There is a growing belief among men in Swaziland that circumcision provides complete protection against HIV, a perception that worries non-governmental organisations (NGOs) battling the highest HIV prevalence rate in the world.

In recent years circumcision has been lauded by Swazi public health officials as a procedure that reduces the rate of HIV transmission by about 50 percent, but it is far from the silver bullet solution some men see it as.

"The problem is not with the procedure, but the way it is abused by men, so that men think they are now immune from HIV contagion," said Siphiwe Hlope, an HIV-positive woman and founder of the support group, Swazis for Positive Living (SWAPO).

Hlope said SWAPO members were becoming increasingly aware of an attitude that circumcision protected men from HIV infection, while also providing an excuse not to use condoms; something Swazi men have long loathed doing.

Joy Magongo, a mother of two whose husband moved out to live with his second wife after the couple discovered they were both HIV-positive, told IRIN: "Men say, 'I've been circumcised. I don't have to wear a condom.' They get infected, and they give us HIV.
"He [my husband] was circumcised and felt he didn't have to wear a condom. When we found we had HIV after testing, he blamed me. He said, 'You brought HIV into this house.' It was because I tested first, when I was pregnant with my second child," she said.

"My husband did not believe he could be HIV-positive because he was circumcised. I did all I could to convince him to test, and he finally did. That was the end. He took another wife and left us," Magongo said. Polygamy is legally recognised in Swaziland.

"AIDS in Africa has a woman's face," Hlope said. "People think the disease originates with women. Why? Because it is the women who are tested first, when they are about to give birth."

She said Magongo's story was an unintended consequence of the circumcision campaign by the country's health ministry and AIDS NGOs. "Families blame women when HIV comes into the house, and it results in all sorts of abuse, from physical abuse to denial of spousal and child support, and loss of property rights."

While not disputing the advantages of male circumcision in reducing the rate of HIV transmission, Hlope said the gender dynamics of Swaziland's culture should be taken into account. The incorrect belief that circumcision was a panacea for the disease was making life more difficult and dangerous for women.

Law of unintended consequences

"It's the law of unintended consequences," said a Zambian doctor who treats HIV/AIDS patients at government hospitals, and who declined to be named. "Introducing the procedure, there was insufficient attention given to cultural factors, attitudes and human psychology.

"Many of the men I speak with think circumcision is like an AIDS vaccine. It's not. It's a useful tool to reduce chances of infection at a time and place where few other tools are available, but you can still contract HIV and pass it onto a partner," he said.
Jackson Dlamini, 25, a strapping man taking a break from weight training at a local gym, told IRIN he was considering circumcision as a way to protect himself from HIV. "This AIDS is bad. Nobody admits they are HIV [positive], but so many people are dying. I don't want to give up sex, so I am getting circumcised," Dlamini said.

When told that counsellors at Mbabane Government Hospital would advise him to carry on using condoms even after the operation, Dlamini said, "It is painful to get circumcised. If I have to wear a condom anyway, what is the point?"

HIV counsellor Henry du Pont is used to hearing men express similar sentiments. "The problem with male circumcision is not the procedure, but communications," he told IRIN. "We always end up against men's stubborn dislike of condoms."

A recent study by the UN Development Programme found only 20 percent of Swazi men consistently used condoms, which Hlope said probably indicated that circumcised men did not stop using condoms after circumcision, but had never used them in the first place.

Education about circumcision should stress a clear and consistent message that the procedure should be part of the HIV prevention measures, she said. "Until that happens, women will be infected with HIV this way, and ... male circumcision may do more harm than good if it is misused to deny women full protection."

IRIN