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.

Une des questions les plus débattues dans le domaine de l’éthique en ce XXIème siècle entre l’Afrique et le monde occidental concerne le respect de l’intégrité physique des femmes. Parmi les actions humaines qui touchent le plus l’intégrité corporelle, les excisions et les infibulations sont les plus dénoncées en Afrique. Longtemps considérées comme des rites d’initiation pubertaire des filles, ces pratiques sont maintenant considérées comme néfastes à la santé, et communément désignées par la communauté internationale de « mutilations sexuelles féminines ». Au cours des dernières décennies, ces pratiques ont été progressivement interdites légalement tant dans la plupart des pays d’Afrique que dans les pays occidentaux. Le Comité Inter-Africain (CIAF) contre les mutilations sexuelles demande la « tolérance zéro » par rapport à ces pratiques. La communauté internationale les combat avec des armes juridiques, en se référant aux conséquences médicales et aux droits de l’homme. Notre thèse est née d’une interrogation sur les raisons pour lesquelles ces rites se poursuivent encore en Afrique et plus spécialement au Mali, alors que dans les pays occidentaux, on élève fortement la voix pour les dénoncer comme sévices infligés aux femmes. Sur le plan international, on hésite à imposer des valeurs universelles à un phénomène perçu dans une large mesure comme une tradition conforme aux normes sociales des communautés qui les maintiennent. Afin de mieux cerner le sujet, notre questionnement a été le suivant : « Comment les pratiques culturelles des excisions et des infibulations, dans la ville de Bamako au Mali, interpellent-elles l’éthique : en quoi l’analyse de ces rites constitue-t-elle un domaine légitime d’application des principes de la bioéthique ? » Notre réflexion part du postulat que la dignité humaine est une norme à l’aune de laquelle se mesurent les défis éthiques liés à ces rites. Un proverbe Bambara dit ceci : « Une seule main ne lave pas proprement un éléphant ». La logique de cette sagesse met en évidence qu’une seule approche disciplinaire ne saurait faire ressortir les enjeux éthiques de ces pratiques. Notre analyse bioéthique se veut une démarche interdisciplinaire, qui permet d’articuler les approches philosophiques, anthropologiques, sociologiques et biomédicales de ces pratiques. Le premier chapitre, à travers la revue des écrits, présente la problématique de ces rites. Le deuxième chapitre présente le cadre théorique basé sur la notion de dignité humaine et délimite « ses contours, ses sources, ses formes et ses conséquences » afin de la rendre plus efficace et opérationnelle comme moyen de protection de l’être humain. Le troisième chapitre présente la méthodologie de la recherche basée sur la méthode qualitative et l’induction analytique et décrit le contexte de l’étude. Le quatrième chapitre présente les résultats de la recherche qui font ressortir que ces pratiques se résument essentiellement au contrôle du désir sexuel féminin. Ces pratiques sont par ailleurs déritualisées, touchent de plus en plus des enfants, comportent des risques et des conséquences sur la santé avec des coûts humains et financiers pour la société. Le cinquième chapitre analyse ces pratiques avec les principes éthiques qui démontrent qu’elles constituent un problème de santé publique malgré leur caractère culturel. Enfin, le sixième chapitre présente la portée et la limite de la thèse. Celle-ci montre qu’il est possible de mener un débat sur les excisions et les infibulations à travers une éthique de discussion. Elle offre un moyen pour y parvenir avec une vision de la notion de dignité humaine comme une « valeur éthique universelle » susceptible d’être utilisée dans toutes les actions impliquant l’être humain et dans tous les contextes socio-culturels. Notre démarche élargit ainsi le champ d’application des principes bioéthiques à des pratiques non-médicales. Par cette thèse, nous souhaitons contribuer à enrichir la réflexion éthique sur les excisions et les infibulations et inspirer les politiques de santé publique dans le respect des diversités culturelles. Nous espérons pouvoir inspirer aussi d’autres recherches en vue de rapprocher la bioéthique des pratiques culturelles traditionnelles afin de trouver des compromis raisonnables qui pourraient renforcer le rôle de protection de la dignité humaine. / One of the most debated issues in the area of ethics in the twenty first century between Africa and the Western world concerns the respect for the women’s physical integrity. Among human actions that most affect the bodily integrity of women, female circumcision and infibulation are the most denounced in Africa. Long regarded as rites of puberty and initiation of girls, these practices are now considered as exceedingly harmful to health, and commonly called "female genital mutilation" (FGM) by the international community. In recent decades, these