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Palmer E, Marais L, Engelbrecht M. Black Women's Perceptions Towards Infant and Child Male Circumcision. Matern Child Health J 2023:10.1007/s10995-023-03693-6. [PMID: 37273136 DOI: 10.1007/s10995-023-03693-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The objective of this article was to analyse women's perceptions of ICMC and to propose a framework for ICMC decision-making that can inform ICMC policies. METHOD Using qualitative interviews, this study investigated twenty-five Black women's perceptions of ICMC decisionmaking in South Africa. Black women who had opted not to circumcise their sons, were selected through purposive and snowball sampling. Underpinned by the Social Norms Theory, their responses were analysed through in-depth interviews and a framework analysis. We conducted the study in the townships of Diepsloot and Diepkloof, Gauteng, South Africa. RESULTS Three major themes emerged: medical mistrust, inaccurate knowledge leading to myths and misconceptions, and cultural practices related to traditional male circumcision. Building Black women's trust in the public health system is important for ICMC decision-making. CONCLUSIONS FOR PRACTICE Policies should address misinformation through platforms that Black women share. There should be an acknowledgement of the role that cultural differences play in the decision-making process. This study developed an ICMC perception framework to inform policy.
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Affiliation(s)
- Eurica Palmer
- Centre for Development Support, Faculty of Economic and Management Sciences, University of the Free State, Bloemfontein, South Africa.
| | - Lochner Marais
- Centre for Development Support, Faculty of Economic and Management Sciences, University of the Free State, Bloemfontein, South Africa
| | - Michelle Engelbrecht
- Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa
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Asa GA, Fauk NK, Ward PR. Traditional male circumcision and the risk for HIV transmission among men: a systematic review. BMJ Open 2023; 13:e072118. [PMID: 37208134 DOI: 10.1136/bmjopen-2023-072118] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
OBJECTIVES To synthesise evidence to determine whether, in contrast to medical male circumcision, traditional male circumcision (TMC) practices may contribute to HIV transmission and what the impacts of TMC are on the initiates, their families and societies. DESIGN Systematic review. DATA SOURCE PubMed, CINHAL, SCOPUS, ProQuest, Cochrane database and Medline were searched between 15 and 30 October 2022. ELIGIBILITY CRITERIA (1) Studies involving young men, young male adults, male adults and mixed male and female participants; (2) studies on TMC involving men living with HIV (married and non-married); (3) studies on TMC, HIV transmission and impact in low-income and middle-income countries; (4) qualitative, quantitative and mixed-method studies and (5) studies aimed at exploring TMC and how it contributes to HIV transmission and the impacts of HIV on circumcised men and their families. DATA EXTRACTION Data were extracted based on study details, study design, characteristics of participants and results. RESULT A total of 18 studies were included: 11 were qualitative studies, five were quantitative studies and two were mixed-method studies. All the studies included were conducted in areas where TMC was performed (17 in Africa and one in Papua New Guinea). The review's findings were categorised into themes: TMC as a cultural practice, consequences of not being traditionally circumcised on men and their families and TMC-related risk of HIV transmission. CONCLUSION This systematic review highlights that TMC practice and HIV risk could negatively impact men and their families. Existing evidence suggests that little attention has been paid to men and their families experiencing the impacts of TMC and HIV risk factors. The findings recommend the need for health intervention programmes such as safe circumcision and safe sexual behaviours following TMC and efforts to address psychological and social challenges in communities practising TMC. PROSPERO REGISTRATION NUMBER CRD42022357788.
