Exploring factors influencing integration of traditional and medical male circumcision methods at Ingquza Hill Local Municipality, Eastern Cape: A socio-ecological perspective

Abstract

BackgroundMedical male circumcision (MMC) and traditional male circumcision (TMC) are reportedly having negative and positive outcomes in the Eastern Cape province. Researchers show contradictory remedies; some advocate for abolishment of TMC and others call for the integration of both methods.AimThis study aimed to explore factors influencing the integration of TMC and MMC at different socio-ecological levels.SettingThe study was conducted at Ingquza Hill Local Municipality in the Eastern Cape province.MethodsAn explorative qualitative study design, using in-depth interviews (IDIs) and focus group discussions (FGDs), was employed in this study. Purposive sampling was used to select the participants. A framework analysis approach was used to analyse the data, and the themes were developed in line with the socio-ecological model.ResultsFour main themes emerged from the data as important in influencing the integration of TMC and MMC methods. These included: (1) individual factors, related to circumcision age eligibility and post-circumcision behaviour; (2) microsystem factors, related to alcohol and drug abuse, peer pressure, abuse of initiates, and family influence; (3) exosystem factors, related to financial gains associated with circumcision and the role of community forums; and (4) macrosystem factors, related to stigma and discrimination, and male youth dominance in circumcision practices.ConclusionMale circumcision in this area is influenced by complex factors at multiple social levels. Interventions directed at all of these levels are urgently needed to facilitate integration of the TMC and MMC methods.

Soccer clubs as avenues for gender transformative socialization of adolescent boys in Cape Town and Mthatha, South Africa: A qualitative study

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Key challenges to voluntary medical male circumcision uptake in traditionally circumcising settings of Machinga district in Malawi

“…Traditional leaders, on the other hand, can be incorporated to promote collaboration between the community and health workers in order to prevent unsafe circumcisions by untrained local providers [48].…”

Could Vhavenda initiation schools be a panacea for HIV and AIDS management in the Vhembe district of South Africa?

“…Admittedly, the process is mainly signified through male circumcision, which is a very important aspect (rite) of the entire ritual. In most African countries, the aim of initiation schools is to circumcise and prepare young boys for their conversion to ‘manhood’ (maturity), in keeping with a cultural philosophy (Prusente, Khuzwayo & Sikweyiya 2019 :02). Young men are educated about courtship and marriage, cultural expectations of social responsibility and male behaviour in society.…”

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“…Uncertainties remain about conventional surgical processes that can increase HIV transmission and about the viable impact of cultural guidance on sexual risk-taking and gender-based violence, which are also major drivers of HIV transmission. Improved expertise at these intersections is important for developing and implementing suitable HIV prevention strategies (Prusente et al 2019 :04).…”