The potential of involving traditional practitioners in the scaling up of male circumcision in the context of HIV prevention in Tanzania

Abstract

Male circumcision (MC) has been practiced worldwide for religious, cultural, social and medical reasons. Recent studies in Africa have indicated that MC to be highly protective against HIV transmission. However, incorporating MC in HIV/AIDS prevention programme will increase its demand in Tanzania where traditional male circumcision is common and the health care system is weak. The objective of this study was to determine the challenges and opportunities of involving traditional practitioners in scaling up safe MC in the context of HIV prevention in Tanzania. The study was conducted in Monduli, Bahi and Mkuranga districts of Tanzania. Both quantitative and qualitative methods were employed. Household survey involved community members from the selected villages. Indepth interviews involved traditional practitioners and key informants at national, district and facility levels. A total of 601 householders were interviewed. Most (71.4%) household respondents preferred traditional MC as it was part of their culture and tradition. A similar response was obtained from other respondents. It was mostly preferred because it was used as an initiation school, turning of boys to warriors and sense of social cohesion. Only 228 (37.9%) of the respondents were aware of the adverse events associated with MC. The most frequently mentioned adverse effects were severe bleeding (65.0%), delayed wound healing (17.5%) and wound sepsis (8.4%). The risk of acquiring HIV through male circumcision practice was poorly known among community members except medical respondents. Single unsterilized local surgical equipment was used to circumcise several initiates. It was observed that interference with traditional values associated with circumcision to be the main hindrance of linkage between traditional and conventional practitioners. On the other hand it was reported that there was no policy or guidelines on Traditional MC (TMC). Most of respondents supported the efforts to establish and promote formal linkages between traditional and conventional practitioners. In conclusion, under the current HIV pandemic and TMC being prevalent in Tanzania, it is high time for the government to establish a linkage between traditional and conventional practitioners for safe practices in order to minimize HIV transmission.

Key considerations in scaling up male circumcision in Tanzania: views of the urban residents in Tanzania

“…This is in keeping with the observation that MC is widely accepted in Tanzania as reported in various studies (Nnko et al, 2001;Weiss et al, 2008;Wambura et al, 2009;Mshana et al, 2011, Kilima et al, 2012. Previous studies in sub Saharan Africa have reported on strategies to scale up MC ( Ngalande et al, 2006;WHO, 2007;Wambura et al, 2009) such as circumcision campaigns in non-circumcising communities, reducing the cost for a circumcision procedure and sensitizing women attending RCH clinics.…”

“…In the situational analysis report to the Ministry of Health and Social Welfare it was recommended that the services be provided free of charge to boys aged less than 10 years (Wambura et al, 2009). In another study in three districts of Tanzania, Kilima et al (2012) proposed that male circumcision procedure should be covered under the current health insurance schemes.…”

The male circumcision: the oldest ancient procedure, its past, present and future roles.

“…However and it is believed that, the technique varies from one ethnic group to another (Kilima et al, 2012). This is reflected by the extent of removal of foreskin and on the part removed whether ventral or dorsal.…”

“…For example it has been witnessed that Gogo tribe in central Tanzania circumcise in such a way that a flap of foreskin is folded back under the ventral aspect of the penis to make a small swelling considered to have sexual functions (Kilima et al, 2012). Maasai on the other hand leave a hanging flap of foreskin on ventral aspect of the shaft of the penis, which is also considered to increase female stimulation during coitus and in other ethnic groups the foreskin is completely removed (Kilima et al, 2012). As indicated earlier, in traditional male circumcision neither anaesthesia nor analgesics are used with aim of testing bravery, endurance and strength of the participants.…”

“…The procedure has been successfully practiced and transferred from one generation to another for many years among the Maasai in Northern Tanzania (Kilima et al, 2012). However in some of the circumcising communities, Mwita et al (2009) suggested that traditional and religion influences may have converging roles in male circumcision such that, the practice varies from one group to another depending on the prevalent religion.…”