By Thobile Mkhonta
Can you say it? Uso-ki-le yi-ni?
I ask this question every day, to boys, men, husbands, brothers and grandfathers. I ask it at community meetings, in family compounds, on sports grounds. It’s a sensitive question, and when you hear what it means, it might make you uncomfortable. It might even make you blush.
But in Swaziland, it is a matter of life and death.
All I am asking is: Are you circumcised?
It’s a question that’s at the core of the work my team and I do under Pact’s Voluntary Medical Male Circumcision – or VMMC – project. Funded by USAID, the project works to increase male circumcision rates in Swaziland as a means to stop the spread of HIV.
You see, circumcision isn’t common in Swaziland. But HIV is.
Now called the Kingdom of Eswatini, Swaziland is a small, landlocked monarchy in southern Africa. It’s known for its wilderness reserves, its festivals showcasing traditional Swazi culture, and the humility of its people.
It’s also known for this: With a population of about 1 million, Swaziland has the highest HIV prevalence in the world. An estimated 26 percent of people aged 15 to 49 are infected with the disease.
Think about what that means to the Swazi people, to my people. Think about what that means for people like Musa – a 27-year-old with three children who lives in a rural part of Swaziland.
We found Musa with his friends in one of the local sports grounds. When they first saw us, their faces changed. Because of the t-shirts we were wearing, they already knew that we were there to talk about circumcision. They started making funny comments and stated up front that they were not going to circumcise.
Each time we meet such a group, we get excited because we know that they are not circumcised and we need to change that. We take it as a challenge and an opportunity.
Thobile, right, and her team in the field.
We spent about 30 minutes discussing circumcision with the group. They asked many questions, some valid and some just to get others to laugh. Questions are usually about fear of pain, the healing period and some religious beliefs. We assured them that procedure is safe, and healing starts in three to seven days, but they must abstain from sexual activity for six weeks for complete healing. These are common concerns that men have, and it’s important for us to answer their questions honestly and openly.
Two of the most important things my team and I must exhibit are compassion and patience. We know, we have targets to hit! We sometimes wish we could quickly sign people up, quickly assure them it’s ok, and then move on because there are more men to reach.
But it just doesn’t work that way on the ground. So we sit with groups of men. We talk. We answer question after question. And then, often, we leave without getting anyone registered.
But we come back.
When we met Musa, he was at first very loud and asked a lot of questions. But when we started showing pictures of STIs, he fell quiet.
We concluded the session and, as always, asked those interested to register. Musa immediately collected his things and started walking home. A couple of the other men registered and we got in the car and left. We didn’t get through to everyone – but we were happy about those we were able to register.
As we were driving away from the sports grounds, we saw Musa on the road ahead. He was looking back toward us, waiting. He stopped our car. He said that he did not want the others to see that he was talking to us. This behaviour is common amongst men Musa’s age. They do not want to be associated with circumcision. It’s a challenge because it defeats our efforts to normalize male circumcision in the country, but we also have to respect Musa’s privacy.
Musa told us that he had one of the STIs that we showed and asked if he could be circumcised. We were happy to hear that, because even if he wasn’t going to be circumcised there and then, he was going to receive the treatment he needed and an HIV test if he chose to.
Musa, and the thousands of men like him, are why male circumcision was adopted as a strategy to reduce HIV transmission in Swaziland following conclusive research that showed it substantially reduces men’s risk of acquiring HIV – by 60 percent. Pact’s VMMC project educates communities about the benefits of circumcision. My team and I go out every day, talking to community members in their homes, to boys at their schools, to anyone who is willing to stop and listen to us, wherever they are.
We are in it to save lives. As many lives as we can.
We are working to spread information and knowledge about the procedure, and allay fears – many of which are based on misconceptions. When we get men like Musa, in their late 20s and 30s, who commonly have multiple concurrent partners, to agree to get circumcised, we know that we are not only potentially saving their lives. We are potentially saving the lives of their future partners. That’s three, four, maybe five women who won’t have to live with this disease.
We have educated thousands of Musas in Swaziland and have managed to circumcise just over 6,000 since the project started in 2015. We’re so proud of what we’ve accomplished so far. But we know we have much work ahead of us: The country aims to circumcise 80 percent of males, but only about 30 percent have been reached so far.
It might be a little bit shocking to hear me ask: Are you circumcised?
But in Swaziland, when your goal is to save lives, it’s easy to ask. When you know that it’s not just about the man in front of you, but the many partners he’ll have throughout his life, it’s simple.
And when you live in my country, with the highest HIV prevalence in the world, you need to ask: Usokile yini?
Thobile Mkhonta is a program officer in Pact’s Swaziland office. This blog is adapted from the speech she gave before Pact’s leadership in Washington, D.C., in May, when accepting the Louis Collins Stamberg Spirit of Pact Award for African Leadership. The award, named for the late Pact board member and dedicated civil servant, recognizes outstanding service to Pact and the communities the recipient serves.
Lead photo: Thobile Mkhonta in the field.