Abstract
Botswana has been running Safe Male Circumcision (SMC) since 2009 and has not yet met its target. Donors like the US Centers for Disease Control and Prevention and Africa Comprehensive HIV/AIDS Partnership (funded by the Gates Foundation) in collaboration with Botswana's Ministry of Health have invested much to encourage HIV-negative men to circumcise. Demand creation strategies make use of media and celebrities. The objective of this paper is to explore responses to SMC in relation to circumcision as part of traditional initiation practices. More specifically, we present the views of two communities in Botswana on SMC consultation processes, implementation procedures and campaign strategies. The methods used include participant observation, in-depth interviews with key stakeholders (donors, implementers and Ministry officials), community leaders and men in the community. We observe that consultation with traditional leaders was done in a seemingly superficial, non-participatory manner. While SMC implementers reported pressure to deliver numbers to the World Health Organization, traditional leaders promoted circumcision through their routine traditional initiation ceremonies at breaks of two-year intervals. There were conflicting views on public SMC demand creation campaigns in relation to the traditional secrecy of circumcision. In conclusion, initial cooperation of local chiefs and elders turned into resistance.
Highlights
Voluntary medical male circumcision (VMMC) is esteemed by UNAIDS and World Health Organization (WHO) as a great contribution towards the reduction of HIV infections
Our exploration of responses to Safe Male Circumcision (SMC) in relation to circumcision as part of traditional initiation practices is presented according to themes emerging from the data analysis
Cultural circumcision taboos breached Secrecy Traditional leaders clearly described cultural circumcision as a secret domain not to be shared with women
Summary
Voluntary medical male circumcision (VMMC) is esteemed by UNAIDS and World Health Organization (WHO) as a great contribution towards the reduction of HIV infections. The motivation to use VMMC for HIV prevention originates from three largescale randomised control trials (RCTs) in Rakai, Uganda; Kisumu, Kenya and Orange Farm, South Africa which concluded that VMMC reduces the risk of men acquiring HIV through vaginal sex by 50–60%, is safe and has potential to give lifelong benefits (Auvert et al, 2005; Bailey et al, 2007; Gray et al, 2007). WHO made policy recommendations that countries with high HIV prevalence ( African countries) and low prevalence of male circumcision (MC) scale up VMMC as a priority in HIV prevention (WHO, 2007). While critics note hastiness in pushing to implement VMMC, the very energetic response by WHO and UNAIDS demonstrates the motivation and deep desire to control this longstanding pandemic (Dowsett & Couch, 2007). Daniel to the number of HIV/AIDS strategic programmes that are not initiated locally but are negotiated into African countries by external bodies (UNAIDS, 2010)
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