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Reproductive Health Matters
An international journal on sexual and reproductive health and rights
Volume 15, 2007 - Issue 29: Male circumcision for HIV prevention / Taking on the opposition
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Original Articles

“You Can Also Cut My Finger!”: Social Construction of Male Circumcision in West Africa, A Case Study of Senegal and Guinea-Bissau

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Pages 22-32 | Published online: 17 May 2007

The aim of this study was to contribute to the current debate on male circumcision through an analysis of the cultural concepts, practices and social relations associated with male circumcision in two West African countries, Senegal and Guinea-Bissau. The research methodology was qualitative. The findings highlight the complex conceptualisation of male circumcision present among a wide variety of ethnic groups, which cover religious, spiritual and biomedical aspects. An understanding of local concepts of male circumcision and the world views represented can lay the foundations for the development of holistic approaches to promoting male circumcision in the struggle against HIV. The findings also illustrate the central place of women in male circumcision traditions at many levels. The preparation and carrying out of the surgical operation and the processes of traditional initiation are marked by complex interactions linked to the philosophy and social organisation of the societies studied. The findings reveal the need for reflection on how to create synergy between traditional and modern perspectives when developing programmes for male circumcision in West African societies.

Background

Reflection on whether and how to provide male circumcision takes on a particular importance since the clinical trials in South Africa, Kenya and Uganda have shown that male circumcision may reduce the risk of HIV infection by more than 50% in men having sex with an HIV positive woman.Citation1–3 These studies confirm the evidence from earlier ecological studies in sub-Saharan Africa which established that there is a geographical association between areas of higher prevalence of HIV and of lower prevalence of male circumcision,Citation4 and studies showing that in men having regular sexual intercourse with HIV positive women over four years, the rate of HIV acquisition was higher in those who were not circumcised.Citation5Citation6 The correlation between lack of male circumcision and risk of HIV acquisition by men has also been established in social and demographic surveys in Africa,Citation7 but the focus has so far remained on statistical analysis in response to epidemiologic and biomedical problems.

Apart from research conducted by Cheikh Anta Diop, there are very few contemporary studies on the history of male circumcision in Africa, its symbolism and related cultural concepts, changes in how it is being practised, or the influence of social relations and sociopolitical environments on how it is perceived.Citation8 Generally, research about male circumcision in Africa is descriptive or ethnographic. Most of the practices are presented according to their differences from each other and as something exotic, and there is no attempt to understand the coherence in the conceptual and philosophical principles and broader social dynamics involved.Citation9,10 Indeed, due to a lack of holistic vision on the part of those doing such research, a distinction is almost always made between male circumcision for medical reasons as opposed to cultural or religious reasons or as a rite of passage.Citation11Citation12 In the context of the HIV epidemic, there is certainly a risk that the perceptions of male circumcision in Africa will continue to be dominated by the biomedical approaches and points of view still strongly influenced by Western cultural perspectives. Collins Airhihenbuwa has already identified this risk in broader approaches to health and HIV prevention and argued against it.Citation13Citation14

HIV prevalence is 0.7% in Senegal and 3.8% in Guinea-Bissau.Citation15 In both countries, HIV rates are higher amongst women (58% of all cases). In Guinea-Bissau, the major ethno-linguistic groups are the Balante, Fulbe, Manjack, Manding and Papel. In Senegal, they are the Wolof, Fulbe, Diola and Manding. The Balante, Manjack and Manding live on both sides of the border between the two countries, but are proportionally more numerous in Guinea-Bissau. In both countries, these ethnic groups all give great importance to age-groups in relation to social organisation. The majority of these ethnic groups, with the exception of the Balante, Papel and Manjack, also have a social system based on social caste. In Senegal, almost 95% of the people are Muslim, and in Guinea-Bissau 30%. Christianity accounts for 7% in Guinea-Bissau and less than 5% in Senegal. Traditional African religions prevail in Guinea-Bissau (55% of the population) while officially, these are less than 1% in Senegal. But spirituality and African traditional religious beliefs are still strongly present in people whose formal religion is Islam or Christianity.Citation16Citation17