practices have gradually been legally prohibited in most African countries as well as in Western countries. The Inter-African Committee on Traditional Practices Affecting the Health of Women and Children (IAC) demands 'zero tolerance'. The international community fights them with legal weapons, basing on the medical consequences and the infringement of human rights. Our thesis was born from a question on the reasons why these rites are still going on in Africa and more especially in Mali, while in Western countries; voices are strongly raised to denounce them as abusive to women. On the international front, we hesitate to impose universal values to a phenomenon, perceived to a large extent as a tradition in conformity with the social norms of the communities that maintain them. In order to better circumscribe the subject, our question is as follows: “How do the cultural practices of female circumcision and infibulation in the city of Bamako, Mali, challenge ethical norms : in what way does the analysis of these rites constitute a legitimate sphere of application of the principles of bioethics?” Our reflection starts from the assumption that human dignity is a standard against which measuring the ethical challenges associated with these rites. A Bambara proverb says: “One hand does not properly wash an elephant.” The logic of this wisdom highlights the fact that using only one approach from a certain discipline cannot bring out the ethical issues of these practices. Our bioethical analysis is meant to be an interdisciplinary approach that allows one to articulate the philosophical, anthropological, sociological and biomedical approaches to these practices. The first chapter, through the literature review, presents the problem associated with these rites. The second chapter presents the theoretical framework based on the concept of human dignity, and delineates its contours: its sources, its forms and its consequences in order to make it more effective and operational as means of protection of the human being. The chapter three presents the methodology of the research based on the qualitative method and analytical induction, and describes the context of the study. The chapter four presents the results of the research which highlights the fact that these practices essentially refer to the control of female sexual desire. These practices are also “deritualized” and affect more and more children, which involves risks and consequences on health with enormous human and financial costs to society. The fifth chapter analyses these practices with the ethical principles which demonstrate that these ritual practices constitute a public health problem despite their cultural character finally. The sixth chapter presents the scope and the limit of the thesis. It shows that it is possible to have a debate on female circumcision and infibulation through an ethic of discussion. It provides a way to achieve this with a vision of the concept of human dignity as a “universal ethical value” which can be used in all actions involving the human being and in all socio-cultural contexts. Our approach broadens the field of application of the bioethical principles to non-medical practices. By this thesis, we wish to contribute to the enrichment of the ethical reflection on female circumcision and infibulation and to inspire public health policies keeping in mind the respect for cultural diversity. We also hope to inspire further research in view of bringing together the bioethics of traditional cultural practices in order to find reasonable compromises which could strengthen the role of protection of human dignity.

Ľubica Guindon :Universalism of Human Rights in the Light of pluralism of African cultural values The purpose of this thesis is to analyze actual discourse in international law terms about universal or culturally determined characters of human rights. This theoretical problem is introduced with the focus on legal qualification of female circumcision (FC/ FGM ) in international human rights protection. The study goes beyond the scope of international law and reaches cross-disciplinary analysis related to the African context and its cultural, political and social factors. Chapter One addresses the theoretical issues of the notion of human rights, its sources and models in international law. This passage challenges an African approach to human rights bills including a catalogue of individual duties towards family, state and society as a whole. This concern about collective identity of a person within his or her community is a very important feature of African understanding of human rights and human dignity, and can enrich the universal consensus in this field. Within the theoretical issues of the international human rights protection it is necessary to look at the global, regional and local dimension of legal regulation. The most influential strategies on the global level are universal treaties with...

Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Based on the significant evidence from the three African randomized controlled trials, the WHO and UNAIDS recommended in 2007 that medical male circumcision should be a priority HIV prevention intervention. The three randomized trials in Africa demonstrated that adult male circumcision decreases the human immunodeficiency virus (HIV) acquisition in men between 51% to 60%, with long-term protective efficacy. This study intends to document and analyze the effectiveness of three communication interventions used in transferring knowledge about medical male circumcision as an HIV preventative strategy. Furthermore it also aims to determine which communication intervention will have the greatest effect in improving knowledge and understanding about medical male circumcision as an HIV preventative measure for implementation in future health promotion programmes. The research in this comparative study was conducted on a farm in the Overstrand sub-district of the Western Cape Province in South Africa, Haygrove Haven. A total of 30 male employees aged 18 to 45 was randomly selected to participate in the study. The data was collected using a self-administered pre-test questionnaire. In order to compare the pre- and post-test answers, the questions were repeated to determine the knowledge transfer after the respective information and training sessions. Analysis of the data was a simple process and limited to the necessary information to graph the required conclusions by using the computer programme Microsoft Excel 2010. The study looked at the statistical indicators of knowledge, perception and awareness of participants with regards to medical male circumcision as an HIV and AIDS prevention strategy. The findings exhibited that most people knew about MMC but very few had knowledge of the protective effect of the procedure against HIV acquisition and transmission. The study concluded that providing accurate information with fitting communication material at the right literacy levels, peoples’ knowledge of the benefits of medical male circumcision does increase. This will contribute to change the perception and therefore increase the acceptability of the procedure. This conforms to the subject of the WHO and UNAIDS 2007 study and can improve their findings. / AFRIKAANSE OPSOMMING: In 2007 het die WGO en UNAIDS aanbeveel dat mediese manlike besnydenis ‘n prioriteit MIV-voorkomings program moet raak, wat gebaseer is op die beduidende bewyse van drie Afrika gerandomiseerde gekontroleerde proewe. Die drie gerandomiseerde proewe in Afrika toon dat volwasse manlike besnydenis verminder die menslike immuniteitsgebreksvirus (MIV) in mans met 51% tot 60%, met 'n lang-termyn beskermende doeltreffendheid. Hierdie studie is van voorneme om die doeltreffendheid van drie kommunikasie-intervensies wat gebruik word in die oordrag van kennis oor mediese manlike besnydenis as 'n MIV-voorkomende strategie, te dokumenteer en te analiseer. Verder stel dit ook ten doel om te bepaal watter kommunikasie-intervensie die grootste invloed in die verbetering van kennis en begrip oor mediese manlike besnydenis as 'n MIV-voorkomende maatreël, vir implementering in toekomstige gesondheidsbevorderingsprogramme. Die navorsing in hierdie vergelykende studie is uitgevoer op 'n plaas in die Overstrand-sub-distrik van die Wes-Kaap in Suid-Afrika, Haygrove Haven. 'n Totaal van 30 manlike werknemers tussen die ouderdomme 18 tot 45 is lukraak gekies om deel te neem aan die studie. Die data is ingesamel met behulp van 'n self-geadministreerde vraelys waar die pre-toets vrae in die post-toets herhaal word, om die antwoorde met mekaar te vergelyk, om sodoende te bepaal watter opleidingsessie die grootste kennis oordrag laat plaasvind. Ontleding van die data is beperk en so eenvoudig as moontlik om die gevolgtrekkings te maak en grafies deur te gee deur gebruik te maak van die rekenaarprogram Microsoft Excel 2010. Die studie kyk na die statistiese aanwysers van kennis, persepsie en bewustheid van die deelnemers met betrekking tot mediese manlike besnydenis as 'n MIV-en VIGS-voorkoming strategie. Die bevindinge van die studie is dat die meeste mense bewus is van mediese manlike besnydenis, maar baie min kennis gehad het van die beskermende effek van die prosedure teen MIV verkryging en oordrag. Die studie het bevind dat die verskaffing van akkurate inligting met gepaste kommunikasie materiaal op die regte geletterdheidsvlakke, mense se kennis van die voordele van mediese manlike besnydenis kan laat toeneem. Dit is bydraend om ‘n individu se persepsie te verander en dus die aanvaarbaarheid van die prosedure te verhoog. Dit voldoen aan die onderwerp van die WHO en UNAIDS 2007 studie en kan sodoende hul bevindings verbeter.

Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: World Health Organisation (WHO) and UNAIDS named male circumcision as a key intervention in halting the spread of HIV in Africa. Several countries in sub-Saharan Africa with low levels of male circumcision (MC) and high HIV prevalence are scaling up MC services, Swaziland being one of them. Despite the circumcisions done in Swaziland it seems there is no significant decrease in HIV prevalence which might be due to various reasons. One of the reasons noted was the behaviour of men after circumcision because of the belief of total of immunity. This has led to an increase in high risk behaviour, increased promiscuity, multiple partners, more unsafe sex and failure to use condoms, thereby defeating the own stated purpose. Objectives: 1) To identify the knowledge, attitude and practices (KAP) of circumcised men towards safe sex. 2) To establish the existing knowledge of the relationship between circumcision and HIV prevention. 3) To establish whether men in Swaziland take part in riskier sexual behaviour after or before being circumcised. 