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 Tuesday 30 October 2007
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At the Cutting edge - male circumcision and HIV

Lead Feature

  • Male Circumcision in HIV Prevention: What Else Do We Need to Know?
  • "Just a Snip"?
  • Potential Impact of Male Circumcision on HIV in Sub-Saharan Africa
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KENYA: Traditional post-circumcision sexual coercion puts the youth at risk

Photo: Manoocher Deghati/IRIN
Boys who underwent traditional circumcision rites ostracised those who opted for church-supervised circumcision
Sexual peer pressure is forcing many newly circumcised young men in central Kenya to engage in sex before they are fully healed, negating the procedure's protective effects against HIV, according to the preliminary findings of an ongoing regional study.

"The research in Maragua and Murang'a districts shows that boys who undergo circumcision are encouraged by older boys to approach girls for sex to prove their manhood, a practice known as 'kwihura mbiro' or wiping the soot," Dr Anne Kamau, study author and research associate at the University of Nairobi, told a recent HIV research conference in the western Kenyan city of Kisumu.

Studies in Kenya and Uganda have shown that circumcision can reduce the chances of men contracting the HI virus by as much as 60 percent.

Kamau's research, part of a wider investigation into circumcision-related violence among adolescent boys in the two districts, included individual interviews with 89 boys between the ages of 10 and 17, as well as focus group discussions with parents, government officials, youth representatives and faith-based organisations.

Circumcision is a traditional rite of passage for adolescent boys of the Kikuyu ethnic communities in central Kenya. Although the procedure is now mainly done in hospitals, a period of instruction still follows before the circumcised youths take their place as adults in Kikuyu society.

"Forty-two of them reported being advised by older boys to have sex after the procedure," Kamau said. "The boys are advised that to prove their manhood they must sleep with a girl; they are also told myths, like kwihura mbiro will help heal the wound faster, and that if one does not wipe the soot then they will get sick and die."

Twenty of the 42 boys advised to wipe the soot said they did so, 11 of them within three months or less of being circumcised, for reasons that included proving their manhood, avoiding ridicule and preventing illness.

"They [older boys] would also tell me how I could cheat [persuade] a girl [to have sex] ... one becomes a complete man after kwihura mbiro," a 16-year-old boy told the author. "They told me I should do this at least within a month after healing."

Twelve boys said they did not use a condom the first time they had sex after being circumcised, citing a lack of awareness of the dangers they were exposed to, and fear that the prophylactics would injure the healed wound as their main reasons.

"You just sleep with a girl without a condom to clean yourself well," said another boy, aged 17. "The first time you have sex you should not use a condom, so that mbiro [soot] can come out."

Kamau said some boys also mentioned condom tightness and the fact that the church did not support condom use as reasons for having unprotected sex.

"There is a need for pre- and post-circumcision counselling for adolescent boys, to educate them about the dangers of circumcision-related unprotected sex, and address circumcision-related sexual myths and sexual coercion," she commented.

Religious groups had begun to provide supervised circumcision for boys, keeping them in seclusion in church or school settings to receive pre- and post-circumcision counselling on sexuality and HIV/AIDS issues, but the cost of US$30 to $50 per boy often made this unaffordable.

She also said that because the Roman Catholic Church did not support the use of condoms, the counselling the boys received was not as comprehensive as it could be.

Kamau also found that boys who underwent traditional circumcision rites ostracised those who opted for church-supervised circumcision, and some yielded to peer pressure for fear of harassment or continued exclusion. "We need more research to better understand the role of kwihura mbiro among adolescent boys, and the challenges boys face following male circumcision."


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