The study

The study was conducted between January 2004 and February 2007 by the Social Aspects of HIV/AIDS Research Alliance, specifically the Dakar (Senegal) office at the University Cheikh Anta Diop, with the collaboration of the Human Sciences Research Council, Cape Town, South Africa. The ethnic groups selected for this study were the Wolof, Manding, Fulbe, Laobe, Manjak, Serer and Balante. Data collection was through participant observation carried out by a member of the team in a Balante zone of Guinea-Bissau, where he followed the whole process of preparation for and carrying out of male circumcision and the leave-taking afterwards, and conducted individual interviews with key informants (male and female) from selected ethnic groups and focus group discussions with mixed ethnic groups. During the focus group discussions, participants learned to listen to those from other ethnic groups, to identify differences and recognise by themselves whether certain practices, which at first seemed to be specific to only one ethnic group, were not in fact also present in their own respective groups. A database of circumcision songs and photographs of events related to circumcision was also developed. The analysis of all this information aimed to uncover broad themes and hidden and symbolic meanings, which were later presented to the various focus groups for validation.Citation18Citation19

Conceptualisation of male circumcision

Among most of the ethnic groups studied, “male circumcision” means the removal of the whole foreskin of the penis. In contrast, the Balante make a distinction between “small circumcision” (Foo ntiufa) and “large circumcision” (Foo or Fanadoo Garandi). Large circumcision is the removal of the whole foreskin, whereas small circumcision is an incision made on the foreskin. It takes place when the man is 18–20 years of age, at the point when he enters the Nkess age-group. The Fulbe were also said to use the practice of incision on the foreskin in the past. The Balante use a phrase or a compound word to designate small circumcision. When used on its own, the generic term Foo refers exclusively to the complete removal of the foreskin. When people talk about male circumcision, they generally mean large circumcision. Small circumcision is a “would-be” circumcision and is considered as a kind of preparation for large circumcision, with which it shares ontological meaning.

Regardless of the ethnic group, male circumcision has several related dimensions – religious, social, philosophical and biomedical. Although it is an important rite of passage among the Balante, it also has religious dimensions. For the Balante, male circumcision comes from the supreme God (ŋala) and becomes sacred through the reproduction of a primordial, divine act.

“ŋala created the world in seven days; on the sixth day, he performed male circumcision. This explains why we consider male circumcision so important. It is sacred. By performing male circumcision, we show our commitment to God.” (Balante informant, Guinea-Bissau)

In the Wolof culture in Senegal, the word for the circumcised man (njulli) has the same origin as the word for prayer (julli). The circumcised man is one who prays and who meets the conditions of spiritual purity required for an act of religious communion. In this world view, male circumcision has a sacrificial function that is related to its religious meaning. It is a ritual form of blood sacrifice to the ancestors, who are represented by the ground on which the circumcised blood falls. Thus, the Balante perform the ritual of male circumcision in their rice fields, where it symbolises their homage to their dead ancestors and to the resources of the Earth. The belief in communion with the Earth and with their ancestors is present in beliefs about male circumcision held by the members of every ethnic group represented in this study. That is why the Manding circumciser squeezes the ends of the removed foreskins, to make some drops of blood fall on the ground. It is also believed that if the foreskins are buried in the field, the crops will flourish.

All the ethnic groups in the study also think that male circumcision has prophylactic properties. The foreskin is considered dirty, a source of bad smells and disease, or even of evil. The Balante consider sexual relations between a man who is not circumcised and a woman who is a virgin as particularly serious, as they think it can cause a terrible disease called Pusoonu, whose symptoms are similar to those of AIDS. In this sense, they link the lack of cleanliness associated with the foreskin with its impure nature. For the Wolof, Serer and Manding, one of the main reasons why a woman might feel sexual repulsion towards a man is the absence of circumcision. The repulsion represents the confluence of the lack of cleanliness with the lack of purity necessary to sanctify sexual relations. In the Manding language, one of the most common metaphors for male circumcision is “to wash the hand” (K'a bulo Ku), in which the hand represents the male sex and the moral qualities associated with operations performed on it. That is why the Wolof say, literally, “the child who has clean hands can eat with adults” (Xalé bu loxom set mena lekka ak mag yi). The image of a child who is allowed to sit with adults (whereas in community meetings, adults and children eat separately) suggests that the child is well-educated (conferred by the circumcision) and that he can therefore enter the world of adults. For the Balante, the image of the circumcised man is that of a wise man who understands and respects what is socially prohibited and social mores. Circumcision makes a man more human and “less dissolute”, and transforms the status of his words and acts. Among the Balante, the circumcised man does not indulge in petty crimes or the stealing of cattle, which are tolerated in the non-circumcised. He must also exercise great control over his sexual desires. The Manjack call the non-circumcised man nayafan, one whose actions are of no importance and who is without responsibility. The Balante say that even if a non-circumcised man has all the wealth in the world, he cannot belong to the group of community leaders or take part in their meetings, and his words are not worth considering. If he dies, the death-drum (Bombolom) will not be beaten and his death will be announced only by young men. Nor can the dead body of a non-circumcised man be washed in the rice fields, because he did not shed his blood there.

