Dicking around in the dark

Male circumcision has of late filled media from the Big Apple to the Big Naartjie. In populations that circumcise—such as Muslim and Jewish—data has long shown that cervical cancer rates are low.

Cervical cancer is mainly caused by a virus—the human papilloma virus (HPV)—and with circumcision, transmission is decreased. In three study sites in Southern Africa—one in Orange Farm—scientists have found that medical male circumcision has reduced the transmission of HIV/Aids by 60% (recent data leans to 50%) from women to men. A similar study has confirmed that this holds true for the transmission of HPV.

African traditional circumcision has not mirrored this pattern: one only has to compare disease incidences in non-circumcising communities in KwaZulu-Natal with traditionally circumcising communities in Khayelitsha or Gugulethu.

South Africa is now developing a policy on this, but the matter is complex. With recent reports of the tragic deaths—more than 50—in the process of “becoming a man” in traditional circumcision, we are concerned about reports of an increased demand for circumcision—particularly because poorer people hear snippets of messages that are confusing but inspire some hope in addressing the devastating Aids epidemic.

Given cultural practices, it is also of concern that single mothers are barred from checking on their boys. Male circumcision policy involves both tradition and gender. As white women, we feel we are more able to speak on gender than tradition, although both issues are critical.

Our male sexual health could do with some guidance, to judge from proceedings at the Equality Court this year over rape, taxi fares and breakfast. And some recent media reports have added a strange “mine’s bigger than yours” dimension—one surgeon proudly reported how in Orange Farm he does 53 circumcisions in a seven-hour day.

Most bizarre were some presentations by scientists at last month’s Aids conference in Cape Town, declaring that women find circumcised men more sexually satisfying. In most areas of sexuality to ask questions of such a sensitive nature one has to craft safe spaces and methodologies to measure accurately the answers. The question also assumes that women all think the same. Women are different—they have a continuum of identities and sexualities and can’t be said to want one thing.

One thing that women do agree on is that gender-based violence is not great. But as Rachel Jewkes, the director of the Medical Research Council’s gender and health unit, noted at the Aids conference, violence is not a priority for leaving a relationship—economic vulnerability clearly trumps this.

Discussion also broached the limited sexual health that women enjoy: most sex is endured in the dark, no touching of a partner’s penis is tolerated, and at times the interaction can be viewed primarily as an economic arrangement.

With the imposed intervention of medical male circumcision, women are talking about their experiences of violence. They are reporting that they are not able to negotiate safer sex as men now talk about circumcision as a “natural condom”. Women also fear that men, believing that they are immune, will blame them for bringing HIV into the relationship.

Medical male circumcision does hold the promise that we can talk about a policy that can attempt to remedy and redress some devastating male sexual health problems in our country. We need to have conversations about masculinities, gender, violence, sexual diversities and identities, vulnerabilities, injustices and pleasure.

Is this an opportunity to start a sexual consciousness movement like Black Consciousness? This would be a consciousness that it is not about how long you take, or how big or small you are or feel, but about our sexual health, an inner life force that is essential to our core humanity. It would be an opportunity to create positive media messages and safer-sex campaigns that would support pleasure as part of safety.

It would be about having the courage to talk to your partner about how you feel about yourself and your own body; and about more than being held economically. It would be about asking a partner what he or she feels and how he or she would like to be held or touched.

And finally it is an opportunity for better, ethically approved and rigorous qualitative social science research to inform an indigenous sexual consciousness. Failure to do so will lead to more of the same—dicking around in the dark.

Marion Stevens and Nicole le Roux work at the Women’s and HIV/Aids Gauge within the Health Systems Trust. This article is written in their personal capacities



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