4) To make recommendations for the counseling programme. Methodology: A cross-sectional analytical study whereby both qualitative and quantitative methods of data collection was used. Simple random sampling was used to select circumcised men from Mankayane hospital, Mankayane and Holy Rosary high schools and a total of 90(60 adults and 30 teenagers) filled in self- administered questionnaires and also took part in focus group discussions. Purposive sampling was used to choose the MC Counsellors and in-depth interviews were done to complement the information on knowledge, attitudes and practices of men towards safe sex before, during and after circumcision. An observation checklist was also used to check what they included in their counselling sessions. Results: The responses solicited from the men who participated in this study show that there is basic knowledge with regards to safe sex and the value of MC in the prevention of HIV. The pattern in the data however shows that those that were the most recent to undergo medical circumcision had the most varied opinions on the extent to which MC protect one from HIV. There was mixed attitude towards safe sex after circumcision, some wanting to maximise their satisfaction without using protection. The data also points to a pattern were the men have a high relationship turnover and this was more discernible among the teenagers who suggest that the relationships are not built on commitment but possible experimentation. While the study did not have control that tracked uncircumcised men for comparative purposes, the findings point to inconsistent use of condoms among men which heightens the risk of HIV transmission. The results point to a well-structured programme of counseling followed by MC counselors. Conclusion: The study was able to satisfy the aim and objectives. The research process was designed to collect the necessary data and be analysed in a manner that answered the research question. The research target population and subsequent sample represented the geographical scope of the study. The research tools were designed to be easy for the respondents to use. The distribution and collection method was designed to give the respondents less hassle as possible. This had a positive impact on the response rate, which increased the validity of the data collected. Both the literature review and primary research findings affirm that MC without behaviour change is not the panacea for prevention of HIV. / AFRIKAANSE OPSOMMING: Die Wêreldgesondheidsorganisasie (WGO) en UNAIDS het manlike besnydenis as ’n belangrike intervensie uitgewys om die verspreiding van MIV in Afrika te stuit. Verskeie lande in Afrika suid van die Sahara met lae vlakke van manlike besnydenis (MB) en hoë vlakke van MIV is tans besig om MB-dienste uit te brei, en Swaziland is geen uitsondering nie. Ondanks die besnydenis wat in Swaziland gedoen word, blyk daar egter geen beduidende afname in MIV te wees nie. Dít kan aan verskillende redes toegeskryf word. Een daarvan is mans se gedrag ná besnyding vanweë hul oortuiging dat hul geheel en al immuun is. Dit het tot ’n toename in hoërisikogedrag, meer promiskuïteit, veelvuldige bedmaats, meer onveilige seks en ’n gebrek aan kondoomgebruik gelei, wat uiteraard die doel verydel. Oogmerke: 1) Om besnyde mans se kennis, houdings en praktyke met betrekking tot veilige seks te bepaal. 2) Om bestaande kennis oor die verband tussen besnydenis en MIV-voorkoming te bepaal. 3) Om vas te stel of mans in Swaziland voor of ná besnyding geneig is tot meer riskante seksuele gedrag. 4) Om aanbevelings te doen vir die MB-beradingsprogram. Metodologie: ’n Deursnee- analitiese studiebenadering met sowel kwalitatiewe as kwantitatiewe datainsamelingsmetodes is gevolg. Met behulp van eenvoudige ewekansige steekproefneming is mans van Mankayane-hospitaal en tienerseuns van Mankayane- en Holy Rosary-hoërskool gekies. Altesaam 90 respondente (60 volwassenes en 30 tieners) het vraelyste op hul eie ingevul en ook aan fokusgroepbesprekings deelgeneem. Doelbewuste steekproefneming is gebruik om ’n groep MB-beraders te kies, met wie daar diepteonderhoude gevoer is om die inligting oor mans se kennis, houdings en praktyke met betrekking tot veilige seks voor, gedurende en ná besnyding aan te vul. ’n Waarnemingskontrolelys is ook gebruik om af te merk wat die beraders by hul beradingsessies insluit. Resultate: Die antwoorde van die mans wat aan hierdie studie deelgeneem het, toon basiese kennis met betrekking tot veilige seks en die waarde van MB in die voorkoming van MIV. Die patroon in die data toon egter dat diegene wat mees onlangs mediese besnydenis ondergaan het, die mees uiteenlopende menings het oor die mate waarin MB jou teen MIV beskerm. Daar is ’n gemengde houding oor veilige seks ná besnyding: Party mans jaag eenvoudig so veel moontlik bevrediging na, sonder enige beskerming. Die data dui ook op ’n patroon van ’n hoë verhoudingsomset onder die respondente. Dít was veral waarneembaar onder die tieners, wat te kenne gee dat hul verhoudings nie op toewyding gegrond is nie, maar eerder moontlike eksperimentasie. Hoewel die studie geen kontrolegroep met onbesnyde mans vir vergelykende doeleindes gehad het nie, dui die bevindinge op inkonsekwente kondoomgebruik onder mans, wat op sy beurt die risiko van MIV-oordrag verhoog. Die resultate dui voorts daarop dat MB-beraders ’n goed gestruktureerde beradingsprogram volg. Gevolgtrekking: Die studie het in sy doel en oogmerke geslaag. Die navorsingsproses was ontwerp om die nodige data in te samel en te ontleed ten einde die navorsingsvraag te beantwoord. Die navorsing steikenpopulasie en gevolglike steekproef was verteenwoordigend van die geografiese studiebestek. Die navorsingsinstrumente was ontwerp vir maklike gebruik deur respondente. Die verspreidings- en insamelingsmetode is gekies om so min moontlik moeite vir respondente te veroorsaak. Dít het ’n positiewe impak op die reaksiesyfer gehad, wat weer die geldigheid van die ingesamelde data verhoog het. Sowel die literatuuroorsig as die primêre navorsingsbevindinge bevestig dat MB sonder gedragsverandering allermins ’n ‘wondermiddel’ vir MIV-voorkoming is.

Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Background: Medical male circumcision (MMC) has emerged as one of the Human Immunodeficiency Virus (HIV) prevention methods for HIV negative men engaged in heterosexual contact. Many studies have documented its efficiency in reducing the risk of contracting HIV infection in men. Because of that, Zimbabwe like other countries in the Southern Africa region, with generalised HIV infections is finding ways to scale-up MMC in non-circumcised communities. This study searched for knowledge, perceptions and attitudes of males in Bindura urban towards MMC. Bindura is the capital city of the Mashonaland Central Province of Zimbabwe. This town has diverse people with different social backgrounds who economically depend on the surrounding mines and commercial farms. Given the enormous differences in culture, religion, social and value systems among these people it was of particular importance to understand how they perceive medical male circumcision. Methodology: The study was conducted using quantitative data collection method. Random selection was done to choose respondents and age was used to determine eligibility to the study. The qualifying age was 18-49 and a sample size of 60 was considered to be appropriate taking into consideration financial and time associated with large samples. Structured questionnaire with open-ended and closed questions were used to gather data. Likert scale was used on some questions to determine perceptions and attitudes of respondents. The questionnaires used to solicit information did not require respondent to provide his name for purposes of maintain confidentiality but contained identification number. In some cases, Chi-square test for independence was conducted to test for associations between demographic characteristics and observed responses. Comparison of responses between the age groups 18-29 and 30-49 years were also done to determine if there were some differences in representations of respondents in observed responses. Results: The study aimed to assess knowledge, perceptions and attitudes of males in Bindura urban towards MMC and barriers they were confronting in accessing MMC. Respondents showed high level of awareness about HIV/AIDS intensity in Zimbabwe. Male circumcision (MC) was perceived by the majority of respondents as important in curbing HIV infections. A significant proposition of respondents regarded medical reasons as the most common reason why people undergo MC. However respondents demonstrated poor knowledge or understanding of other strategies that must be used in conjunction with MC. Risks associated with operation, its cost and protection of confidentiality and consideration of family concerns were considered by respondents as barriers to MMC. Availability of accurate information about MMC and easing of access to MMC services were considered to be very important facilitating factors. Religious and cultural reasons and stigma from peers and friends were considered non barriers. Statistically significant associations were only detected between MMC being motivated by medical reasons and demographic characteristics of age and marital status and also an association between education level and stigma as a barrier for MMC. The study failed to show a significant association between other observed responses and demographic characteristics. / AFRIKAANSE OPSOMMING: Agtergrond: Mediese manlike besnyding (MMB) het na vore gekom as een van die metodes vir die voorkoming van die oordrag van die menslike immuniteitsgebreksvirus (MIV) deur MIV-negatiewe mans betrokke by heteroseksuele kontak. Baie studies het reeds die doeltreffendheid daarvan ten opsigte van die vermindering van die risiko van MIV-infeksie by mans gedokumenteer. As gevolg daarvan is Zimbabwe, soos ander lande in die Suider-Afrika-streek met algemene MIV-infeksies, op soek na maniere om MMB by onbesnyde gemeenskappe uit te brei. Hierdie studie wou kennis, persepsies en gesindhede van manlike persone in die Bindura-stadsgebied ten opsigte MMB bepaal. Bindura is die hoofstad van die sentrale provinsie Masjonaland in Zimbabwe. Hierdie stad word bewoon deur diverse mense met verskillende maatskaplike agtergronde wat ekonomies van die omliggende myne en kommersiële plase afhanklik is. Gegewe die groot verskille in kultuur, godsdiens, maatskaplike en waardestelsels onder hierdie mense, was dit van besondere belang om te begryp hoe hulle mediese manlike besnyding verstaan. Metodologie: Die studie het van die kwantitatiewe data-insamelingsmetode gebruik gemaak. Ewekansige seleksie is gebruik om respondente te kies en ouderdom is gebruik om