Lastly, the foreskin is associated with ugliness and lack of pride. Thus, it is not by chance that one of the terms used by the Wolof for male circumcision (jongal) is of the same origin as the words for beauty (Jongama, the beautiful woman representing sexual maturity, and jołé, physical attraction). Moreover, in all the languages spoken by the groups represented in this research, there are different words to designate the circumcised penis and the non-circumcised penis.

Circumcision is also related to the ontological system of meaning of these ethnic groups. Both in Senegal and Guinea-Bissau, what it means to be human (regardless of a person's sex) is that the person has characteristics related to masculinity and characteristics related to femininity. Masculine characteristics are prevalent in men but do not exclude feminine characteristics; on the other hand, feminine characteristics predominate in women but not exclusively. Due to the dynamic and evolving nature of the relationship between femininity and masculinity, the society acts, at critical moments in the life of the individual, to reinforce one or the other set of characteristics, according to the social circumstances, expectations and needs that are recognised, both at the individual and social level. Male circumcision is a critical act of reinforcement of what is considered masculine in a man, which is considered to be greatly threatened by an excessive presence of what is considered feminine, symbolised by the foreskin.

But beyond the establishment of these differences, male circumcision plays a part in the construction of a set of equivalences between the life-cycles of men and women. Male circumcision is considered to be equivalent to the loss of virginity of a woman upon her marriage. The Manjack say that male circumcision is the man's loss of virginity (kacium aci bnim nint). Among the Balante, a woman must have her first sexual relations with a circumcised man (a ritual marriage) even if afterwards she has sexual relations with or is married to a non-circumcised man. On the other hand, a man who is not circumcised but has reached the Nkess age-group (Kess is a tree considered to be very beautiful that serves as model for men wanting to be at their best to seduce women) can have sexual relations only with a woman who has already had sexual relations with a circumcised man. Such a woman (called Binaga) is also responsible for ensuring that her Nkess partner does not have sexual relations with young girls.

Both male circumcision and the loss of virginity at marriage are sacrificial acts whose meaning is amplified by animal sacrifice (of oxen, sheep, goats or pigs) on these occasions. Both are interpreted as personal challenges which confer on the man and the woman a new status, which also affects the social status of their family.

In all the groups studied, women not only play a part in the construction of a union between the male and female principles, they are also at the centre of the ontological meaning of male circumcision. Male circumcision has a symbolic relationship, among others, to dying (the man's clothes and a powder smeared on the body of circumcised men are the colour of the shroud and of mourning), and is constructed and interpreted as a death (the death of the boy or the non-circumcised man) followed by a birth (the birth of the man or of the circumcised man) just as the woman gives birth and directly supports life through breastmilk. In the traditional Serer model, just after circumcision, the man is breastfed by his mother. The idea is that of a rebirth after death which requires the ingestion of life-giving nourishment from the mother.

On the symbolic plane, male circumcision reproduces the central place of woman in the processes associated with birth and protection of life. A Serer myth illustrates this philosophy: Mama (the grandmother in Serer) swallows those who have undergone initiation and then spits them out again. She is an invisible spirit for the initiates (in her presence, the initiates must lower their heads and close their eyes). Mama appears as soon as the circumcised men have began to chant, with all their strength, the songs which are dedicated to her. The notion of an invisible spirit, who is called forth by the songs of the initiates, is also found in the Manding rite called Kankurang. The Manding also refer to the Kankurang as “grandma” (Mama) and the refrain of a song which is dedicated to her pays homage to her loincloth (“With her loincloth mama came!” Anala fano séguélingué mama nata yé!). The loincloth is always a symbol of woman and represents female sexuality, marriage, childbirth and care of the newborn. Among the Balante, to begin the male circumcision ceremonies, men must go to the bush to find the invisible spirit of circumcision (Wuléfoo). To do this, they dress up as women. Afterwards, these men will attain the highest level in the age-group hierarchy, charged with the daily transport of gourds containing meals to the circumcised men, who are in a place of reclusion outside the village. They are “the men of the gourd”. The gourd also typically represents the female and is one of the most constant symbols of woman. Moreover, the men of the gourd are called “mother” or “mummy” by the circumcised men they attend to.

In all the cultures in this study, male circumcision is also conceived as a rite of passage, performed at a particular time in a man's life and marks the passage of the individual from a lower status to a higher one. Even if, due to his young age (and more and more often in urban settings), the circumcised boy is not totally integrated into the adult world, officially he still begins a new relationship with his body and with the opposite sex, e.g. his mother will no longer bathe him and he cannot sleep in the same bed as a female.

