Traditional male circumcision and adolescent reproductive health in Western Kenya

While recent controlled studies from Africa indicate that male circumcision is highly protective of HIV, evidence suggests that traditional male circumcision practices may encourage early sexual debut, rigidify gender roles, and occasionally injure the penis—thereby mitigating some of its beneficial impact. In alternate Augusts, the Luhya of Western Kenya conduct male circumcision ceremonies at puberty. In conjunction with a youth reproductive health program, we developed an educational approach to counteract detrimental messages. First, we held a 1-day workshop in Bungoma district, Kenya, with 28 participants (including 16 circumcised Luhya boys) to identify the main messages communicated to boys prior to circumcision, after circumcision, and what boys discussed amongst themselves. Before circumcision, messages centered on needing to avoid cowardice, boys' debts to society and circumcision's importance for transition to adulthood. After circumcision, messages became highly sexualized and gender-stereotyped. Boys were informed that “open doors” (vaginas of unmarried women) were now theirs and they should eschew household work. Peers encouraged each other to demonstrate sexual prowess and “hunt” together, using monetary gifts received to procure sex. During the workshop, participants agreed on the main unfavorable messages and suggested appropriate/feasible responses and strategies. Subsequently, we trained 15 male peer educators from local secondary schools to meet with initiates from late July to August 2006 (either before or after circumcision) in groups or individually to discuss messages and encourage critical thinking. Altogether, 1195 initiates were reached. In this session, the intervention's main components, lessons learned and implications for HIV prevention will be discussed.