Thesis (MPA.) -- University of Limpopo, 2018 / The study was about the knowledge and attitudes of offenders towards the performance of medical male circumcision in prisons. The aim of the study was to determine and asses the knowledge and attitudes of offenders towards the performance of medical male circumcision in prisons. A quantitative study was conducted by using researcher-administered questionnaires at Leeuwkop Management area, maximum centre. A simple random sampling of two hundred and twenty-three male respondents was selected from all races and only two hundred and three managed to complete the questionnaires correctly. Data was analysed using Statistical package for the social sciences software program. Data was presented using descriptive and inferential statistics. More than half of the respondents were medically circumcised and less than half of the medically circumcised respondents had performed it in prisons. Most respondents were between the ages of 25-35 years and majority of them have shown fair knowledge and negative attitude towards the performance of medical male circumcision in prisons. It was recommended that thorough health education on the benefits of medical male circumcision should be stressed to offenders. For medical male circumcision programme to succeed, offenders should have adequate knowledge on male circumcision and its benefits.

Thesis (MPhil)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: In efforts to combat the global HIV/AIDS pandemic, the WHO/UNAIDS published the Joint Strategic Action Framework to Accelerate the Scale-up of Voluntary Medical Male Circumcision for HIV Prevention in Eastern and Southern Africa which outlines the aim of a VMMC (voluntary medical male circumcision) prevalence of 80% among males 15-49 year old in 14 countries by 2016 (WHO/UNAIDS, 2011). In line with this directive, South Africa has launched a national VMMC campaign. However, a lot of ethical issues remain unaddressed surrounding VMMC. These can be categorised as individual considerations (autonomy and informed consent; non-maleficence and unintentional, unforeseen harm; risk compensation in circumcised men; risk of undermining current HIV prevention strategies; age of circumcision), community considerations (cultural considerations; justice: the gender divide and female subjugation; distributive justice; social stigmatisation as a result of VMMC), national considerations (adverse events and complications on a macro level; cost saving and unforeseen expenditure of VMMC; the implications of international funding for VMMC; the public health ethics of VMMC; risks of “de-medicalisation” of a surgical procedure; the ever present danger of corruption), global considerations (female genital mutilation; non-sexual HIV transmission; a dangerous shift in focus) and other considerations (a statistical perspective on VMMC; circumcision technique; lack of ethical awareness; dealing with medical uncertainty). Finally, I shall consider neonatal circumcision, which is in itself a contentious issue, and has no role to play in VMMC. The unresolved issues raised by these ethical considerations cast doubt on the moral status of VMMC and I conclude that the VMMC campaign as it stands in South Africa currently is morally indefensible. There is, undeniably, a pressing need for HIV/AIDS prevention strategies in South Africa and other developing countries but the role of circumcision has been overemphasised to the detriment of more holistic approaches. While there are no easy answers to any of the ethical dilemmas presented in this thesis, it is imperative to raise ethical awareness surrounding VMMC. / AFRIKAANSE OPSOMMING: In ‘n poging om die globale MIV/VIGS-pandemie te bekamp, het die WHO/UNAIDS in 2007 die Joint Strategic Action Framework to Accelerate the Scale-up of Voluntary Medical Male Circumcision for HIV Prevention in Eastern and Southern Africa gepubliseer wat ‘n aksie-plan is wat poog om ‘n voorkoms van VMMC (vrywillige mediese manlike besnyding) van 80% in 14 lande onder 15-49 jaar oue mans in 2016 (WHO/UNAIDS, 2011) te bewekstellig. In ooreenstemming met dié riglyn, het Suid-Afrika 'n nasionale VMMC veldtog geinnisiëer. Maar baie van die etiese kwessies verbonde aan VMMC is nie bevredigend aangespreek nie. Hierdie kwessies kan geklassifiseer word onder individuele oorwegings (outonomie en ingeligte toestemming; nie-kwaadwilligheid en onbedoelde, onvoorsiene skade; risiko vergoeding in mans wat besny is; VMMC ondermyn die huidige MIV-voorkoming strategieë; ouderdom van besnyding), gemeenskap oorwegings (kulturele oorwegings; geregtigheid: die oorweging van die geslag verdeel en vroulike onderdanigheid; distributiewe geregtigheid; sosiale stigmatisering as gevolg van VMMC), nasionale oorwegings (newe-effekte en komplikasies op 'n makro-vlak; kostebesparing en onvoorsiene uitgawes van VMMC; die implikasies van internasionale befondsing vir VMMC; die openbare gesondheid etiek van VMMC; risiko's van "de-medikalisering" van 'n chirurgiese procedure; die alomteenwoordige gevaar van korrupsie), globale oorwegings (vroulike genitale verminking; nie-seksuele oordrag van MIV; 'n gevaarlike verskuiwing in fokus) en ander oorwegings ('n statistiese perspektief op VMMC; besnyding tegniek; die gebrek aan bewustheid van hierdie etiese kwessies; die hantering van mediese onsekerheid) bespreek. Ten slotte, sal ek neonatale besnyding ondersoek, wat op sigself 'n omstrede kwessie is, en geen rol behoort te speel in VMMC nie. Die onopgeloste kwessies wat deur hierdie etiese oorwegings aan die lig gebring word veroorsaak twyfel oor die morele status van VMMC. Ek lei dus af dat die VMMC veldtog soos dit tans bestaan in Suid-Afrika moreel onverdedigbaar is. Daar is ongetwyfeld 'n dringende behoefte vir MIV/VIGS- voorkoming strategieë in Suid-Afrika en ander ontwikkelende lande, maar die rol van besnydenis word oorbeklemtoon ten koste van ‘n meer holistiese benadering. Hoewel daar geen maklike antwoorde op enige van die etiese dilemmas wat in hierdie skripsie verken is nie, is dit noodsaaklik dat etiese bewustheid rondom VMMC verhoog word.