In all the ethnic groups studied, male circumcision is perceived as the source of new social relations. Men who were circumcised in the same group are considered to be bound by undying closeness, even stronger than that with a parent. From now on, any violence between them is prohibited. Such a bond has a sacred dimension. The Wolofs say: “The bond between men who have been circumcised in the same group is the bond that God approves most”. Those who were circumcised together should help and assist each other, even at the cost of their own lives. When a baby is ill, his mother asks a man who was in the circumcision group of the baby's father for his hat. The baby has to wear the hat (dëpël ko mbaxané) to be cured. The hat represents the head, which is the part of his body that a man must be ready to give to heal the child of his comrade.

In rural settings, where male circumcision is still generally carried out in large groups, the practice is a collective rite of passage of identity and status from one age-group to another. In the community or the society, insofar as the age-groups correspond to status, roles and defined power relations, the male circumcision right of passage represents a moment of controlled implosion, of social realignment and recomposition.

Among the Balante, the rites associated with male circumcision are organised at the same time in the sacred woods (where the circumcised men are in retreat) and in the village. The pigs that each circumcised man leaves for his maternal uncle are killed and burned, which corresponds to the removal of the foreskin. From this day and during a cycle of six days, the village is marked by sadness and all recreational activities are suspended; moreover, clothes are not washed, rooms and yards are not swept and nothing is cleaned in the village. In the bush, this period corresponds to the period when the circumcised men recover from the operation and are reborn; it is like the period which follows death, during which rebirth is not yet completely accomplished. In the village, this is a mourning period. The seventh day marks the entry into the new life-phase of the circumcised men; first, a ceremony of cleansing is organised at their retreat in the forest. This ceremony corresponds to a major ritual cleansing of the village, which again begins to be swept and cleaned.

In all the groups studied, there is a temporal, conceptual and symbolic closeness between male circumcision and initiation into manhood. The initiation period is above all for the physical healing, but male circumcision is not only a physical intervention, it is equally a social and educational one. On the other hand, there is often a spatial or temporal separation between male circumcision and initiation; they are not carried out at the same place and circumcised men sometimes have to wait for several years before being initiated. Male circumcision is also sometimes performed in a modern (urban) health centre and initiation is carried out in the bush during a stay at the village. In other cases, as is the case in some ethnic groups, young men undergo initiation before being circumcised.

Preparation for the circumcision

All the ethnic groups in the study adopt a long and complex process of preparation including diverse physical, psychological, spiritual or economic aspects that take place at individual, family, lineage or community level.

The physical preparation of the penis of the young man to be circumcised is long and difficult; it is not an individual process, but includes the involvement of members of the family circle or the age-group. When he is playing with friends, the boy can practise this preparation himself. Indeed, among the Serer, he can himself proceed to open the tissue covering the head of the penis. This is called “to kill the foreskin” (war o sumtax) and is done just before the full circumcision takes place.

In the traditional model described by Wolof and Manding informants, there is a precise and detailed terminology to describe the physical preparation of the penis, in order to retract the foreskin from the penis easily at the moment of circumcision. This consists of massage, generally carried out by the mother. The role of the mother, from this point of view, is totally consistent with her responsibility for the future sexuality of the child. The inspection of the penis to check that there is no dysfunction begins from when he is very young and his mother or grandmother massage his body. Indeed, the grandmother puts pressure on the mother when the mother delays circumcising her grandson, whose pet name is “her little husband”.

One of the most important challenges for the family is to guarantee that the boy will have enough courage and self-control to face the moment of circumcision. Courage thus becomes a social product. The Wolof say, literally, “every hero was helped” (jambar bo gis daň ko dooleel), or “the man who shows courage has had intimate words addressed to him” (ku am fit daňu la deey). His mother, brothers, sisters and cousins will take an active part in the mental preparation of the soon-to-be-circumcised boy and stress that he must be courageous and take up the challenge. The father also emphasises the exploits of their ancestors and the humiliation the boy would bring on himself and the family if he flinches under the pain.

Dancing and singing events are often organised the day before the circumcision. They also give the family the opportunity to observe the child's behaviour closely, to assess his ability to undergo the ordeal. If the way the child expresses himself physically betrays a lack of preparation, the parents can try to prepare him further or he can even be withdrawn from the list of those to be circumcised. In this latter case, he is told that, for the moment, his spirit is still stronger than that of the circumciser. Thus, the frustration derived from having to withdraw him is to some extent compensated for. Among the Serer, the community organises singing and dancing starting 48 hours before the circumcision ceremony.Citation20 The boys to be circumcised are present and made to wear lavish clothes. The female singers compose songs in which they are described as lions.

