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July 19, 2012

Ugandan Circumcision Campaign Goes Awry

by Andrew Green

MBALE, Uganda – Uganda’s national campaign to help reduce HIV/AIDS transmission through male circumcision has taken an unexpected turn in eastern Uganda, where Bamasaba tribesmen forcibly circumcised more than 20 men in recent weeks.

Traditional male circumcision is an important cultural tradition for the eastern Ugandan ethnic group, for which the procedure represents entry into manhood. Every other year, the tribe holds a ritual circumcision ceremony called Imbalu. Although the decision to be circumcised is supposed to be voluntary, men have consistently been pressured to participate. Now that pressure has spread beyond the tribe.

Seeking work, Charles Mukwana arrived in Mbale, a town in the heart of Bamasaba lands, from a neighboring region. It was after he started driving a motorcycle taxi that he overheard other drivers at the staging area talking about forcibly circumcising the transplant.

“I feared, because they were bothering me," he says. "I heard them talking about me when they wanted to force me. They were asking me why I’m staying here and I’m not circumcised in their land."

Mukwana avoided forced circumcision by voluntarily undergoing an operation at a local health facility, but others weren't so lucky. For several days at the end of May and beginning of June, local officials say more than 20 men were forcibly circumcised, a half-dozen of whom were hospitalized. Many of those targeted were outsiders like Mukwana, who had come to Mbale in search of work.

Officials say dozens of people have since fled Mbale, and several businesses owned by non-Bamasaba remain shuttered more than a month later.

John Martin Okware, another motorcycle taxi driver, was part of a group that encouraged four men to undergo circumcisions. There was no specific intention to drive outsiders away, he says, but only to reduce their risk of getting infected or transmitting HIV.

"We were taking them to circumcise, because they get HIV very fast," he says. "A person who is not circumcised, he gets HIV very fast. The person who [is] already circumcised, he cannot get that disease immediately at that time."

Attacks Coincide With Campaign

In Uganda, where more than 75 percent of the population is uncircumcised, the Ministry of Health has been encouraging men to undergo the procedure. Research has shown circumcision can reduce the risk of HIV transmission by up to 60 percent, and the attacks come amid an ongoing national campaign for safe male circumcision.

Since the campaign launched, the Bamasaba have been praised for already practicing circumcision, although the region’s HIV infection rate is only slightly less than the national average of 7.3 percent. By forcing men to get circumcised, Okware says, he is doing his part to reduce HIV transmission and uphold tribal tradition.

But Charles Siango would disagree. As Bamasaba minister of culture, heritage and sports, he says forced circumcisions do not represent the tribal culture. Circumcision, he says, has always been a decision men make voluntarily in consultation with their family and that uncircumcised outsiders are welcome.

“We quickly went to radio and told people concerned -- circumcisers, those surgeons, the rest of them -- to stop, because that’s not the way our cultural things should be taken," he says.

But recent attacks still raise questions about the ritual practice of Imbalu, during which, Siango says, trained professionals perform the circumcisions, albeit in an area outside of town and away from medical facilities.

Local officials says they are working with the Bamasaba to make next month’s Imbalu as medically sound as possible, and district health educator Deborah Alupo recommends seeking circumcision at a health facility, even if the advice contradicts cultural norms.

“You have to undergo that process," she says. "But if you go to hospital and it is done there, they say you’re a coward ... [that] the way the hospital cuts is not [in keeping with the] cultural way.”

She hopes expansion of safe male-circumcision facilities, a part of the government’s health campaign, might help to change attitudes.