Provincial Government, Traditional Leaders Sign Medical Male Circumcision Agreement

The event is the signing of a landmark agreement between Chief Mayataza, leader of the local traditional initiation forum and respected community leader in the Langeberg, and Western Cape Government Health.

The undertaking, the first of its kind in the Western Cape, aims to build bridges between traditional and medical circumcision practices. The agreement focuses on methods that can be implemented without compromising the cultural practice of initiation, therefore the main focus is the supply of services that support and respect the initiation process.

The department has undertaken to supply HIV testing and counseling to all initiates and the delivery of sterile surgical packs for use during traditional circumcision, as well as and post-operative counseling, where requested.

Western Cape Government Health's approach is that the department plays a secondary role in that the department is geared to perform medical male circumcisions (MMCs), but that the Department of Cultural Affairs and Sport is the primary role player, as initiation constitutes an important cultural practice among a significant section of the population of the Western Cape.

The objective is to promote the cultural practice without compromising our health objectives.

The departments have, in collaboration with all relevant stakeholders, embarked on a process that will culminate in the formulation of a joint strategy for the Western Cape.

In 2011 the Department of Cultural Affairs and Sport (DCAS) developed an initiation framework and protocol. The recommendations of the Department of Health’s circumcision strategy are included in this framework.

The two departments have jointly established a steering committee, driven by DCAS. This committee drives closer collaboration and co-ordination between DCAS and the Department of Health with regard to MMC and the initiation or traditional circumcision programme.

Some facts
MMC forms part of the three-step approach to prevention of HIV infection. The total removal of the foreskin can reduce contraction and therefore infection of HIV by up to 60%.

In the Cape Winelands District, approximately 1 500 MMCs have been performed since April 2013.

Traditional circumcision, together with safe sexual practice and condom use, can help turn the tide on HIV Infection in our youth.

In total from April until August this year, Western Cape Government Health has performed 3 666 MMCs throughout the province, with 123 adverse events. This is well within the normal range of 2-4%.

MMC in the province is steadily increasing, yet much more needs to be done to ensure that males, firstly, know about the service and then access it.

We have routinised the service by adding it to the daily "tally sheets" doctors and nurses are using. From this alone we have seen an increase in health workers talking about MMC. The next step should be to create the demand and get the numbers.

Social Mobilisation Strategy
One of the projects of our department to promote MMC is our social mobilisation strategy that targets the segment of the population who are not affected by cultural circumcision. One project is a weekly blitz by a community action team to sign up men for the procedure. The other aspect is making containers and equipment available.

In collaboration with the Department of Cultural Affairs and Sport, we are:

• Providing first aid training
• Providing first aid kits
• Providing bibs to nurses
• Providing overalls to traditional surgeons/circumcisers
• Availing doctors on call for emergencies during circumcision camps
• Encouraging local authorities to provide clean water
• Engaging traditional surgeons through their local forum

Western Cape Minister of Cultural Affairs and Sport, Dr Ivan Meyer, commented: "Stakeholders such as Western Cape Government Health in the Langeberg (Robertson area), as well as Chief Mayataza of the local Initiation Forum exemplify what will certainly become, in my view, best practice as far as traditional initiation is concerned.

"The MOU allows for the establishment of partnerships that can build on: Initiation forums, entrusted with activities related to pre-, actual and post- initiation phases; traditional surgeons (iingcibi) who through continuous training and up-skilling will enable the delivery of delegated initiation assignments and carers (amakhankatha), whose primary care-giving responsibility remains intact and unshaken due to the attendance of capacity building workshops. However, given the health challenges faced by many young initiates, this integrated approach between the initiation practice and medical circumcision provides a logical and viable solution that can save this diminishing part of our heritage.

"Essentially, if we want to enjoy a lasting solution to the problem, the initiation practice and medical circumcision must be harmonised in a systematic and sensitive manner."