In the Laobe, Balante and Serer communities, the soon-to-be-circumcised boy is expected to make public pronouncements (Kaň boppam) in the form of poems or songs that confirm he will be able to face the pain. Thus, every Blufudan (the boy who will be circumcised in Balante communities) creates his own song and repeats it with the people of his hamlet. One of these songs, collected by Dione in Serer communities, has the following words:

“Duma daw Saala Saala maa ko dige” (I will not avoid the knife because I requested it)”Citation20

Some Wolof poems are also an homage to the mother: sama yaay bul ragal dara, kuuy magana, linga ligeyoon ba fi, moom la lay fayé (literally, mother, don't be afraid of anything, the ram is older, I recompense all your past efforts). Here the mother understands that, because of her personal sacrifices, the qualities and merits of the child she has produced come back to her.

But one of the most important forms of preparation is the spiritual preparation. The goal is to protect the child from evil spirits and malevolent supernatural forces, or any person who would like to hurt him, even unconsciously, as circumcision is a period of extreme vulnerability. Beyond spiritual protection, there is also a lot to do for the spiritual preparation of the boy to be circumcised. He must arrive spiritually pure for the circumcision. This being a sacrificial act, the sacrifice must be undergone only by those who are pure. The ritual baths are a large part of this concept. For the Balante, before going to the circumcision, it is necessary to carry out all the ritual obligations towards the ancestors and protective spirits, and to correct any injustices committed; if not, the circumcised man could die during the retreat, given his extreme vulnerability.

A symbolic form of communication which is believed to have protective qualities takes the form of efforts to renew familial ties, particularly between women on the maternal side and paternal sides of the family, and community relationships. Thus, a month before the circumcision, the Blufudan who will be circumcised always carries in his left hand a piece of wrought iron. With this distinctive sign, he visits members of his family, allied families and members of the community to announce his taking part in the coming event. In the Serer communities, it is the father's sister who gives a bracelet to wear on his left arm to the boy to be circumcised. In Manding communities, Diabaté tells about how the mother gives her ring to her child that will be circumcised to prepare him not to feel the pain of the knife of the circumciser:

“Put this ring on your biggest finger… then you will put it in your mouth. And when the circumciser comes to you, bite down on the ring with all your might. Thus, you will feel only the sting of a wasp, and I will cry in pain in your place.” Citation21

In the Balante community, the preparation of the circumcision is also a process of preparing the entire age-group and the reorganisation of the social system resulting from their rite of passage. The day before, the age-group of the Izan and Lantendan (initiated men) go and seek Wuléfoo (the spirit of the circumcision). During this time, the Bulufudan sing and dance together as a group. The ŋayé, the age-group that will be circumcised after the Bulufudan, wrestle. When the Izan and Lantendan (with Wulefoo, invisible to most mortals) return to the village, the Bulufudan face them and try to cross a line manned by them. This confrontation stops as soon as at least one Bulufudan manages to cross this adversarial line. In any case, the Lantendan and the Izan will let the Bulufudan cross the line. The idea here is the soon-to-be circumcised should show their resolve. During the confrontation, the Lantendan and the Izan keep on the women's clothes that they wore earlier (see photo). They mean by this that it is the female principle which should incite the Bulufudan and let the male principle go through obstacles in order to reach circumcision. When this ceremony is finished, each Bulufudan is taken in charge by his maternal uncle, who starts to prepare him for the ordeal of the following day, the circumcision itself. The next morning, the Bulufudan begin to sing and dance in small groups, and walk around the village. Then, they gather for a ritual bath. After this bath, they again stroll around the village, this time wearing masks with cow horns; the maternal uncles accompany them and carry the mats on which they will sleep during their retreat in the woods. Then the villagers, including women and children, begin to go down towards the rice fields. At the entrance to the fields, only the initiated men (Izan and Lantendan) and the Bulufudan continue walking into the field.

The preparation for male circumcision can be compared to what people do before dying – summarising one's life, moving backwards through the former stages of life. For instance, among the Wolof, the boy sucks the left nipple of his mother before going to meet the circumciser. This return to the mother is supposed to give the boy the psychological, emotional and spiritual resources he will need during this critical moment (in the Sérer community, the boy goes to breastfeed after the removal of the foreskin). Similarly, the same symbolic act of breastfeeding takes place for the young woman before she goes to her marital home for the first time.

