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Culture, religion in HIV battle


By Owen Nyaka:

SAIDI—We should do more

The influence of culture and religion on sexual behaviour is complex at individual and society levels. In different societies, cultural practices and traditions that fulfilled important functions in the past still exist.

At the individual level, many men and women publicly subscribe to strict moral norms of their religions and cultures while behaving differently in private.

Mangochi, Zomba, Thyolo and Mulanje in the Southern Region are some of the districts whose religious and cultural practices prescribe a number of guidelines to promote sexuality and sexual health.

In all these districts, male circumcision is either imposed by religion or culture, sometimes even both. The practice has been promoted by the cultures and religion for hygienic reasons while it has also been believed to promote sexual vivacity.

It is often done through traditional, non-medical ways.

However, modern science and medicine suggest that proper circumcision protects against HIV infection and other sexually transmitted infections (STIs) by reducing the risk of contracting diseases by half or more.

Voluntary Medical Male Circumcision (VMMC) has now become a fairly known method in preventing the spread of HIV in Malawi where over one million people are infected.

But VMMC campaigns have been met with mixed reactions from communities that have previously been practicing circumcision for religious or cultural reasons.

Meanwhile, studies reveal that a target of circumcising 250,000 men nationally by 2015 was too modest for the exercise to have a significant impact on new HIV infections.

“Circumcising an additional 250,000 men, in addition to the current cultural practices, which maintain male circumcision levels, will increase the percentage of men circumcised to about 27 percent,” says a report titled ‘Modes of Transmission Analysis’.

Despite launching VMMC campaigns in Mangochi, for example, health records since the introduction of medical male circumcision at the district hospital in 2011, indicate that only one person went for circumcision.

Village Head Saidi in Traditional Authority Mpondasi in the lakeshore district, says the reason for the low response to the campaign include low awareness of the need to undergo the process since most males in the district are already circumcised under religious or cultural teachings.

Saidi, who is chairperson of Network of Mangochi Traditional Initiators, a group of traditional leaders who supervise traditional initiation ceremonies that include cultural male circumcisions, says most people feel the call by governments is redundant.

“As a leader, I understand that sometimes the traditional process does not go all the way to remove the whole foreskin, leaving part of it vulnerable to contracting HIV. But, there are others who still believe once they have been circumcised using traditional methods, then that is all,” he says.

Researchers and virologists believe that HIV spreads more easily through the special immune receptors known as Langerhans cells, which are highly concentrated in the foreskin and other genital mucosa but largely absent from circumcised male genitalia.

Saidi says it is important for the government to work with communities and circumcision practitioners to make the operation safer and less traumatic as it has been reported that some traditionally circumcised children die under the pain of the knife.

“On the other hand, the government should also understand that the practice is a source of income for the initiators, so there is need for a balance on how these people are going to earn their living if the practice is consigned to be done by medical doctors only,” says the chief, suggesting that government could as well train the initiators on how best to conduct the operations.

However, a Group Village Head (GVH) in Thyolo, who did not want to be named, completely supports medical circumcision.

He even believes that those who have gone through the traditional types of circumcision have to still go to the hospital to find out if there is need for a complete removal of the viral receptor skin.

“There is vast information that medical circumcision is the best because it is conducted by experts. They ensure they follow all the guidelines and provide all the necessary counselling in terms of how to take care of the wound and how to remain safer,” the GVH says.

Andrew Chamdula, VMMC Coordinator for Thyolo, says VMMC has become one of the major entry points for HIV prevention for males who have slight access to health care services than women.

“VMMC is not by any means complete protection against contracting HIV or STIs. People must still practice safer sex all the time,” he says.

Chamdula says apart from circumcision reducing chances of getting HIV or STIs, “it also reduces the risk of genital ulcer diseases, penile cancer in men and cervical cancer in women.”

And such messages have sunk among traditional leaders in Chimaliro in Thyolo who are also leading by example.

“I got circumcised myself after analysing the messages on the same and appreciating views of different people. There are misconceptions which are completely baseless because everything bad said about medical circumcision is not true. I am a witness,” another GVH says.

Apparently, over 51 Group Village Headmen under the jurisdiction of Traditional Authority Ngolongoliwa have been active in HIV and Aids fight by sensitising their subjects to HIV and Aids prevention messages.

Thyolo District Health Officer, Arnold Jumbe, salutes the chiefs for the role they are playing in fighting HIV and Aids.

He says it is refreshing that more people are also coming forward to get tested, a development which also helps in fighting the epidemic.

Meanwhile, National Aids Commission (Nac) also praises various stakeholders including traditional leaders who are playing roles in fighting HIV and Aids.

Nac singles out the high turnout of people seeking VMMC services in the majority of hospitals in Malawi as an indication that messages about the efficiency of the process are being embraced.

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