geskiktheid vir deelname aan die studie te bepaal. Die kwalifiserende ouderdom was 18-49 jaar en ʼn monstergrootte van 60 is geskik beskou in ag geneem finansiële beperkinge en tyd verbonde aan groot monsters. ʼn Gestruktureerde vraelys met oop en geslote vrae is gebruik om data in te samel. ʼn Likert-tipe skaal is by sommige vrae gebruik om persepsies en gesindhede van respondente te bepaal. Die vraelyste wat gebruik is om inligting te ontlok, het dit nie vir respondente nodig gemaak om hulle name te verskaf nie ten einde vertroulikheid te verseker, maar het ’n identifikasienommer bevat. In sommige gevalle is die chi-kwadraattoets vir onafhanklikheid gedoen om te toets vir verbande tussen demografiese eienskappe en response wat waargeneem is. Vergelyking van response tussen die ouderdomsgroepe 18-29 en 30-49 jaar is ook gedoen om te bepaal of daar enige verskille in verteenwoordigings van respondente in die waargenome response was. Resultate: Die studie wou kennis, persepsies en gesindhede ten opsigte van MMB by manlike persone in die Bindura-stadsgebied en hindernisse waarvoor hulle te staan kom ten einde toegang tot MMB te verkry, bepaal. Respondente het ʼn hoë vlak van bewustheid omtrent die intensiteit van MIV/VIGS in Zimbabwe getoon. Manlike besnyding (MB) is deur die meerderheid respondente as belangrik by die beperking van MIV-infeksies beskou. ʼn Beduidende aantal respondente het mediese redes gesien as die algemeensien rede waarom mense MB ondergaan. Respondente het egter swak kennis of begrip van ander strategieë wat tesame met MB gebruik moet word, getoon. Risiko’s geassosieer met die operasie, die koste daarvan en beskerming van vertroulikheid en agting vir die familie se bekommernisse is deur respondente as hindernisse met betrekking tot MMB beskou. Beskikbaarheid van akkurate inligting omtrent MMB en vergemakliking van toegang tot MMB-dienste is gesien as baie belangrike fasiliterende faktore. Godsdienstige en kulturele redes en stigmatisasie deur portuurs en vriende is nie as hindernisse beskou nie. Statisties beduidende verbande is slegs tussen MMB gemotiveer deur mediese redes en demografiese eienskappe van ouderdom en huwelikstatus bespeur en ook ʼn verband tussen opvoedingspeil en stigma as ʼn hindernis vir MMB. Die studie het nie daarin geslaag om ʼn beduidende verband tussen ander waargenome response en demografiese eienskappe aan te toon nie.

Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Background: Scaling up of male circumcision in Namibia is running at a low pace. People need to understand the role that male circumcision plays in the prevention of HIV acquisition. Therefore, it is important to increase knowledge among individuals in order to make them acquire positive attitudes and perceptions towards male circumcision as an HIV preventive strategy. Method: This research study investigated the perceptions of men and women towards male circumcision as an HIV prevention intervention in the Windhoek District. A total number of 250 respondents were conveniently selected for participation in the study, of which 50% were males and another 50% represented females. All respondents were 18 years and older. A quantitative method of sampling was employed with the use of anonymous questionnaires. Data were captured and analyzed using SPSS version 20. Results: Most respondents (76.8%) reflected good knowledge about male circumcision and positive attitude (93.6%) towards male circumcision and its benefits but there were still a proportion of respondents (23.2%) who are not knowledgeable about the benefits of MC, and 6.4% of the respondents have negative attitude towards MC, whilst a large proportion of 53.2% have negative perceptions towards MC and its benefits. The study also found that there is an association between knowledge and perceptions of 0.250 at p-value < 0.05, as well as an association between attitudes and perceptions 0.213, p-value <0.001. Conclusion: It was concluded that knowledge plays a major role on attitude and perception changing. The more knowledgeable an individual is, the more the chances of them of having positive attitudes towards MC, which could also influence positive perceptions towards MC. In order to strengthen male circumcision as an HIV prevention strategy, it is imperative to provide the population that reflected low knowledge and negative attitudes with information, education and counselling services. This may help to make them change their attitudes towards MC and acquire positive perceptions towards it. On barriers, the relevant authorities should come up with a strategy to eliminate barriers in order to facilitate acceptability