The Wolof informants also noted that when the boy is about to leave to be circumcised, his mother lets him take a few steps towards the door, then calls him back and draws two lines on the floor and says to her son “Go and return in peace”. This signifies that the third line (the number three represents a man) will be drawn by the boy when he comes back home, after the test of circumcision. According to other informants, the mother draws nine lines, and the child has to draw the tenth. In the Wolof language, ten is a complete number, the end of a process or cycle which leads to another (fukk is the number ten and also the word for the jolt caused when finishing the pounding of grains). The number ten is also the square root of 100 (temeer), which is the symbol of the wholeness of being (temm) and is represented by the multiplication of the number of fingers by the number of toes.

At the end of the process of observing that the boy is ready, the event is announced publicly in socially relevant ways. The family send cola nuts, as is done to announce a wedding, a death or a baptism. The circumcision causes substantial material and financial expenses. Thus, it is prepared long before it takes place, with contributions from members of the family and community.

Carrying out the circumcision

Among the Balante, circumcision ceremonies are carried out by groups of villages every four to six years. But sometimes, villages can wait up to 16 years to organise a circumcision ceremony. In the village of Nagué, where the field research took place, the most recent ceremony was held in 2006 and before that, the last was in 1990. In Balante society, male circumcision is at a late stage in life, the average age being around 40. For most of the other ethnic groups (Manding, Wolof, Serer, Fulbe), male circumcision is generally performed between the ages of six and 13. Informants from all these groups say that it used to take place around the age of 20. Among the Layene, a sub-group of the Wolof, most children are circumcised the seventh or eighth day after birth.

In the larger cities of Senegal, male circumcision is more and more often practised only by the family and more frequently performed in medical centres. Huge community circumcision ceremonies are tending to disappear. But the traditional system is still strong in the rural areas.

Traditionally, the operations are done within a structured situation, including the circumciser and his helpers, and a person who supervises them who is often called the master of circumcision (Kuyan Mansa, in Manding, and Kumax for the Serer). Dione writes that the master “is selected from among the elders of the village. The selection criteria are rather complex. The Kumax must exhibit exemplary behaviour, be generous, supportive and especially patient, as his role consists of protecting and making great decisions”.Citation20

As described earlier, the Balante perform male circumcision in their rice fields. For the other ethnic groups, male circumcision is generally performed in an open setting near the village. It can also be held in the garden of a house. But there are always witnesses.

In societies with castes, it is often (but not always) a man from the caste of blacksmiths or shoemakers who performs the actual circumcisions. He uses a knife invested with sacred qualities. The knife will have been treated beforehand (lugu) so that it does not cause infection (toké). It is said that in expert hands, the action is so fast and the blade so sharp that it can cut the foreskin without being touched by the blood of the circumcised man. At the end of the removal of the foreskin, a powder is applied to help seal the wound.

At the moment of the operation, a mortar is laid down and the young boy/man sits astride it. Nobody forces him. He has to muster sufficient courage to come and undergo the ordeal himself. The mortar is associated with the feminine world and certain practices using it symbolise the end of an era. For example, a bride kicks the mortar when she leaves her own home to go to the home of her husband. The man never sits on a mortar again after he is circumcised.

In certain cases, as with the Serer, before the surgery the circumciser asks for forgiveness (waasanaam) from the boy, who answers “I forgive you” (waasanaaong).Citation20 The circumciser shows that he knows, having gone through the operation himself, the pain he will inflict. The goal is to create a communion, a lack of tension and a spiritual union, allowing the safe implementation of a very dangerous practice, which can mean death for the person to be circumcised and also for the circumciser (his failure would result in a moral penalty that is similar to death).

All ethnic groups think that there is a battle that no one else can see between the man to be circumcised and the circumciser. According to Dione, the Serer say that the men to be circumcised can enlarge their foreskins so that they cover the whole mortar. Some are metamorphosed into women; others make their penis invisible. The circumciser will then have to draw on his spiritual force to remain calm and find a suitable response.Citation20 Among the Manding, there are songs that honour the circumciser and say that the man to be circumcised cannot compare himself to the circumcisers.Citation21

At the end of the process, however, enduring the operation without wavering is a victory of the circumcised man over the circumciser. Thus, the Fulbe and Balante say that some circumcised men are so brave and have such contempt for pain that after the circumciser has removed the foreskin, they show him their index finger and say: “You can also cut my finger”. Thus, the circumcised man means that he is ready to suffer any physical wound and carry out any sacrifice without losing his courage. The finger or the hand directed towards the sky is a sign of triumph; it shows that nobody has had the better of him. Just as the woman who is still a virgin on the day of her wedding will be able to say: “I raise my hand very high and no man will be able to lower it”.

