This essay examines Dirie’s and Miller’s Desert Flower and its depiction of Female Genital Mutilation (FGM) and the effect that this violation has had on the narrator. The analysis has been conducted through the critical lens of trauma studies with emphasis on how bearing witness of traumatic events can serve as healing and empowerment in the struggle to end FGM. As the multicultural classroom has grown extensively over the past years, the demand for an intercultural awareness is placed on the schools, where the pupils are to be given the chance to develop an understanding and acceptance of people from different ethnic and cultural backgrounds. This essay argues that, in spite of the dilemmas that often occur when teaching trauma as a sensitive and controversial issue, Desert Flower can in fact be used in the EFL classroom to engender intercultural awareness as well as offering the pupils a chance to develop self-actualization and social consciousness.

Bakgrund: Kvinnlig könsstympning är en djupt rotad sed. Ingreppet påverkar flickors och kvinnors livsvärld genom inverkan på deras fysiska och psykiska hälsa, samt begränsar deras reproduktiva och sexuella hälsa. En bra fysisk och psykisk hälsa hos elever ökar förutsättningarna för inlärning. Det hälsofrämjande arbetet är en av skolsköterskors huvudsakliga arbetsuppgifter. Syfte: Syftet med studien var att belysa skolsköterskors förebyggande och hälsofrämjande arbete med flickor som är eller kan komma att bli könsstympade. Resultat: Analysen från intervjuerna resulterade i fyra huvudkategorier och åtta underkategorier. Huvudkategorierna blev följande: att skapa en respektfull relation med elever, att identifiera elever som är eller kan komma att bli könsstympade beskrivs som komplext, betydelsen av kunskap och att känna trygghet i arbetet, att samverka är betydelsefullt för erfarenhetsutbyte och leder till ökad kunskap. Konklusion: Studien visar att skolsköterskorna uttrycker behov av ökad kunskap, tydliga rutiner och samverkan i arbetet att identifiera och bistå elever som är, eller kan komma att bli könsstympade. Skolsköterskorna beskriver att de har ett ansvar i att informera om kvinnlig könsstympning. För det krävs kunskap samt förutsättningar för att etablera goda relationer med elever, vårdnadshavare och övriga professioner inom skolan. / Background: Female genital mutilation is a deeply rooted custom that affects the lifeworld of women and girls by causing physical and psychological damage, and also limiting their reproductive and sexual health. A student´s good mental and physical health improves the conditions for learning. Health-promoting work is one of the main duties of a school nurse. Aim: The purpose of this study was to highlight school nurses´ preventative and healthpromoting work with girls who have undergone or are at risk of female genital mutilation. Method: A qualitative study design was chosen. Qualitative content analysis with an inductive approach was used to analyse results. Semi-structured interviewes where conducted with eight school nurses in a large city in western and in middle-sized town in mid Sweden. Results: The analyses of the interviews resulted in four main categories and eight subcategories. The main categories found were: to create a respectful relation with the pupils, identification of pupils in risk of or those already undergone female genital mutilation was found to be complex, the importance of knowledge and confidence at work, and collaboration is important in terms of exchanging experience and leads to increased knowledge. Conclusion: This study indicates a demand for greater knowledge, clear routines and collaboration in the work with identifying and assisting pupils at risk of, or who have already been exposed, to female genital mutilation. The school nurses describe that they have responsibility when it comes to information concerning female genital mutilation, which requires knowledge and prerequisites to establish a relation with pupils, caretakers and other professionals in the school environment.

O objetivo deste trabalho é analisar a aliança da circuncisão (bᵉrît mūlāh) como portadora de distinção e ressignificação da identidade do patriarca Abraão em seu contexto familiar, constitutivos das promessas divinas, e seu vínculo com a divindade por meio de um rito de passagem encontrado e analisado, em forma de perícope, na narrativa bíblica de Gênesis 17. Para tal, analisamos o uso do termo circuncisão como aliança e/ou sinal da aliança através do estudo do texto literário, em questão, além dos contextos históricos e culturais, filológicos e etimológicos envolvidos. Como resultado pudemos assinalar que a aliança da circuncisão, embora seja um conceito complexo, se mostrou uma marca indelével na vida, tanto, de Abraão, quanto de seus descendentes. Entendemos que as alianças narradas na Bíblia Hebraica, em geral, e a aliança da circuncisão, em particular, teve grande pertinência na fundação do passado ancestral de Israel. E a compreensão do significado da aliança da circuncisão nos aproximou da visão de mundo do patriarca Abraão. / The purpose of this work is to analyze the covenant of circumcision (bᵉrît mūlāh) as the bearer of distinction and resignification of the identity of the patriarch Abraham in his family context, constitutive of the divine promises, and his bond with the divinity through a rite of passage found and analyzed in the form of a pericope in the biblical narrative of Genesis 17. For this purpose, we analyze the use of the term circumcision as an covenant and / or sign of the covenant through the study of the literary text in question, in addition to the historical, cultural, philological and etymological contexts involved. As a result, we could point out that the covenant of circumcision, although a complex concept, was an indelible mark on Abraham\'s life as well as his descendants. We understand that the covenants narrated in the Hebrew Bible in general and the covenant of circumcision in particular had great relevance in the foundation of Israel\'s ancestral past. And the understanding of the significance of the covenant of circumcision brought us closer to the world view of the patriarch Abraham.