among non-circumcised groups. / AFRIKAANSE OPSOMMING: Agtergrond: Die opskaling van manlike besnyding in Namibië word teen ‘n stadige pas uitgevoer. Mense moet die rol verstaan wat manlike besnyding in die voorkoming van MIV speel. Dit is daarom belangrik om hierdie kennis onder individue te vermeerder ten einde hulle te bemagtig om positiewe houdings en persepsies teenoor manlike besnyding as MIV-voorkoming strategie te bekom. Metode: Hierdie navorsingstudie het die persepsies van mans en vroue teenoor manlike besnyding as MIV-voorkoming ingryping in die Windhoek streek ondersoek. ‘n Aantal van 250 deelnemers is geselekteer vir deelname aan die studie, waarvan 50% manlik en 50% vroulik was. Alle deelnemers was 18 jaar en ouer. ‘n Kwantitatiewe metode en anonieme vraelyste is vir steekproefneming gebruik. Data is vasgelê en ontleed met behulp van SPSS weergawe 20. Resultate: Die meerderheid van die respondente (76.8%) het goeie kennis van manlike besnyding en ‘n positiewe houding (93.6%) teenoor manlike besnyding getoon, maar daar was ‘n deel van die respondente (23.2%) wat nie ingelig was oor die voordele van manlike besnyding nie, en 6.4% van die respondente het ‘n negatiewe houding teenoor manlike besnyding gehad, terwyl ‘n groot deel van 53.2% negatiewe persepsies van manlike besnyding en die voordele daarvan gehad het. Die studie het ook bevind dat daar ‘n verband is tussen kennis en persepsies van 0.250 teen p-waarde < 0.05, sowel as ‘n verband tussen houdings en persepsies 0.213, p-waarde <0.001. Gevolgtrekking: Daar is tot die gevolgtrekking gekom dat kennis ‘n belangrike rol speel in die verandering van houdings en persepsies. Hoe meer ingelig ‘n individu is, hoe beter is die kanse dat hulle ‘n positiewe houding teenoor manlike besnyding sal hê, wat ook positiewe persepsies van manlike besnyding kan beïnvloed. Ten einde manlike besnyding as MIV-voorkoming strategie te versterk is dit noodsaaklik om die bevolking wat min kennis en negatiewe houdings getoon het met inligting, opvoeding en berading te verskaf. Dit kan help om hul houding teenoor manlike besnyding te verander en om meer positiewe persepsies daarvan te ontwikkel. Met betrekking tot hindernisse moet die relevante owerhede vorendag kom met ‘n strategie om die struikelblokke uit te skakel ten einde aanvaarbaarheid van manlike besnyding onder groepe wat nie besny is nie, te fasiliteer.

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.

Do people’s attitudes towards female genital cutting (FGC) change after they migrate from a country where the practice is common, to one where it is not? Alongside increased levels of migration, this question is increasingly being raised. This thesis aimed to expand the understanding about attitudes towards FGC held by Somali men and women in Sweden, and thereby to identify potential factors that impede or facilitate the cessation of FGC. Cross-sectional questionnaire data were collected in four Swedish municipalities to assess attitudes to FGC. To further explore perceptions of FGC, as well as the circumcision of boys, semi-structured interviews and focus group discussions were conducted. Data were collected in 2015. The findings identified an overall widespread opposition to forms of FGC that cause anatomical change. A majority (78%) expressed an opposition to the continuation of all forms of FGC, with the odds of supporting FGC decreasing with increased years of residency in Sweden. An identified 18% reported a support for the continuation of pricking (FGC type IV). A support of pricking was linked with perceiving it as acceptable according to Islam, not a violation of children’s rights, and not causing long-term health complications. Pricking was not defined as a form of FGC by 32%. Most men described a preference to marry an uncircumcised woman (76%) or one who had had pricking (16%). How the individuals perceived the support of FGC in the Swedish Somali community corresponded well with their own approval of the practice. While there seemed to be a continuity regarding the Swedish Somalis’ core values of being a good Muslim, not inflicting harm, and upholding respectability, re-evaluation of how these are applied when it comes to circumcision of girls and boys was identified. This resulted in FGC being viewed as a practice that could be abandoned or adapted. Paradoxically, based on the same core values, the circumcision of boys was continuously perceived as an unquestionable required practice. Altogether, these results suggest that a shift in convention towards no FGC is taking place. However, the identified lack of consensus on practices regarded as FGC needs further attention.

