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.

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.

Gender-based violence (GBV) has reached a state of epidemic proportion globally and in particular in Africa. There have been a few studies that have been conducted on GBV in Sub-Saharan Africa. Lesotho, situated in the heart of South Africa has one of the highest prevalence of GBV. An Ecological Framework by the WHO has divided the risk factors into individual, relationship, community and societal factors. Lebollo is overlapping with most factors but it is mainly an exclusive entity. Lebollo is the cultural circumcision of men and the most common cultural practice amongst Basotho men. Lebollo influences gender roles, normative perceptions and the behaviour of Basotho men. The aim of this study was to assess the impact of Lebollo on men’s perceptions on women beating in Lesotho. A cross-sectional study that is based on the DHS survey of Lesotho 2014 was used in this study. Basotho men, ages 15-55, with a sample size of 2921, were selected through a two-stage cluster sampling and completing a standardized questionnaire. Univariate and multivariate logistic regression models were used to analyse the data. Lebollo was not significantly associated with weakly rejecting GBV perceptions. This was the finding after adjusting for education and socioeconomic factors, that Lebollo was significantly associated with weakly rejecting GBV perceptions. Age, religion, education, wealth and Livential area were identified to affect men’s perceptions of GBV. Most men agreed to women beating with the justification of arguing with her husband. When the Null hypothesis was considered, it was found that Lebollo does not influence the GBV perceptions of men in Lesotho. This is in view of the fact that education and wealth was found to be the strongest predictors and influenced the association between Lebollo and women beating justification (confounders). The Legal and education system of Lesotho including Lebollo needs to be restructured and monitored.