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Affiliation(s)
- Gregorius Abanit Asa
- Research Centre for Public Health, Equity and Human Flourishing (PHEHF), Torrens University Australia, Adelaide, South Australia, Australia
| | - Nelsensius Klau Fauk
- Research Centre for Public Health, Equity and Human Flourishing (PHEHF), Torrens University Australia, Adelaide, South Australia, Australia
| | - Paul Russell Ward
- Research Centre for Public Health, Equity and Human Flourishing (PHEHF), Torrens University Australia, Adelaide, South Australia, Australia
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Earp BD. Genital Cutting as Gender Oppression: Time to Revisit the WHO Paradigm. FRONTIERS IN HUMAN DYNAMICS 2022. [DOI: 10.3389/fhumd.2022.778592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The World Health Organization (WHO) condemns all medically unnecessary female genital cutting (FGC) that is primarily associated with people of color and the Global South, claiming that such FGC violates the human right to bodily integrity regardless of harm-level, degree of medicalization, or consent. However, the WHO does not condemn medically unnecessary FGC that is primarily associated with Western culture, such as elective labiaplasty or genital piercing, even when performed by non-medical practitioners (e.g., body artists) or on adolescent girls. Nor does it campaign against any form of medically unnecessary intersex genital cutting (IGC) or male genital cutting (MGC), including forms that are non-consensual or comparably harmful to some types of FGC. These and other apparent inconsistencies risk undermining the perceived authority of the WHO to pronounce on human rights. This paper considers whether the WHO could justify its selective condemnation of non-Western-associated FGC by appealing to the distinctive role of such practices in upholding patriarchal gender systems and furthering sex-based discrimination against women and girls. The paper argues that such a justification would not succeed. To the contrary, dismantling patriarchal power structures and reducing sex-based discrimination in FGC-practicing societies requires principled opposition to medically unnecessary, non-consensual genital cutting of all vulnerable persons, including insufficiently autonomous children, irrespective of their sex traits or socially assigned gender. This conclusion is based, in part, on an assessment of the overlapping and often mutually reinforcing roles of different types of child genital cutting—FGC, MGC, and IGC—in reproducing oppressive gender systems. These systems, in turn, tend to subordinate women and girls as well as non-dominant males and sexual and gender minorities. The selective efforts of the WHO to eliminate only non-Western-associated FGC exposes the organization to credible accusations of racism and cultural imperialism and paradoxically undermines its own stated goals: namely, securing the long-term interests and equal rights of women and girls in FGC-practicing societies.
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Rennie S, Gilbertson A, Hallfors D, Luseno WK. The Ethics of Stigma in Medical Male Circumcision Initiatives Involving Adolescents in Sub-Saharan Africa. Public Health Ethics 2021; 14:79-89. [PMID: 34239604 DOI: 10.1093/phe/phab004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Ongoing global efforts to circumcise adolescent and adult males to reduce their risk of acquiring HIV constitute the largest public health prevention initiative, using surgical means, in human history. Voluntary medical male circumcision (VMMC) programs in Africa have significantly altered social norms related to male circumcision among previously non-circumcising groups and groups that have practiced traditional (non-medical) circumcision. One consequence of this change is the stigmatization of males who, for whatever reason, remain uncircumcised. This paper discusses the ethics of stigma with regard to uncircumcised adolescent males in global VMMC programs, particularly in certain recruitment, demand creation and social norm interventions. Grounded in our own experiences gained while conducting HIV-related ethics research with adolescents in Kenya, we argue that use of explicit or implicit stigma to increase the number of VMMC volunteers is unethical from a public health ethics perspective, particularly in campaigns that leverage social norms of masculinity. Ongoing global efforts to circumcise adolescent and adult males to reduce their risk of acquiring HIV constitute the largest public health prevention initiative, using surgical means, in human history. VMMC programs in Africa have significantly altered social norms related to male circumcision among previously non-circumcising groups and groups that have practiced traditional (non-medical) circumcision. One consequence of this change is the stigmatization of males who, for whatever reason, remain uncircumcised. This paper discusses the ethics of stigma with regard to uncircumcised adolescent males in global VMMC programs, particularly in certain recruitment, demand creation and social norm interventions. Grounded in our own experiences gained while conducting HIV-related ethics research with adolescents in Kenya, we argue that use of explicit or implicit stigma to increase the number of VMMC volunteers is unethical from a public health ethics perspective, particularly in campaigns that leverage social norms of masculinity.
