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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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AFRICA-MOZAMBIQUE: Traditional rites, modern world

Photo: Mercedes Sayagues/PlusNews
PEMBA - I learned how to circumcise from an old nekanga [master] in Nangade, in the north of Cabo Delgado Province, in Mozambique. It was 1983, before AIDS.

The old man would circumcise as many as 100 boys at one time. First he would invoke the ancestors; a night of dancing would follow. The next day, at around 2 p.m., he would gather the children in the forest, about 3km from the village centre.

He would trace a magic circle on the ground with an animal tail - a place where predatory animals couldn't enter - and he would conduct the ritual.

He used a crude method: two or three adults would hold a child in place, he would extend the foreskin, cut it, and put it in his mouth. This was the part of the ritual that gave him supernatural power.

When he had finished doing this with all the children, he would take the foreskins out of his mouth, put them in a bowl, and wash them. I don't know what he did with them afterwards.

AIDS arrives

I first heard of AIDS in 1985, when a foreign doctor died in Cabo Delgado. It was the first AIDS death in the country, and greatly publicised. At a seminar in 1986 I learned about HIV transmission and the importance of using clean instruments, and how to care for children.

In 2002 I was transferred to Pemba, the provincial capital of Cabo Delgado, where more and more patients came looking for me. From October to January, the traditional time to carry out circumcisions, I might do the procedure for as many as 15 children, the maximum number I take in one weekend.

When parents prefer to call in a traditional healer, I speak with him and explain the importance of hygiene and post-procedure care. I make sure that his materials are clean, I give him blades, gloves and disinfectant. Sometimes the healer does the cut, but I do the disinfecting and bandaging, and take care of the wound.

My cuts heal in 15 days; those of the old nekanga take 60 days to heal. My son's healed in 10 days - he was 4 years old when I circumcised him.

Key values

During the initiation ritual, children learn to respect their fathers and elders, and learn about funeral ceremonies. During this time families come together; they forget whatever disputes there might be between them.

Some days before the circumcision I examine the child to see if he has scabies, malaria or anaemia and, if there is, I treat it.

I charge 100 meticais (US$4) [per circumcision]: half is for the cost of materials, because I prepare a kit for each child.

The procedure lasts about seven minutes. First I calm the child by talking to him, then I disinfect the area and inject ... [a local anaesthetic] in the foreskin. I pull, cut, and do the suture. When I tell the child it is already done, he is surprised - the parents are as well.

It is a neat procedure and I do it with pride.


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