IMPACT
11/08/2014 09:27 am ET Updated Dec 06, 2017

Teens Circumcised To Reduce HIV Risk In Mozambique Shift Gender Norms Surrounding Sex

MANHICA, Mozambique -- A group of boys and teens queued up outside a registration tent at a male circumcision clinic last week, looking almost as if they were waiting in line at a baseball game concession stand. They played cards and traded breezy jokes, waiting to go in for their voluntary procedures.

Helio Raimundo Ubisse, 15, stood off to the side of the traveling pop-up clinic. Last year, his friend who was infected with HIV died at the age of 19, Helio told The Huffington Post. Not long after, Helio asked his grandfather if he could be circumcised.

Helio is part of a wave of boys and men in Mozambique who are being encouraged to get circumcised to reduce the risk of HIV contraction. The national government launched an initiative in 2013 with the goal of having 80 percent of men ages 10 to 49 voluntarily undergo the procedure.

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Helio Raimundo Ubisse, 15, waits in line to undergo a voluntary circumcision at a pop-up mobile clinic in Manhica, Mozambique.

Mozambique has one of the highest HIV/AIDS rates in the world at 11.5 percent among adults ages 15 to 49, according to the World Health Organization. And in the U.S., the National Institutes of Health has pointed to research saying that male circumcision cuts the risk of HIV infection by about 50 percent.

Experts say that Mozambique's circumcision campaign has been well received among the public. They note that the strong participation rates are indicative of the way that more Mozambican men are being proactive about their own health and taking responsibility for their sexual behavior. Traditionally, in Mozambique as well as many other parts of the world where HIV is prevalent, it's been common for men and boys to demonstrate their toughness and their masculinity by engaging in unsafe sex and steering clear of medical treatment, according to a 2007 WHO report.

For Lourenco Zuanza, 17, the opposite is true. Lourenco, who plays soccer and says he gets good grades, was at the circumcision clinic last week because he learned about HIV in school. He said that among his friends, the circumcision issue is closely linked to masculinity.

"Those who don't get cut and take care of themselves -- they are not a strong man," he told HuffPost.

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Lourenco Zuanza, 17, waits with friends for a voluntary circumcision procedure to reduce the risk of HIV at a mobile clinic in Manhica, Mozambique.

For the procedure itself, the patient receives local anesthesia. Two nurses make a quick incision on the foreskin and sew together the edges. The patient receives counseling beforehand to emphasize the fact that the operation lowers the risk of HIV infection but does not actually prevent it. The pre-surgery process also includes safe-sex education and an HIV test.

The medical basis for circumcision is that once the foreskin is removed, the head of the penis is harder and less prone to infection, Marcos Canda, a biomedical prevention adviser for the Centers for Disease Control and Prevention, told HuffPost. After circumcision, there is also less surface area for infectious cells to enter, he said.

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A nurse operates on a voluntary 16-year-old circumcision patient. The teen received local anesthesia prior to the procedure, which takes about 20 minutes.

As a result of public information campaigns throughout Africa, the number of males undergoing the procedure has dramatically increased. Between 2012 and 2013, in 14 countries with high rates of HIV and AIDS in East and Southern Africa, the number of males who volunteered to be circumcised almost doubled, according to the WHO. Between 2008 and 2013, 5.82 million males in these countries underwent the voluntary procedure.

Though Mozambique's poor infrastructure makes health care difficult, efforts are being made to bring the doctors to the people.

Helio rode his bike about 10 miles to the pop-up clinic, which is operated by the government and supported by Jhpiego, a nonprofit health organization affiliated with Johns Hopkins University that provides services in developing countries. Helio said most of his friends have been circumcised.

"It's kind of both serious and a joking matter -- since it is a health issue, but we also joke about, 'Oh, you didn't do it,'" Helio told HuffPost through a translator. "But my friends will advise, 'Don't laugh, it is not a joke and it's your health.'"

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Boys and teens line up outside a tent at a pop-up voluntary circumcision clinic in Manhica, Mozambique. The procedure can help reduce the risk of HIV contraction by about 50 percent, studies say.

Jhpiego reports that one new HIV infection will be averted with every 13 male circumcision procedures performed in Mozambique. The health center performs between 45 and 50 circumcisions in one day, and less than 1 percent of patients have adverse affects, Canda said.

But not everyone is in favor of the practice.

Jhpiego health workers say some men question the importance of circumcision and raise concerns about where the skin ends up, saying they are worried about losing a piece of themselves. Lisete Macaringue, a program adviser of male circumcision at Jhpiego, told a group of reporters last week at the clinic that "there is some resistance ... They will deny or refuse and say 'No, you want to cut us, you want to kill us!'"

What's more, some activists say that the focus on male circumcision could distract from other, higher-priority measures used to combat HIV and AIDS.

"[Antiretroviral] treatment is the priority," Julio Ramos Mujojo, executive secretary of Rensida, an association for people in Mozambique living with HIV, told a United Nations news service in 2007. "To treat a person is more important than to circumcise, because a healthy person will be able to provide for his family and protect them from HIV."

Still, overall, the movement toward taking responsibility for one's own health is a positive development, Macaringue said. She stressed the importance of education and awareness.

"Now when they're here," she told HuffPost, "we also talk about condoms, fidelity and not having early sex."

Jessica Prois reported from Mozambique on a fellowship from the International Reporting Project (IRP).

Clarification: This story has been updated to reflect the fact that Jhpiego supports the clinic, but does not operate it.

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