Health-e (Cape Town)

South Africa: Circumcision Demand Shoots Up

The winter months are normally associated with the traditional circumcision season in South Africa. Thus, it is not entirely surprising that clinics that offer medical male circumcision are also experiencing a surge in the number of boys who want to be circumcised this winter.

In just one week following the start of the winter school holidays over 1000 boys queued up to get circumcised at the Zola and the Bophelo Pele clinics in Soweto and Orange Farm, south of Johannesburg, respectively. By 11h00 on the morning of my visit, more than 30 boys had already been circumcised at the Zola Clinic for Medical Male Circumcision.

"This morning, so far, we have done 35. By 12h00 we would have done 50. By 15h00 we would have done 85. By 17h00 we would have done 120", said Dr Thembinkosi Ngwenya, a senior doctor at the clinic.

Dr Dino Rech, co-founder and medical director of the Centre of HIV and AIDS Prevention Studies (CHAPS), which in partnership with government, runs the Zola and Orange Farm medical male circumcision clinics, said the surge in numbers was expected.

"The clinic's always busy and we average around 50 boys a day in normal months. I think a lot of boys have heard about it and they wait for school holiday periods - and there is still the traditional belief that in winter it's a better time to circumcise because it's cold and more hygienic. So, we see men waiting for the winter school holidays, specifically, but school holidays in general - when we have a surge of sustained numbers of up to 100 boys a day that we're doing", Said Dr Rech.

In one week only, from 27 June to 01 July, the Zola Clinic for Medical Male Circumcision has performed 559 circumcisions, while the Bophelo Clinic in Orange Farm has circumcised 525 boys. The demand has meant that working hours and some of the staff turn-around had to increase.

"A normal working day would normally be from 09h00 until about 16h30. We're starting at 07h00 and we're ending at 19h00. With our Saturday shifts normally being 09h00 - 13h00, our Saturday shifts have been extended to 14h00 - 15h00 to try and do extra boys. We've had to just increase the doctors. Generally, there is one doctor that mans the clinic when our numbers are at around 50 a day. But to go at a 100 and above, we're having to use two and, sometimes, a third doctor. But our nursing staff is maintained the same. The pressure's on everyone, but the nurses really take the bulk of the pressure working at an intense rate for extended periods of time", according to Dr Rech.

Most of the advertising for the clinics is through word of mouth. Fifteen year-old Buhle, who also goes by the name Mr Swagger, is one of the 35 boys who had already had the fore-skins removed by 11h00 on the day of my visit to Zola Clinic.

"My cousin told me that in Zola Clinic there is circumcision for free. He came first and then I circumcised today", said the teenager with the bling-blings.

Why did you want to circumcise, I asked Buhle.

"To avoid the diseases because in South Africa there are many diseases by having sex with no condom. So, it protects you from the diseases because if you are circumcised, it's 60% less diseases", he replied.

Did you have to talk to your parents about circumcising?

"Yes, it's them who told me that I have to come circumcise", he said.

Then, he gushed about the quality of counselling he got at the centre.

"Oh, counselling! It's the counseling that made me to be here today because I wasn't going to be here because I was scared. The counselling is very good because it's talking to you to know how to know yourself, know your status they even test you here high blood, sugar. They were telling us about condoms, how to use them. Condoms are important because if you are circumcised there is 60% less (chances of getting HIV), but if you use condoms that 40% is going to be on that means 100% safer for you".

Are you already sexually active, I went on to ask.

"Haai, no! I'm still young for that! After marriage", then he laughed.

Professional nurse and centre manager at Zola Clinic, Pauline Mulashi-Biola, said they have circumcised more than 5 000 men since the service opened in November 2010. On average, the young men who come in for circumcision are between the ages of 18 - 35. But since the winter school holidays started, the age has dropped to 15 - 20. However, they will not circumcise any young boy without the consent of the parents or guardians.

"Now it's a lot of school boys - the 15 years until 17 years. They have to come with the parents for - approval for the consent form", Mulashi-Biola, said.

Not only has the clinic increased the number of circumcised boys. It has also increased the number of boys who take up HIV counselling and testing. And so has the Bophelo Pele centre in Orange Farm. Over 80% of the 1084 boys who were circumcised at both centres have accepted the HIV test. Scientific research shows that circumcised men have a 60% less risk of infection. Combined with the use of condoms, the protectiveness is increased.

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