Traditional male circumcision practices among the Kurya of North-eastern Tanzania and implications for national programmes

Abstract

The World Health Organisation and the Joint United Nations Programme on AIDS recommend male circumcision (MC) as an additional intervention against HIV infection. Various sub-Saharan African countries are at different stages of rolling out MC programmes. Despite initial fears, studies conducted among traditionally non-circumcising communities in Africa have shown that MC is widely accepted as a biomedical intervention. However, little is known on how traditionally circumcising communities where MC carries considerable social meaning and significance would respond to such programmes. This study was conducted among a traditionally circumcising community in Tarime district in Tanzania as part of a national situation analysis prior to initiating a national MC programme. It employed key informant interviews and focus group discussions for data collection. Results show that the Kurya ethnic group practice MC as a rite of passage from childhood to adulthood. Each clan organises its own circumcision ceremony, which takes place every even numbered years. Clan leaders and traditional circumcisers are central to its organisation. Among the Kurya, there is high regard for traditional MC as it is perceived as upholding cultural practice and identity. It also embodies notions of bravery since anaesthetics are not used. On the other hand, medical MC is not viewed as prestigious since anaesthetics are used to suppress pain. Social pressure for traditional MC is applied through ridiculing of those uncircumcised or circumcised at health facilities. In general, there are positive attitudes towards MC as it is perceived as enhancing personal hygiene and having a protective effect against sexually transmitted infections. For the success of nation-wide MC programmes, there is need to develop programmes that incorporate both clinical and sociocultural interests.

Keywords:

• male circumcision
• traditional
• Africa
• HIV

Acknowledgements

We thank the Government of Tanzania for funding this study through the Ministry of Health and Social Welfare (MoHSW) and the National AIDS Control Programme (NACP). In particular we thank Dr Bennet Fimbo of NACP for his continued encouragement and support. In planning and carrying out this study we received support from various partners. Many thanks to members of the Male Circumcision National Technical Working Group for their constructive comments while planning this work. Dr Awene Gavyole at the country office of the World Health Organisation (WHO), and the International Centre for AIDS Care and Treatment Programme (ICAP) of Columbia University provided invaluable support during the planning and implementation of this study.

We are grateful to the regional and district authorities of Mara for their support. We wish to extend our gratitude to all study participants in Tarime for their valuable information and time. We benefited greatly from the dedicated work of our fieldworkers Marygoreth Gervas, Levina Mbogoma, Charles Chehna, Misana Musokwa, George Augusto, and the late Anna Lufutu. We also thank our transcribers, Ms Happiness Ng'habi, Ms Joyce Silas, and Ms Mbango Mhamba and translator Mr Stanslaus Shitindi for their high quality work.