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.

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