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Aghvinian M, Santoro AF, Gouse H, Joska JA, Linda T, Thomas KGF, Robbins RN. Taking the Test: A Qualitative Analysis of Cultural and Contextual Factors Impacting Neuropsychological Assessment of Xhosa-Speaking South Africans. Arch Clin Neuropsychol 2020; 36:976-980. [DOI: 10.1093/arclin/acaa115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/27/2020] [Accepted: 10/28/2020] [Indexed: 12/22/2022] Open
Abstract
Abstract
Objective
There is an urgent need to make neuropsychological (NP) testing more acceptable, accessible, and culturally salient, particularly for culturally, educationally, and linguistically diverse individuals from countries who may have little-to-no experience with NP testing. In settings with limited resources such as South Africa, unique cultural and contextual factors (e.g., structural inequality, poverty) may impact the experience of NP evaluation. Research in this area is limited and requires further exploration. This qualitative study explores the role of cultural and contextual factors that may impact the experience of NP evaluation in a sample of Xhosa-speaking South African adults. Participant interviews explored the context from which individuals arrived at the NP assessment (e.g., quality of education, understanding of cognitive disorders), and their experience of completing NP tests.
Method
This qualitative study used data from semistructured interviews to conduct a thematic analysis exploring contextual factors and the experience of completing NP tests for the first time among Xhosa-speaking South African adults (N = 22). Results: Although no participants had prior experience with NP testing, most found testing procedures acceptable. Most participants, however, reported a limited understanding of the purpose of NP testing and cognitive problems. Additionally, some participants reported perceptions and attitudes that could affect test performance, such as misinterpreting standard testing procedures (e.g., no feedback from the examiner, being stopped mid-task) as indicative of poor performance.
Conclusions
This study provided much needed exploration into unique cultural factors that may impact the experience of NP assessment in South Africa, which could bias test performance and interpretation, and may aid the field of cross-cultural NP in better serving culturally and linguistically diverse populations. In these countries, neuropsychologists may need to actively evaluate participants’ understanding of NP testing to help foster optimal assessment conditions. They may also need to educate participants on possible causes of cognitive disorders.
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Affiliation(s)
- Maral Aghvinian
- Department of Psychology, Fordham University, New York City, NY, USA
| | - Anthony F Santoro
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York City, NY, USA
| | - Hetta Gouse
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - John A Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Teboho Linda
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Kevin G F Thomas
- ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Reuben N Robbins
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York City, NY, USA
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George C, Roberts R, Deveaux L, Brennen DFP, Read SE. "Getting to Zero New HIV Infections in the Caribbean": Knowledge and Attitudes Toward Male Circumcision Among Adolescent Males in The Bahamas. Am J Mens Health 2020; 13:1557988319872074. [PMID: 31431104 PMCID: PMC6704421 DOI: 10.1177/1557988319872074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Male circumcision (MC) plays a significant role in reducing new HIV infections, particularly in high prevalence countries. This cross-sectional study assesses the prevalence of MC and attitudes toward MC among youth aged 15-18 years in The Bahamas, a medium HIV prevalence country. The survey included 797 young men who completed a questionnaire on MC. Data analyses included chi-squared tests. The self-reported prevalence of MC among youth was 16.7% (121/759). Most of the circumcised youth were circumcised as infants, 84% (107/121) were pleased with their circumcision, and 71% would recommend it to others. For uncircumcised youth, 35% (189/533) would consider voluntary male circumcision (VMC) and 26% would recommend MC to others. In all scenarios, circumcised youth were more likely to be positive about MC. Among uncircumcised young men, being older (17-18 years compared to 15-16 years) was the only variable statistically associated with considering MC or recommending MC. After being presented with information on the benefits of MC for HIV prevention, the number of men who were positive about MC increased. Most of the young men in this cohort would consider VMC for reducing HIV incidence. Also, many stated that, if they had a male child, they would have him circumcised. The attitudes of these youth emphasize the need to provide information on HIV in addition to general health benefits of MC if there were to be a sustainable MC program within this population.
