March 2007

GABORONE – Male circumcision is not widely practiced in Botswana as a strategy for HIV prevention, but it appears to be highly acceptable among the Batswana anyway, according to a study on the subject.

Known as “go rupa” or “Bogwera,” male circumcision was once traditionally practiced by most tribes in Botswana to mark the transition from boyhood into manhood. It may have also served as protection against infections in the hot and sandy desert environment.

However, circumcision was mostly abandoned during the 19th and 20th centuries through the influence of western medical missionaries who were concerned about unhygienic conditions.
“At present, few tribes still practice it as part of cultural ceremonies,” says Dr. Poloko Kebaabetswe, one of the co-authors of the 2001 study on male circumcision and a senior clinical research scientist at BOTUSA. “Some Botswana tribes, like the Bakgatla, Balete and some Babirwa still practice it.”

Circumcision is not routinely offered in clinics, and according to the 2004 BAIS II national household survey, less than 10 percent of Batswana males claim to be circumcised.

In light of new evidence from three trials in eastern Africa and South Africa, which showed male circumcision significantly reduces risk of acquiring HIV, many governments are looking for evidence at how acceptable the practice is within the cultural and social context of their own countries.

Kebaabetswe and her colleagues put Botswana ahead of the game by conducting a study in 2001 to determine the acceptability of circumcision in the country, as well as the preferred age and setting for male circumcision.

The study, entitled “Male Circumcision: an Acceptable Strategy for HIV Prevention in Botswana,” was done in nine locations throughout Botswana with interviews representing 29 ethnic groups. Among the men, 25 percent reported that they were circumcised.

Among the 605 people who participated in the survey, 68 percent responded that they would definitely or probably circumcise a male child if it was offered free of charge in a hospital setting. This number increased to 89 percent after an informational session.

Among the 238 uncircumcised men, 61 percent said they would definitely or probably get circumcised themselves if it was offered free of charge in a hospital setting. This increased to 81 percent after the informational session.

Many people felt that the ideal age for circumcision is before 6 years and that circumcision should be performed in a hospital setting.

Kebaabetswe said more information is needed about public interest, readiness and cost infrastructure before Botswana or other countries should consider scaling-up the practice in health settings.

“Of course, a number of challenges have to be addressed, such as: Who will do the circumcision – nurses or doctors? Where should circumcision be done – clinic or hospitals? Who will be offered circumcision – babies, newborn, teens, or adults?” she said.

Public education and sensitization, as well as how to handle issues of behavioral dis-inhibition (practicing risky behaviors after being circumcised), are other issues to consider, she said.

Pullout Boxes or Quotes:

- 81% of uncircumcised men interviewed said they would definitely or probably get circumcised themselves if it was offered free of charge in a hospital setting.

- Just 9 percent of Batswana males (10 years and above) claim to be circumcised (BAIS II, 2004)