O objetivo deste trabalho é analisar a aliança da circuncisão (bᵉrît mūlāh) como portadora de distinção e ressignificação da identidade do patriarca Abraão em seu contexto familiar, constitutivos das promessas divinas, e seu vínculo com a divindade por meio de um rito de passagem encontrado e analisado, em forma de perícope, na narrativa bíblica de Gênesis 17. Para tal, analisamos o uso do termo circuncisão como aliança e/ou sinal da aliança através do estudo do texto literário, em questão, além dos contextos históricos e culturais, filológicos e etimológicos envolvidos. Como resultado pudemos assinalar que a aliança da circuncisão, embora seja um conceito complexo, se mostrou uma marca indelével na vida, tanto, de Abraão, quanto de seus descendentes. Entendemos que as alianças narradas na Bíblia Hebraica, em geral, e a aliança da circuncisão, em particular, teve grande pertinência na fundação do passado ancestral de Israel. E a compreensão do significado da aliança da circuncisão nos aproximou da visão de mundo do patriarca Abraão. / The purpose of this work is to analyze the covenant of circumcision (bᵉrît mūlāh) as the bearer of distinction and resignification of the identity of the patriarch Abraham in his family context, constitutive of the divine promises, and his bond with the divinity through a rite of passage found and analyzed in the form of a pericope in the biblical narrative of Genesis 17. For this purpose, we analyze the use of the term circumcision as an covenant and / or sign of the covenant through the study of the literary text in question, in addition to the historical, cultural, philological and etymological contexts involved. As a result, we could point out that the covenant of circumcision, although a complex concept, was an indelible mark on Abraham\'s life as well as his descendants. We understand that the covenants narrated in the Hebrew Bible in general and the covenant of circumcision in particular had great relevance in the foundation of Israel\'s ancestral past. And the understanding of the significance of the covenant of circumcision brought us closer to the world view of the patriarch Abraham.

Female genital mutilation (FGM) is a global problem that stems from gender inequality. Increased migration from countries that perform FGM to England has led to the practice travelling across borders. FGM is subject to heightened political debate and media sensitivity in the England and across the Western world. Debates about FGM often proceed from a universal standpoint that the practice should be prohibited through law. However, the efficacy of FGM legislation is questionable and rarely subjected to scrutiny. Despite implementing a criminal offence of FGM in 1985 and introducing subsequent stringent legal changes, there has not been one conviction for a practice, which remains prevalent in England. A failure to secure convictions for a practice that continues suggests that the law has left women and girls unprotected. To understand why the practice persists in a context in which FGM is criminalised, this thesis aims to address the potential and limitations of social and cultural change through the law. My qualitative research findings are based on two focus groups each with 11 women from FGM-performing communities and 79 semi-structured interviews with women and stakeholders who are responsible for designing and enforcing FGM legislation, including legal professionals, police officers, Members of Parliament and Members of the House of Lords. I chose to interview these two groups of participants to understand the different perspectives of women subject to the law and stakeholders responsible for enforcing the law. The interview data shows the importance of an intersectional analysis of FGM that accounts for women’s experiences of gender, race, ethnicity, nation, nationality and religion. While FGM is performed upon girls and women’s bodies to control their sexuality, women also identified FGM as representative of other identity issues including race, group rights, migrant culture and religion. The data highlights the complex meanings women ascribe to FGM and the challenges they encounter in accessing the criminal justice system. In contrast, stakeholders believe anti-FGM legislation is a means for the state to eliminate ‘cultural’ violence against women and girls and enforce British values upon minority groups. The findings from the interviews with women and stakeholders revealed a stark divide in the two groups understanding of FGM and their attitudes towards the law. Examining FGM in the context of criminalisation from two different perspectives highlights the core barriers to the enforcement of law.

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.