Magister Artium (Medical Anthropology) - MA(Med Ant) / This research study investigates Xhosa men’s perceptions of voluntary medical male circumcision (VMMC) in Khayelitsha township (Cape Town). It explored whether the introduction of VMMC as a state HIV-prevention strategy had engendered shifts in constructions of masculinity and negative perceptions of men who had undergone VMMC. Previously traditional male circumcision (ulwaluko) was the preferred form of circumcision among amaXhosa and medical male circumcision (MMC) was viewed as alien to Xhosa culture. Xhosa-speaking men who had undergone MMC were stigmatised by peers and viewed as not being ‘real men’. VMMC has the potential to shift constructions of masculinity based on circumcision status. An ethnographic research study was carried out using qualitative research methods, including participant observation, individual interviews and focus group discussions. Data collection occurred over a 6-month period in the Mandela Park community, at Michael Maphongwana Clinic, and at a male initiation school. The study found that ulwaluko remains a definitive marker of masculine Xhosa identity and is still informed by culture and tradition. Despite VMMC, men who undergo ulwaluko continue to perceive men who choose MMC as ‘the other’ and not as ‘real men’. The study highlighted that VMMC advocates need to take cognisance of traditional notions of masculinity and address negative perceptions of men in Xhosa-speaking communities who have undergone VMMC.

Trois essais randomisés contrôlés ont démontré le rôle protecteur de la circoncision dans l'acquisition hétérosexuelle du VIH par les hommes. A la suite de ces essais, l'Organisation mondiale de la santé (OMS) et le Programme commun des Nations Unies sur le VIH/SIDA (ONUSIDA) ont recommandé que des programmes de circoncision volontaire médicalement encadrée (CVME) soient déployés dans les pays où la prévalence du VIH est forte et où peu d'hommes sont circoncis. Par ailleurs, L'OMS recommande une prévalence de la circoncision d’au moins 80% chez les adultes pour avoir un impact substantiel sur l'épidémie de VIH/SIDA en Afrique orientale et australe.Débutés en 2007 dans quatorze pays prioritaires de cette région, les programmes de promotion de la CVME ont permis une augmentation rapide de la prévalence de la circoncision à environ 50% en 2011.L’étude a été conduite à Orange Farm (Afrique du Sud) où un programme de promotion de la CVME similaires à ceux conduits dans les autres pays d’Afrique australe et orientale est en cours depuis 2007. Elle montré que la prévalence de la circoncision a augmenté de 12% à 53% entre 2007 et 2011, et qu'elle est restée stable depuis.Ensuite une stratégie novatrice conçue, basée sur l'information, les entretiens motivationnels, les discussions dans des foyers et une compensation financière a été testée à Orange Farm. Cette intervention a permis d’atteindre une prévalence de la circoncision de plus de 80% dans un temps court. Cette stratégie devrait être aisément adaptable à un autre contexte que celui de l'Afrique du Sud pour augmenter la prévalence de la circoncision à plus 80% en Afrique orientale et de diminuer l'incidence du VIH. / Three randomized controlled trials showed the protective role of circumcision in heterosexual HIV transmission. The World Health Organization (WHO) and the Joint United Nations Program on AIDS (UNAIDS) recommend that voluntary male medical circumcision (VMMC) programs should be rolled-out wherever there is a generalized HIV epidemic and few men are circumcised. WHO recommends a prevalence rate of at least 80% male circumcision in adults to have a substantial impact on the HIV/AIDS epidemic in Eastern and Southern Africa. Starting in 2007 in the fourteen Southern and Eastern Africa countries identified as priority countries, the programs to promote the CVME have allowed a rapid increase of the male circumcision prevalence rate. So very low in 2008, it rose to about 50% in 2011. This study showed that the male circumcision prevalence has remained almost stable among adults in the township of Orange Farm since 2011. Township where a similar promotion program to other Southern and Eastern African countries is underway since 2007. We then designed and tested an innovative strategy combining the existing strategy with the elements of interpersonal communication with a financial compensation and discussions with all members of the household. This new strategy tested showed that a male circumcision prevalence rate of 80% could be obtained in a very short time. This easily reproducible method should be encouraged in order to increase the male circumcision prevalence rate to 80% as recommended by WHO in severely HIV affected countries, and thus to decrease HIV incidence.