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Affiliation(s)
- Clemon George
- 1 University of Ontario Institute of Technology, Oshawa, ON, Canada.,5 Faculty of Medical Sciences, The University of the West Indies, Cave Hill, Barbados
| | - Robin Roberts
- 2 UWI School of Clinical Medicine and Research, Nassau, Bahamas
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Palmer E, Rau A, Engelbrecht M. Changing Cultural Practices: A Case Study of Male Circumcision in South Africa. Am J Mens Health 2020; 14:1557988320927285. [PMID: 32715892 PMCID: PMC7385840 DOI: 10.1177/1557988320927285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This article presents a case study of Simon, a 25-year old Black South African male. According to his Pedi customs, Simon underwent traditional male circumcision (TMC) as a 12-year-old adolescent. He tells of his fears relative to this experience and how, over time, he transitioned from a belief in TMC to a strong preference for medical male circumcision (MMC). Using a single-case study design, the aim of the research was to explore the value of the exercise of choice in TMC, which may influence cultural perceptions of gender and masculinity. The study unpacks the way in which the meaning and experience of TMC is shaped by the social and cultural contexts of South Africa. This qualitative exploration complements conventional medical accounts of circumcision, which are often focused on the medical procedure while ignoring cultural and social factors. Issues of gender, particularly the construction of hegemonic masculinity and how it positions men, women, and young boys in relation to each other and their communities, are discussed. Simon’s case study provides new insights and perspectives on personally and culturally sensitive issues which are not easily accessed nor commonly understood. Data collected via in-depth interviews were transcribed and analyzed thematically. Analysis applied information from the literature and key concepts from the theoretical standpoint of social constructivism. Case study analysis allowed space for unexpected, emergent themes to arise from the data. Four main themes were identified, notably language, silence, patriarchy, and masculinity.
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Affiliation(s)
- Eurica Palmer
- Centre for Development Support, Faculty of Economic and Management Sciences, University of the Free State, Bloemfontein, South Africa
| | - Asta Rau
- Centre for Health Systems Research & Development, Faculty of the Humanities, University of the Free State, Bloemfontein, South Africa
| | - Michelle Engelbrecht
- Centre for Health Systems Research & Development, Faculty of the Humanities, University of the Free State, Bloemfontein, South Africa
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Mpateni A, Kang'ethe SM. An Autopsy of Palliative Health Hazards Associated with the Contemporary Traditional Male Circumcision Rite: The Case of 2016 Alice Study. Indian J Palliat Care 2020; 26:80-85. [PMID: 32132790 PMCID: PMC7017700 DOI: 10.4103/ijpc.ijpc_177_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/02/2019] [Indexed: 11/12/2022] Open
Abstract
Aim: This article examined the health hazards associated with the contemporary traditional circumcision rite in Alice, Eastern Cape, South Africa. Methods: The study from which this article was extracted was explorative, descriptive, and employed a qualitative method. The study took use of one-on-one interviews, with the use of interview guide as an instrument to ease focus group discussions and interviews. Data were then analyzed thematically. Results: The findings brought the following factors; hospitalization of initiates; contraction of diseases; amputation of manhood organs; and maltreatment leading to health hazards. Conclusions: This article then recommended that, government, cultural custodians, and parents are requested to work hand in hand to curb all these health hazards associated with the contemporary rite.
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Affiliation(s)
- Aphiwe Mpateni
- Department of Social Work and Social Development, University of Fort Hare, Alice, South Africa
| | - Simon Murote Kang'ethe
- Department of Social Work and Social Development, University of Fort Hare, Alice, South Africa
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Medich M, Mindry D, Tomlinson M, Rotheram-Borus MJ, Bantjes J, Swendeman D. The pull of soccer and the push of Xhosa boys in an HIV and drug abuse intervention in the Western Cape, South Africa. SAHARA J 2018; 15:187-199. [PMID: 30427256 PMCID: PMC6237168 DOI: 10.1080/17290376.2018.1541024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
There is growing interest in engaging men and boys in health and development programmes targeting the intersection of HIV risk, substance abuse, and violence. Understanding the conceptualisations of masculinities or masculine identities that shape both behaviours and opportunities for intervention is central to advancing the global agenda to engage men in health and development interventions. This paper examines an intervention using soccer and job training to engage and deliver activities for HIV prevention, substance abuse, and gender-based violence in a South African township. A literature review provides theoretical, historical and social context for the intersection of gender, masculinity, soccer, violence, and sexual relationships. Qualitative data from in-depth interviews and focus groups is analysed using theoretical and contextual frames to elucidate the negotiation of shifting, contradictory, and conflicting masculine roles. Results highlight how changing risky, normative behaviours among young men is a negotiated process entailing men's relationships with women and with other men.