Courage has a part in the psychological management of the pain, which is also to some extent diverted by the complex form of staging of the operation and by the projected reward (the gun shots in honour of the circumcised men, the cheers, the celebrations…).

In addition, the courage shown by the circumcised man is perceived to reflect the upbringing he received from his parents. It is the projection of the central values of the society as idealised by the culture. In the Wolof culture, the word for courage (fit) expresses determination and a person surpassing himself (jom). Parents are judged through the child's behaviour. This is also the case with the wedding night, when the test of virginity is really that of the bride's mother.

Organisation of the initiation

In general, initiation is done in a secluded setting, relatively isolated from inhabited areas. It can last from a few weeks to two months (e.g. for the Balante). A few or several dozen participants may attend. Among the Serer, the hut where the initiation takes place is called ndut, which means nest.Citation20 Effectively, boys are pampered and protected, like hens sitting on their eggs. In Wolof language, the place of retreat is called mbar, which means shelter, and the period of retreat is called lel, which refers to the idea of incubation. This symbolises the relationship between the mother bird and its young. The retreat is a place of recovery and rebirth. There, the boys can learn new attitudes, practices and behaviours. It is a critical period for the transmission of esoteric knowledge and the codes needed to interpret the symbols and signs that constitute the messages they will be given. The initiates learn how to interpret the hidden meaning of words which, if analysed literally, may seem incoherent. It is also a period of joy and the learning of songs and dances; but it is, above all, a hard school (with deceptions, disappointments, privations, bullying, humiliation and thrashings), which teach the initiates what it is like to experience and control all the emotions that will arise from the hazards of their future lives. An informant explains that “the harder the situation in the external world (bullying by the colonial system, social injustices, etc), the harder the camps of retreat will be; initiates have to learn to know themselves and what to do in the face of what they will confront throughout their lives”. In all the groups studied, the place of retreat is burned at the end of the period of initiation. With this gesture, the initiates are shown that they have lived in an artificial world, even a kind of nightmare, but that it will be useful to reminiscence about it when they are faced with the hazards of real life.

The period of initiation also includes sexual education. Sexual reserve and control are stressed. The young circumcised men are told that they must avoid frequenting the opposite sex; if they resume sexual relations before waiting a long time, their foreskins will grow back again, and they will have to undergo a new, even more painful circumcision.

The ceremonies of washing are very important and mark an important moment in the recovery of circumcised men and in their acquisition of new knowledge. For the first time since their operation, their bodies and their clothes are washed in swamps, rivers or waterholes near the place of retreat. Washing corresponds to purification at the end of the process of crossing between death and rebirth. It is important in the philosophy of life and death: the bride will wash a lot of clothes on the eighth day after the wedding, the dead are also supposed to wash their clothes at the end of their cosmic journey, and the new year (Tamxarit, for the Wolof) is marked by the appearance of a divinity who does a huge amount of clothes washing in the sky before the eyes of the community and who gives the signal to a great cleaning exercise for all families.

In the Wolof tradition, the management of the place of retreat is ensured by the botal, a word that refers to the idea of a mother carrying a child on her back. There is a male botal who is responsible for the care of the penis and education in masculine values, and another of the female sex botal (also called Bëň leget) who is responsible for food, the supply of water and maintenance of the hut. The Bëň leget has to prepare food whose nutritional value is aimed at speeding up recovery and discouraging any erections likely to delay complete rehabilitation. She accompanies the circumcised men in making ritual journeys to the village where they must learn humility by begging for their food. The Bëň leget is generally selected from a lower caste family (musicians, shoemakers, blacksmiths). Very often, all the circumcised boys from a village (regardless of their original caste) are relegated to a lower caste that will be, inter alia, in charge of the organisation of singing sessions and collective encouragement (Kasak in Wolof). Well after the circumcision, when the men who were circumcised have decided to leave their parents' homes, they will make gifts and honour the woman who was their Bëň leget, especially when they marry or arrange the baptism of their children.

The end of the retreat (generally called the “leave-taking of the circumcised” in all the languages studied in this research) is organised like a process of reintegration of initiates into social life. The customs of the Balante highlight the complexity of this process. In Balante communities, the ceremonies of leave-taking take six days. The first day, the circumcised men are shaved by their maternal uncles before having a ritual bath. Then, the women come to visit the camp but without seeing the initiates, who are kept in seclusion. When they arrive, the instructors (Lantendan) greet them with erotic dances and songs, to which the women answer in chorus. One of the women dresses as a man and holds a sword; at a given time, she approaches the retreat hut while dancing and strikes the walls and pretends to run towards the door. The Lantendan jump up and pretend to prevent her from opening the door and to follow her. After this chase, the other women come and dance around the hut but the initiates do not come out and none of them will be seen. The ritual seems here to develop the idea of privacy and of physical integrity by firmness and sexual reserve (or resistance to sexual attraction).