Magister Public Health - MPH / Voluntary Medical Male Circumcision (VMMC) has been proven to reduce heterosexual HIV transmission to men by approximately 60%. It has been argued that achieving 80% circumcision coverage among males aged 15–49 years within five years and maintaining this coverage rate in subsequent years, could avert 3.4 million new HIV infections within 15 years and generate treatment and care savings of US$16.5 billion. As a result the South African Government plans to circumcise 4.3 million males aged 15 and 49 years by the 2015/2016 financial year. However, in the Western Cape the uptake for circumcision has been poor. While there is not a great deal of knowledge out there about the reasons for the uptake (or lack thereof) of VMMC in the Western Cape, current research focus on Xhosa males predominantly. However, there is limited research on circumcision among the "Coloured" population of the Western Cape. As the "Coloured" population is the largest group in the Western Cape, this gap in research and knowledge is worth noting. The current study aimed to explore the barriers to and enablers of uptake of VMMC among "Coloured" males between the ages of 15 and 49 years in the Cape Town Metropolitan Municipality. Methodology: The study adopted a qualitative design; semi-structured interviews were conducted with seven key informants, and two focus group discussions with men who had undergone VMMC and men who had chosen not to volunteer to undergo VMMC. Thematic analysis was used to analyse the data. Results: The key enablers to uptake of VMMC were: the desire for improved hygiene; the reduction in the risk of contracting other STIs; the reduction in the risk of contracting HIV; the role of partners and family members who can encourage males to access services; the perceived improvement in the males' sexual experience and performance; and cultural reasons and religious injunction. On the other hand the key barriers that discouraged "Coloured" participants from accessing the services include: fear, particularly the fear of pain; the experience of the health services and the role of health staff; the six week healing period in which males cannot have sex; the unwillingness to alter the body that they were born with; role of partners and family as discouragers of uptake; the influence of gangsterism on the ability of males to access services offered on a different gang's 'turf'; and, substance abuse. The recommendations in this study focus largely on the need to expand the coverage of VMMC in the Cape Town Metropolitan Municipality and to increase the uptake among "Coloured" males between the ages of 15 and 49 years. . These recommendations essentially involve the need to break down the barriers and to accentuate the enablers. To this end social mobilisation campaigns should not focus solely on HIV prevention but rather on hygiene and improved sexual experience and appearance as well as the cultural and religious aspects. With regard to the barriers it is essential that any social mobilisation engages with the fear of pain. On method to do this would be through the introduction and expansion of the PrePex™ device. The fear that circumcision could impact on sexual performance and the fear of embarrassment and discomfort the whole process would potentially bring would need to be allayed. In addition it is essential that the health services and health staff are orientated and trained in a way that ensures that the process of circumcision is as easy as possible for the clients. / National Research Foundation

Philosophiae Doctor - PhD / The Joint United Nations Programme on HIV (UNAIDS) strongly recommends that developing countries regard medical male circumcision as a biomedical intervention. This recommendation has caused developing countries seeking a radical solution to the prevailing and persistent social problem of HIV to reform their health policies. Most now discourage traditional male circumcision and promote safe medical male circumcision (SMMC) as a strong contributor to reductions in HIV transmission. This has introduced conflicts in traditional African societies such as the Bugisu, where male circumcision is culturally motivated, symbolising a rite of passage from boyhood to manhood. In the Bugisu sub-region, the local Bamasaaba regard their cultural practice of traditional male circumcision (TMC) as prestigious.