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Affiliation(s)
- Melissa Medich
- Department of Family Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Deborah Mindry
- Center of Expertise on Women’s Health, Gender and Empowerment, University of California Global Health Institute, San Francisco, CA, USA
| | - Mark Tomlinson
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Mary Jane Rotheram-Borus
- Global Center for Children and Families, University of California Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Jason Bantjes
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Dallas Swendeman
- Center of Expertise on Women’s Health, Gender and Empowerment, University of California Global Health Institute, San Francisco, CA, USA
- Global Center for Children and Families, University of California Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Lesch E, de Bruin K, Anderson C. A Pilot Implementation of the Emotionally Focused Couple Therapy Group Psychoeducation Program in a South African Setting. JOURNAL OF COUPLE & RELATIONSHIP THERAPY 2018. [DOI: 10.1080/15332691.2017.1417940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Elmien Lesch
- Psychology Department, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Kathryn de Bruin
- Marital and Family Therapist, Private Practice, San Diego, California, USA
| | - Colleen Anderson
- Clinical Psychologist, Private Practice, Cape Town, South Africa
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Froneman S, Kapp PA. An exploration of the knowledge, attitudes and beliefs of Xhosa men concerning traditional circumcision. Afr J Prim Health Care Fam Med 2017; 9:e1-e8. [PMID: 29041800 PMCID: PMC5645564 DOI: 10.4102/phcfm.v9i1.1454] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/16/2017] [Accepted: 06/20/2017] [Indexed: 11/05/2022] Open
Abstract
Background The practice of traditional circumcision is associated with considerable morbidity and mortality, yet there is a paucity of literature that provides an understanding of the cultural values that influence men to choose traditional rather than medical circumcision. The aim of this study was to better understand the culture surrounding traditional circumcision, with a view to addressing morbidity and mortality rates associated with the Xhosa male initiation rituals. We explored Xhosa men’s perceptions regarding the need for the risks and the social pressure to undergo traditional circumcision, the impact of non-initiation or failed initiation and the perceived barriers to obtaining medical help for the complications of traditional circumcisions. Methods Individual in-depth interviews were conducted with 10 purposively sampled teenagers and adult men. The interviews were recorded, translated, transcribed and analysed using the framework method. Results Traditional circumcision was seen as essential to Xhosa culture. Participants rationalised many reasons for participating, including personal growth and development, family and peer pressure, independence and knowledge gained, a connection with ancestors and initiation into manhood. Despite publicity of the dangers of traditional circumcision and the hardships they have to endure, most young men still saw this process as necessary and worthwhile. Conclusion Traditional initiation and circumcision are here to stay. The majority of boys still trust the elders and supernatural processes to guide them. However, some participants welcomed government initiatives to reduce human error causing unnecessary death and suffering. Current systems to prevent morbidity and mortality are insufficient and should be prioritised.
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Affiliation(s)
| | - Paul A Kapp
- Division of Family Medicine & Primary Care, Stellenbosch University.
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van der Merwe A, Graewe F, Zühlke A, Barsdorf NW, Zarrabi AD, Viljoen JT, Ackermann H, Spies PV, Opondo D, Al-Qaoud T, Bezuidenhout K, Nel JD, Bailey B, Moosa MR. Penile allotransplantation for penis amputation following ritual circumcision: a case report with 24 months of follow-up. Lancet 2017; 390:1038-1047. [PMID: 28823494 DOI: 10.1016/s0140-6736(17)31807-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 05/30/2017] [Accepted: 06/13/2017] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Ritual circumcision complicated by gangrene is a leading cause of penile loss in young men in South Africa. This deeply rooted cultural tradition is unlikely to be abolished. Conventional reconstructive techniques using free vascularised tissue flaps with penile implants are undesirable in this often socioeconomically challenged group because donor site morbidity can hinder manual labour and vigorous sexual activity might lead to penile implant extrusion. The psychosociological effects of penile loss in a young man are devastating and replacing it with the same organ is likely to produce the maximum benefit. METHODS We first performed a cadaver-to-cadaver penile transplantation as preparation. After approval from the Human Research Ethics Committee was obtained, we recruited potential recipients. We screened the potential participants for both physical and psychological characteristics, including penile stump length, and emotional suitability for the procedure. A suitable donor became available and the penis was harvested. We surgically prepared the penile