During the first two nights following their return, the Balant initiates will sleep in the open air in public places chosen by the Lantendan. At nightfall of the third day, former initiates can return to their usual homes, but they will not be allowed to sleep in their bedrooms, but have to sleep on the verandas. The fourth night (the number four symbolises women) they can go to their bedrooms but they are not allowed to sleep in the same bed with their wives, they must lie on the floor. The fifth day, they come together again and go back to the forest for the first time. They must kill the first animal they come across. The sixth day, they go back to the clearings near the village and hunt partridges without using a weapon. They must run and catch a partridge with their hands only, using cunning and stamina. The partridge thus caught will be killed and offered to be eaten by the Lantendan who had slept with them in the retreat (the Lantendan is the one who dressed up as a woman to go and seek the circumcision spirit and who was called “mummy”). Then, the former initiates can have sexual intercourse with their wives. The message here is about the rules of endurance, cunning and generosity, which must be associated with seduction and access to a sexual life.

In another Balant rite, the circumcised men look for a loincloth used to hold a baby (Bambarang) that the lantendang has hidden in the clearing. The Bambarang symbolises maternity and fertility; the first man who finds the loincloth will have the greatest number of children among his circumcised comrades. It is only after this session that the initiates take off the loincloths around their heads and each family publicly recognises the face of its circumcised man. The circumcised men and the children they had before circumcision then receive new first names. The circumcised men receive gifts in public from their female family members – mothers, aunts, grandmothers, sisters, daughters, nieces and granddaughters – but not their wives. The women bring bags full of clothes, shoes, toiletries and… (an important detail that symbolises the origin of the gifts) earrings.

However, the recently released initiates cannot attend the funerals of anyone who dies. Not to attend a funeral is equivalent to social exclusion. Before being authorised to attend a funeral, they must attend the funeral of a woman who has already performed all the rites of passage pertaining to her sexual identity during her life. In fact, this last rite completes the cycle of social reintegration of the circumcised men, by completing the function of production of what is sacred. The woman returns to the central role because it is she who gives birth to the world, and her death is the spiritual symbol of the rebirth of the world.

Conclusion

This research shows that for all the ethnic groups studied, male circumcision carries a complex significance, with multiple and interconnected dimensions – religious, spiritual, social, biomedical, aesthetic and cultural and that there are both similarities and differences between ethnic groups in the underlying concepts and basic philosophical frameworks which affect practice. The primary lesson that can be drawn from the findings in the context of HIV prevention is that efforts to promote male circumcision should move quickly beyond the narrow realm of biomedical intervention to engage with socio-cultural meanings and practices.

The biomedical paradigm, on the other hand, will lead to a reduction in the complexity of the issues related to male circumcision in Africa, by focusing only on the frequency of male circumcision (defined in biomedical terms) and its association with HIV/AIDS, and will fail to integrate an understanding of human thinking and behaviour. This approach could encourage the belief that male circumcision is a “magic bullet” against HIV/AIDS, which would be misleading. It could also divide sub-Saharan Africa as regards its efforts to defeat the epidemic into two artificially separate zones: one that has not become involved in the international mobilisation to carry out male circumcision, and the other that puts all its efforts into the adoption of the biomedical (and Western) construction and delivery of male circumcision services.

To avoid this division, it is crucial to give voice to local people and to understand how they conceptualise male circumcision within their own philosophical systems, social dynamics, gender relations and symbolic modes of learning and transmitting knowledge. Otherwise, the fundamental question of what can be learned from local cultures and communities in relation to male circumcision, in order to combat HIV/AIDS effectively, will be obscured by the imposition on those same communities of what they need to learn and what they must abandon culturally in order to implement someone else's already-made “solutions”. Allowing multiple voices to emerge from the depths of African communities and cultures on whether and how to move forward with male circumcision would help to address its role in prevention of HIV/AIDS in a far more valid way.

Acknowledgements

Our thanks to Dominique Gomis, Mamadou Thioune and Ndack Diop (research assistants, Programme SAHARA), who have read and corrected this article. Serigne Abasse Ndiaye, Mamadou Lamine Sow, Mor Talla, Izaac Pan and Magna Mballi have been resource persons whose contributions to this work have been crucial. Finally, this study would not have been possible without the work of coordination of Oumy Touré.

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