Sammanfattning Bakgrund Fokus för studien är att uppmärksamma Socialstyrelsens vägledande information rörande könsstympning av flickor och kvinnor. Traditionen innebär total eller delvis borttagning av det kvinnliga yttre könsorganet, vilket innefattar avsiktliga skador som förändrar eller orsakar defekter på det kvinnliga könsorganet utan medicinska skäl eller grunder (WHO, 2008). Till följd av migration och befolkningsomflyttningar har traditionen kommit att uppmärksammas internationellt och även i Sverige. I Sverige har traditionen en tydlig relevans för socialt arbete eftersom könsstympning diskuteras och definieras som våld mot kvinnor/barn, förtryck, heder, brott mot mänskliga och barns rättigheter (Talle, 2008). Myndigheter i Sverige står inför en utmaning att informera, uppmärksamma, integrera och arbeta preventivt med denna målgrupp.   Syfte Syftet med studien är att beskriva och analysera hur socialstyrelsen via sin webbplattform förmedlar kunskap om könsstympning av flickor och kvinnor. Utifrån hemsidans tillgängliga texter granskas och analyseras vägledning och kunskapsstöd riktade till olika professioner, exempelvis socialtjänsten och hälso-och sjukvård. Vidare studeras hur kunskapsstöd vägleder professioner till att förstå och handla i frågor som rör könsstympning som ett arbete på samhälls-, grupp och individnivå. Utifrån det analyseras hur socialstyrelsen främja det sociala arbetet kring könsstympning.   Metod Studien bygger på en kvalitativ forskning baserad på systematisk litteraturstudie och induktiv ansats. Litteraturstudien grundades på analys och granskning av socialstyrelsen kunskapsstöd. Genom en webbaserad innehållsanalys granskades 53 publicerade dokument som direkt eller indirekt berör könsstympning av flickor och kvinnor.     Resultat I resultatdelen identifieras tilltänkta mottagare av det publicerade materialet som illustreras i form av ett diagram. Den allmängiltiga informationen representerar hälften av urvalet. De två mer framträdande grupper identifieras som Hälso-och sjukvård och den berörda målgruppen. I mindre omfattning riktas material till socialtjänst och samhälls-/hälsokommunikatörer. Resultat påvisar att Hälso-sjukvården i sitt arbete med könsstympning, har i större omfattning tillgång till praktiskt och teoretisk vägledning i jämförelse med de andra representerade mottagargrupperna.   Slutsatser Studien visar att socialstyrelsen förmedlar ett arbete mot traditionen på individ-, grupp- och samhällsnivå. Information kring könsstympning av flickor och kvinnor stämmer i stort sett överens med tidigare forskning gällande ursprung, förekomst, utformning och konsekvenser. Studien visar att Socialstyrelsen är en källa för kunskap och information kring ämnet. Det föreligger dock skillnader i den praktiska vägledningen som skapar grund för handling. Vid det konkreta arbetet på individnivå framträder skillnader beroende på om frågan aktualiseras inom hälso- och sjukvård eller socialtjänst. / Abstract Background The focus of the study is to draw attention to the National Board of Health and Welfare directory information concerning female genital mutilation (FMG). The tradition involving the total or partial removal of the female external genitalia, including intentional damage which alter or cause defects on the female genitalia without medical reasons or reasons (WHO, 2008). As a result of migration and population movements, the tradition came to be recognized internationally and in Sweden. In Sweden, the tradition has a clear relevance to social work because FGM is discussed and defined as violence against women/children, oppression, honour, violation of human and children's rights (Talle, 2008). Authorities in Sweden is facing a challenge to inform, alert, integrate and work preventively with this audience. Purpose The purpose of this study is to describe and analyse how the National Board of Health and Welfare by its web platform conveys knowledge of FGM. Based on the websites available texts examined and analysed guidance and knowledge subsidies to various professions, such as social and health care. Further studies show knowledge and support guides professionals to understand and act on issues related to FGM as a work of social, group and at a individual level. Based on the analysis of how the National Board of Health and Welfare promotes the social work of FGM. Method The study is based on a qualitative research based on a systematic literature review and inductive approach. The literature review was based on analysis and review by the National Board of Health and Welfare knowledge support. Through a web-based content analysis examined 53 published documents that directly or indirectly affects FGM. Results In the results section identified the receiver to think of the published material illustrated in the form of a diagram. The universal information represents half of the sample. The two prominent groups identified as Health and the touch target. In smaller scale material is directed to social and community -/health communicators. Results demonstrate that the health-care system in his work on FGM, has been more widely access to practical and theoretical guidance in comparison to the other receiver groups represented. Conclusions The study shows that the National Board of Health and Welfare conveys a work against the tradition of individual, group and societal level. Information about FGM are broadly in line with previous research on the origin, presence, design and impact. The study shows that the National Board of Health and Welfare is a source of knowledge and information on the subject. However, there are differences in the practical guide to creating a basis for action. In the concrete work at the individual level, disparities, depending on whether the issue arises in healthcare or social services.