Medical male circumcision prevalence in Lesotho remains at 23% even though efforts are made to encourage men to be circumcised. The purpose of this study was to explore and describe perceptions of men regarding male circumcision in a hospital in Morija, Lesotho and make recommendations on how to promote uptake of medical male circumcision. A descriptive, explorative and contextual qualitative design was used. In-depth, unstructured individual interviews were conducted on ten (10) uncircumcised men who were selected via purposive sampling. The findings revealed that men’s perceptions on circumcision can be classified under the following themes: perceived health beliefs of men about circumcision, perceived community-held beliefs about circumcision, men’s knowledge regarding circumcision, and perceived misconceptions about circumcision. It is recommended that knowledge on circumcision be reinforced and negative perceptions be corrected with the multi-sectoral approach to promote uptake of circumcision services. / Health Studies / M.A. (Public health)

MAAS / Centre for African Studies / Zimbabwe launched the Voluntary medical male circumcision programme (VMMC) in November 2009, with the primary aim of curbing sexual transmitted infections (STI’s). In 2010, the district of Mazowe managed to adopt voluntary medical male circumcision programme to curb sexual transmitted infections. It is of concern that the voluntary medical male circumcision programme has been below expectations in Mazowe district. Hence, the aim of the study was to explore the effectiveness of the voluntary medical male circumcision programme among secondary school learners in Mazowe district. Furthermore, the primary goals of the study were firstly check the levels of understanding about the voluntary medical male circumcision programme among secondary school learners in Mazowe district. Secondly, explore the reasons behind the low rate of the voluntary medical male circumcision programme among secondary school learners. Thirdly, investigate whether cultural beliefs influence the learners’ choice. Lastly, recommend possible ways of improving the uptake of the voluntary medical male circumcision programme among secondary school learners in Mazowe district. A qualitative research method used in the study. Also, un-structured interviews and focused group discussions. The researcher conducted interviews using purposeful sampling method on three secondary schools in Mazowe district, Zimbabwe and about forty respondents participated in the study. The study adopted a planned behaviour and person/client centered approaches. The thesis’s conclusions deduced that most of the male respondents are not ready or willing to receive circumcision due to fear of being screened for HIV/AIDS, the cost of the procedure, pain, bleeding, to mention but a few. Furthermore, the researcher identified that in the Shona culture, medical male circumcision is rarely unknown. In addition, the Ministry of Health and Child Welfare must introduce new ways of circumcision to avoid bleeding, pain and must remove the screening of the HIV testing procedure before one is circumcise. Therefore, by these outcomes the Ministry of Child and Health Care Centre will try to find strategies in which they can scale the programme, since the study highlighted that most males are not going for circumcision, hence their lives are in predicament. More so, the study recommends v that researchers must obtain consent and ethical clearance from different relevant place so that data there will not be harm to respondents. Also, there is a need to look for policies in which the government will use to assess strategies to scale the programme, since it is of paramount importance to test the VMMC programme about the impact that it is giving to the community and to find out whether it is helpful or not. More so, in terms of future researchers, there is a need to reconnoiter barriers that hinders males from circumcised. Hence, fourth, this will motivate number of District schools to bring awareness towards males to take part in the programme and prevent males from being susceptible to the infections as recommended by the WHO in 2007. In addition, decentralizing the programme to the community, stakeholders would be able to work hand in hand with the District to make sure that the rate of the VMMC is up and those males take part in the programme willingly. Hence, this will create an efficacy of the programme since all stakeholders and the community will scale up the programme since the priority of all sides will be to scale the programme. Furthermore, clearing misconceptions associated with male learners (witchcraft, pain, bleeding, and religion, to mention but the few), providing them with right mentality about the good side of the programme. In addition, there is a need for the Ministry of Health and Child Welfare to amend new polices that allows free male circumcision, especially in public hospitals, hence, through these amendments, males might be willing to get the services. Lastly but not least, the Department of Education in Zimbabwe must set up tight mechanism for assessment for the programme, especially at secondary and high schools. This will in turn, develop an effective assessment system to see how effective the programme is in the districts. Finally, it is of paramount importance that the National HIV/AIDS council collaborates with the Ministry of Health and Child Welfare in decentralizing the service of the VMMC, since some respondents were concerned that the distance to the service centers were a hindrance for circumcision. / NRF