nationwide roll-out of MMC services. However, in the wake of these findings have come concerns that decreases in men’s perceived risk of contracting HIV could spark increases in risky sexual behaviour (risk compensation), in turn, driving up HIV incidence as opposed to abating it (Cassell et al. 2006). Accordingly, the World Health Organisation has identified social change communication as one of the ten key elements critical to the success of a wide scale MMC roll out (WHO & UNAIDS, 2010). Aside from creating demand, the role of MMC health communication efforts in crafting messages delineating the scope of MMC’s protective ability is paramount; especially in South Africa, a country hamstrung by a weak public health sector that can ill afford any regression in the fight against HIV and AIDS. This thesis provides a small-scale qualitative study that investigates both the motivating and discouraging factors impacting on men’s choices to undergo MMC, as well as exploring how and what ‘key messages’ of Medical Male Circumcision media and information initiatives are being received. In this way, my study hopes to bring insight into not only risk compensation associated with MMC, but also to provide a glimpse into the condition of health communication for MMC in the South African context. / Thesis (M.Soc.Sc.)-University of KwaZulu-Natal, Durban, 2012.

MAAS / Centre for African Studies / The aim of the study was to examine the challenges experienced at male initiation schools in the Eastern Cape Province, Mthatha District. It is alleged that during the month of June every year, some boys die at initiation schools mostly in Eastern Cape Province. One of the reasons of the cause of death is because some of them attend illegal initiation schools. The overall objectives were to explore the role of initiation schools, to assess the regulations that govern the opening and running of initiation schools, to identify palliatives that can be put in place to curb negative implications at initiation schools. The study was founded on the following theoretical framework to attain its findings; the socio-cultural theory. This study utilised the qualitative research design. Data collection methods included one-on-one interviews, un-structured interviews and focus groups. The study informants were selected using purposeful sampling technique and snow-balling sampling. The study of examining the challenges experienced at male initiation schools submits appropriate recommendations which may help in the effective indigenous knowledge management, curb unethical practices and challenges associated with the running of male initiation schools and sharing strategies in South Africa, other African countries and the world at large, particularly communities that still follow the cultural practice of male initiation. The study recommends that parliamentary legislative framework (policy) on initiation rite should be standardised and promulgated. Also, traditional leadership must have the powers over all matters of initiation rite and initiation schools in particular. Lastly, the study recommends that for future research, the use of male researchers would be advisable to allow more probing.