stump of the recipient and attached the penile graft. Immunosuppression treatment with antithymyocyte globulin, methylprednisolone, tacrolimus, mycophenolate mofetil, and prednisone were commenced. Tadalafil at 5 mg once per day was commenced after 1 week as penile rehabilitation and was continued for 3 months. We collected on quality-of-life scores (Short Form 36 version 2 [SF-36v2] questionnaires) before surgery and during follow-up and measured erectile function (International Index for Erectile Function [IIEF] score) and urine flow rates at 24 months post transplant. FINDINGS The warm ischaemia time for the graft after removal was 4 min and the cold ischaemia time was 16 h. The surgery lasted 9 h. An arterial thrombus required urgent revision 8 h after the operation. On post operative day 6, an infected haematoma and an area of proximal skin necrosis were surgically treated. The recipient was discharged after 1 month and first reported satisfactory sexual intercourse 1 week later (despite advice to the contrary). The recipient reported regular sexual intercourse from 3 months after the operation. An episode of acute kidney injury at 7 months was reversed by reducing the tacrolimus dose to 14 mg twice per day. At 8 months after surgery, the patient had a skin infection with phaeohyphomycosis due to Alternaria alternata, which we treated with topical antifungal medication. Quality-of-life scores improved substantially after the operation (SF-36v2 mental health scores improved from 25 preoperatively, to 57 at 6 months and 46 at 24 months post transplant; physical health scores improved from 37 at baseline to 60 at 6 months and 59 at 24 months post-transplant). At 24 months, measured maximum urine flow rate (16·3 mL/s from a volume voided of 109 mL) and IIEF score (overall satisfaction score of 8 from a maximum of 10) were normal, showing normal voiding and erectile function, respectively. INTERPRETATION Penile transplantation restored normal physiological functions in this transplant recipient without major complications in the first 24 months. FUNDING Department of Health, Western Cape Government.
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Affiliation(s)
- André van der Merwe
- Division of Urology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa.
| | - Frank Graewe
- Division of Plastic and Reconstructive Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Alexander Zühlke
- Division of Plastic and Reconstructive Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Nicola W Barsdorf
- Health Research Ethics, Division of Research Development and Support, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Amir D Zarrabi
- Division of Urology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Jeremy T Viljoen
- Division of Urology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Hilgard Ackermann
- Division of Urology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Pieter V Spies
- Division of Urology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Dedan Opondo
- Division of Urology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Talal Al-Qaoud
- Division of Transplant Surgery, Department of Surgery, University of Wisconsin, Milwaukee, WI, USA
| | - Karla Bezuidenhout
- Division of Nephrology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Johan D Nel
- Division of Nephrology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Bertha Bailey
- Renal Unit, Tygerberg Academic Hospital, Cape Town, South Africa
| | - M Rafique Moosa
- Division of Nephrology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
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Magodyo T, Andipatin M, Jackson K. The role of Xhosa traditional circumcision in constructing masculinity. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2016. [DOI: 10.1177/0081246316678176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ulwaluko is a Xhosa word that refers to an initiation ritual. The purpose is to transform boys into men. Circumcision is one of the rituals performed. The ritual aims to instil good moral and social values. Due to socio-cultural shifts, the practice of Ulwaluko has changed and this has culminated in instances of criminal activity, drug abuse, risky sexual behaviours, and inhumane behaviours among some of the initiates. There has been a recent upsurge in research on Ulwaluko in South Africa. While many studies examined Ulwaluko from a constructionist framework, very few have focused on subject positions and how Ulwaluko contributes to the construction of masculinity in Xhosa men. Using social constructionist theory, the study employed a qualitative exploratory design and semi-structured interviews that were analysed using thematic decomposition analysis and positioning theory. Seven participants, from a university in Cape Town, aged from 19 to 32 were recruited using purposive sampling. The results of the study reflect the fluidity of masculinity as reported in literature. First, in some of the participants, Ulwaluko created an idealised masculine identity that was chiefly characterised by upholding ritual teachings and yet the same men were burdened by a prescriptive set of masculine role expectations. Second, through self-reflection and critical engagement, some men contested Ulwaluko resulting in the creation of rival masculinities and thus the study created spaces to rethink masculine identities.
