In-depth: At the Cutting edge - male circumcision and HIV

SOUTH AFRICA: Taking a shortcut

Johannesburg, 19 July 2007 (IRIN In-Depth) - In South Africa's Eastern Cape Province, Xhosa men circumcised by Western doctors in healthcare facilities are often not regarded as "real men". Richard, a 21-year-old student who was circumcised three years ago, explained: "You are supposed to feel the suffering, pain, and know how to stand on your own in the bush, so if you didn't go all the way, you're not considered a man; I wanted to be considered as a man."

He said he didn't have much choice. "When you're a boy, you don't know anything, so you don't have a say. All you have to do is go [to the bush]. They tell you to endure; the pain doesn't exist."

"My brother went to the bush; so did my father and grandfather. I wanted to follow them, follow Xhosa tradition, and ever since then I'm not complaining. No complications," he added.

His mother was not so keen. "I didn't want my son to die, but I had no choice - it's what he wanted, and what his father wanted. The only conditions I had were that he must go and get the antibiotics at the hospital, and do it with someone we knew."

Richard shook his head when asked about friends who had chosen not to be circumcised in the bush, whom he described as "shortcuts". "They haven't felt the pain I felt; they are deprived of privileges and are not allowed in some places," he said.

"How are you going to take your son there, when you don't know anything?" he asked. "They are afraid of something they don't know, and it's sad because they are missing some part of their tradition."

Cwaka Guzana, 37, a lawyer, made his choice when he was 16. "My grandfather was also a lawyer, so was my father. I had an option to go to Dr Fordyce, but I told them I wanted to do it the traditional way. I had all the facts, I was mindful of the risks, but I still wanted to go that route. I wanted to be accepted ... and be closer to tradition."

In the chaotic, potholed city of Mthata, Dr Fordyce's practice was one of the first to partner with traditional surgeons trained to perform safer circumcisions. "Almost every middle-class man ... was circumcised at his surgery," joked Guzana, who rents premises to the surgery. The practice is now run by another doctor, but remains a popular destination for many young men in the province.

Henderson Dweba, head of traditional health services in the Eastern Cape health department, admitted to IRIN/PlusNews that an emerging trend, particularly among the professional middle class, was to take their sons to Western-trained doctors rather than traditional ones.

"But this is still a small percentage ... there is too much stigma attached to this method for a lot more people to consider it. The outside world doesn't realise the significance of it all. When you do it the traditional way, you are crossing the Rubicon into manhood."

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