L'effet protecteur de la circoncision masculine (CM) contre l'acquisition hétérosexuelle du VIH chez les hommes a été démontré dans trois essais contrôlés randomisés menés en Afrique australe et de l'Est, et sa généralisation a été recommandée par l’OMS et l’ONUSIDA comme une composante complémentaire importante des stratégies de prévention du VIH dans les pays à forte incidence du virus et bas taux de CM. Cependant, la généralisation de la CM dans les communautés ou elle n’est pas une norme sociale pose de nombreux défis en ce qui concerne son acceptabilité, son implémentation, son acceptation et son impact sur les comportements sexuels ainsi que sur les connaissances, attitudes et pratiques concernant la CM. Le projet ANRS 12126 Bophelo Pele a été implémenté à la suite des recommandations internationales dans la communauté d’Orange Farm, en Afrique du Sud, site du premier essai randomisé contrôlé sur la CM, et communauté cible de cette stratégie. Les activités de recherche menées au sein du projet prouvent que la généralisation de la CM est acceptable et réalisable rapidement dans une communauté à ressources limitées, selon les directives des instances internationales, de manière sure et coût-efficace. Son acceptation parmi les hommes non-circoncis est satisfaisante. De plus, trois ans après l’implémentation du projet, et bien que les connaissances envers la CM et son effet sur le risque du VIH restent à être améliorées, aucune différence de comportement sexuel n’a été décelée entre les hommes circoncis et les hommes non-circoncis ainsi qu’entre les partenaires des hommes circoncis et celles des hommes non-circoncis. La CM comme méthode de prévention du VIH dans les communautés hyperendémiques est donc une stratégie qui promet d’avoir un impact considérable sur l’épidémie en Afrique australe et de l’Est. / The protective effect of male circumcision (MC) on HIV heterosexual acquisition among men was demonstrated in three randomized controlled trials conducted in Southern and Eastern Africa, and its roll-out has been recommended by the WHO and UNAIDS as an important complementary component of HIV prevention strategies in high incidence communities with low rates of MC. However, the scale-up of MC in communities where it is not a social norm raises several challenges in regards to its acceptability, its implementation, its uptake, and its impact on sexual behavior as well as knowledge, attitudes and practices about MC. The ANRS 12126 Bophelo Pele project was implemented following the international recommendations in the community of Orange Farm (South Africa), site of the first MC randomized controlled trial, and target community of this strategy. Research activities conducted to evaluate the project show that the roll-out of MC is acceptable and can be implemented quickly in limited resources settings according to international recommendations in a safe and cost-effective manner. MC uptake among uncircumcised men is satisfactory. In addition, three years after project implementation, no difference in sexual behavior between circumcised men and uncircumcised men and between female partners of circumcised and uncircumcised men was detected, although knowledge and attitudes about MC and its association with HIV could be improved. MC as an HIV prevention method in hyperendemic communities is a promising strategy which can have a considerable impact on the epidemic in Eastern and Southern Africa.

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.

This thesis presents data on two separate areas relevant to the prevention of HIV and sexually transmitted infection (STI) transmission in homosexual men. These data arise from the community-based Health in Men (HIM) cohort of HIV-negative homosexual men in Sydney. First, the association of circumcision status with HIV and STIs was examined. Older age, ethnicity and country of birth were demographic factors independently associated with circumcision status. Self-report was a valid measure of circumcision status in this population. Overall, being circumcised was associated with a non-significant reduced risk of HIV seroconversion in the HIM cohort (HR 0.76, 95% CI 0.41-1.41, p=0.381). Among the one-third of participants predominantly practising the insertive role in anal intercourse (AI), being circumcised was associated with a significantly reduced risk of HIV infection (HR 0.15, 95% CI 0.03-0.80, p=0.026). Circumcised HIM participants also had a lower risk of incident syphilis (HR 0.35, 95% CI 0.15-0.84, p=0.019), however circumcision status had no significant effect on the remainder of prevalent and incident STIs examined. Second, risk factors for pharyngeal gonorrhoea and chlamydia were investigated. The BD ProbeTec nucleic acid amplification test (NAAT) had a positive predictive value (PPV) for pharyngeal gonorrhoea diagnosis of only 30.4% (95% CI 25.2-36.1%) when compared to a previously validated NAAT targeting the gonococcal porA pseudogene. Pharyngeal gonorrhoea was common in HIM, mostly occurred without concurrent anogenital infection and may frequently spontaneously resolve. Infection was independently associated with younger age (p-trend=0.001), higher number of male partners (p-trend=0.002), contact with gonorrhoea (p<0.001) and insertive oro-anal sex with casual partners (p-trend=0.044). Pharyngeal chlamydia was less common but a high prevalence/incidence ratio suggested that infection may persist in the pharynx for long periods. Pharyngeal chlamydia was independently associated with receptive penile-oral sex with casual partners (p-trend=0.009). In conclusion, circumcision may have a role as an HIV prevention intervention among the subgroup of homosexual men who predominantly practise insertive rather than receptive AI. Regular screening of the pharynx including a validated supplemental NAAT for gonorrhoea diagnosis may prevent much transmission to anogenital sites, whereas chlamydia occurs too infrequently in the pharynx to recommend routine screening in homosexual men.

Thesis (Ph. D.)--University of Pretoria, 2002. / Includes bibliographical references.