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Affiliation(s)
- Tapiwa Magodyo
- Department of Psychology, University of the Western Cape, South Africa
| | | | - Kyle Jackson
- Department of Psychology, University of the Western Cape, South Africa
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Ntozini A, Ngqangweni H. Gay Xhosa men's experiences of ulwaluko (traditional male initiation). CULTURE, HEALTH & SEXUALITY 2016; 18:1309-1318. [PMID: 27232591 PMCID: PMC5062045 DOI: 10.1080/13691058.2016.1182213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 04/20/2016] [Indexed: 06/05/2023]
Abstract
This paper explores the lives of gay men undergoing traditional initiation in the Eastern Cape. Nine participants aged between 18 and 26 reported their reasons for becoming traditionally circumcised, which included personal validation of cultural manhood, the desire to conform to societal norms and expectations, and pressure from family members to 'convert' them to heterosexuality. While homosexuality remains a target for vilification and abuse both in Southern Africa and across the African continent, practices such as ulwaluko (traditional male initiation) must surely be among the most threatening to a young gay Xhosa man's self-esteem.
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Affiliation(s)
- Anathi Ntozini
- Department of Psychology, University of Fort Hare, East London, South Africa
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Affiliation(s)
- Sakhumzi Mfecane
- Department of Anthropology and Sociology, University of the Western Cape, Bellville, South Africa
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Banwari M. Dangerous to mix: culture and politics in a traditional circumcision in South Africa. Afr Health Sci 2015; 15:283-7. [PMID: 25834561 DOI: 10.4314/ahs.v15i1.38] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Traditional circumcision (initiation) is an integral part of the Xhosa speaking communities. Circumcision is the first step towards manhood. It involves a number of cultural, religious, legal and ethical issues, which in terms of the constitution of the Republic of South Africa, are rights that must be protected. OBJECTIVE To highlight the problem of circumcision related death in South Africa. CASE REPORT This case report examines a 16- year boy who had died as result of botched circumcision by an unqualified traditional surgeon. He kept the boy in his custody despite his serious illness. He applied a tight bandage to control the bleeding, resulting in gangrene of the penis followed by septicemia. The histories, postmortem findings, cause of death and medico- legal and social aspects have been discussed in this manuscript. CONCLUSION There are unacceptable deaths related with circumcision in South Africa. The right to life cannot be sacrificed at the altar of culture and politics.
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Kelly A, Kupul M, Nake Trumb R, Aeno H, Neo J, Fitzgerald L, Hill PS, Kaldor JM, Siba P, Vallely A. More than just a cut: a qualitative study of penile practices and their relationship to masculinity, sexuality and contagion and their implications for HIV prevention in Papua New Guinea. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2012; 12:10. [PMID: 22818494 PMCID: PMC3520875 DOI: 10.1186/1472-698x-12-10] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 06/27/2012] [Indexed: 11/10/2022]
Abstract
Background Male circumcision (MC) has been shown to reduce vaginal transmission of HIV to men. While community acceptability is important in a countries preparedness to introduce MC, it is equally important to map contemporary MC and other penile cutting practices, and the socio-cultural dimensions underpinning these practices. Methods A total of 482 men and women (n = 276 and n = 210, respectively) participated in 82 semi-structured and 45 focus group discussions from four different provinces of Papua New Guinea (PNG), each representing one of the four socially and geographically diverse regions of the country. Results Of the men interviewed 131 self-reported that they had undergone a penile alteration with some reporting multiple types. Practices were diverse and could be grouped into five broad categories: traditional (customary) penile cutting; contemporary penile cutting; medical circumcision; penile inserts; and penile bloodletting practices in which sharp objects are used to incise the glans and or inserted and withdrawn from the male urethra or in order to induce bleeding. Socio-cultural traditions, enhanced sexual pleasure and improved genital hygiene were key motivators for all forms of penile practices. Conclusions The findings from this study highlight the complex and diverse nature of penile practices in PNG and their association with notions of masculinity, sexuality and contagion. Contemporary penile practices are critical to a community’s acceptance of MC and of a country’s ability to successfully implement MC in the context of a rich and dynamic culture of penile practices. If a MC program were to be successfully rolled out in PNG to prevent HIV it would need to work within and build upon these diverse cultural meanings and motivators for penile practices already commonly performed in PNG by men.
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Affiliation(s)
- Angela Kelly
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
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