HIV and AIDS HIV Prevention Men's Health Science, Research & Innovations

Lining up for the cut Living with AIDS # 420

Written by Health-e News

Young men in Orange Farm, a sprawling township south of Johannesburg, are lining up for medical circumcision in large numbers ahead of government moves to add the intervention to its HIV prevention basket. Khopotso Bodibe witnessed a young man’s procedure and spoke to him afterwards.

Since they started operating in 2008, doctors at the Bophelo Medical Male Circumcision Centre have circumcised about 16 000 men in Orange Farm. Ten thousand of the circumcisions were done last year alone. This year, the centre is hoping to increase that figure substantially. It probably will, judging by the eagerness of the community. Tony Smith, a 19-year old resident, recently decided that he also wants to get rid of his foreskin. I witnessed his circumcision. Lying naked on a bed in the centre’€™s buzzing surgery, Tony was a bunch of nerves as he was being prepared for the procedure.

‘€˜Are you very scared?’€™ I  quizz him.

‘€œYes, I am, since they said ‘€˜the needle is the only part that’€™s painful’€™. I’€™m going to take it as a man. So, if I scream as a girl, don’€™t blame me,’€ he answers.

But the doctor attending to Tony assured him that the pain from the needle prick will be minimal. Dr Thabo Mashigo explained that the needle prick will block any pain associated with the actual cutting off of the foreskin. This is  due to the  anaesthesia.

Wearing sterile gloves, he holds Tony’€™s penis in one hand and then administers  an injection with the other on four areas around the organ. After each prick I hear Tony groan.

The anaesthesia takes less than a minute to administer. Thereafter, a nurse applies a Betadine solution onto Tony’€™s genital area to kill any germs that might cause an infection. Then a drape, a covering made of plastic,  is placed over the client to cover his torso from the chest to just below the knees. The drape has a small round hole through which the penis protrudes. Dr Mashigo is ready to use his forceps to pull up and then remove Tony’€™s foreskin. At this stage, Tony is calmer and doesn’€™t seem to be bothered.          

‘€œWe are going to apply what is called the forceps-guided method. I put in the two forceps on either side at a quarter to three level. You hold up the penis. We are now going to apply the bigger forceps, then I feel whether I didn’€™t clip on the glans because, remember, I don’€™t have to transit through the glans. As I’€™m doing this, I’€™m feeling whether I did take enough skin. Remember the aim is not to cut too little, not to cut too much, but just enough’€, says Dr Mashigo as he gets ready to make the cut.

‘€œCan you feel any pain?’€ he asks Tony.

An out-stretched ‘€œnooooooo’€ is his reply.

‘€œNo pain at all, eh?’€ repeats the doctor.

Tony reassured him, with a ‘€œyes’€.

‘€œOK, then’€ replied Dr Mashigo.

‘€œI’€™m ready to cut now’€¦ Simple procedure. There we are… The blade over the major forceps’€¦ There it is. Now the foreskin is gone’€.

With his foreskin gone, Tony is a newly circumcised  man and he’€™s pleased.

‘€œWhat’€™s going to happen to the foreskin ‘€“ does he take it home?’€  I ask.

‘€œI don’€™t want it,’€ says a buoyant Tony. ‘€œIt’€™s been bugging me for almost my whole life. I don’€™t want it,’€ he emphasises.

The whole process, including the after-care following the removal of the foreskin takes about 15 minutes.

I ask Tony what made him come to Bophelo Medical Male Circumcision Centre.

‘€œA friend of mine told me about the centre.”.  

“Did he come here for circumcision himself?” I ask.

‘€œYes, he did. So, I also decided to come,’€, he says.

As though he was pondering before answering, Tony adds: ‘€œIt’€™s quite a big step for me to do this. You have to think about it to be sure when you want to do it because you’€™re not doing it for other people. You’€™re doing it for yourself.’€

Tony was just one of many young men who had made an appointment to be circumcised when I visited the Bophelo Medical Male Circumcision Centre.

These young men come to Bophelo because they’€™ve heard of the free circumcision service from friends who had already undergone the procedure. The centre attracts mostly men in their late teens and early twenties. The popularity of medical male circumcision in this community grew after results of a study conducted in the area showed that medical male circumcision protects men from contracting HIV infection by up to 60%.

After the study, the project remained in the community to continue educating residents of the benefits of medical male circumcision for HIV prevention and to offer free circumcisions. As a result of the study findings, government will introduce a policy this year that will make medical male circumcision one of the interventions in HIV prevention.

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