MEDICAL MALE CIRCUMCISION. A discussion tool

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1 MEDICAL MALE CIRCUMCISION A discussion tool

Stories work best when they move and entertain us, touch our hearts and challenge us to think about our own lives and the lives of people around us.

2 About the MMC Discussion Tool Learn and talk about Medical Male Circumcision with this exciting learning tool. It consists of a 15-minute DVD, which tells the story of two brothers, Samkelo and Mandla, and an easy-to-read booklet with information and questions guide discussion. Stories work best when they move and entertain us, touch our hearts and challenge us to think about our own lives and the lives of people around us. Watch this fun and exciting DVD and then talk about it. Here are some questions to guide you: What do you think of the film? How did it make you feel? Do you agree with the choices the characters made? What would you do differently? What can we do as individuals and communities to support men who get circumcised? How can we ensure men have safe circumcisions and practice safe sex afterwards? What is MMC? MMC is medical male circumcision circumcision that is done in a clinic, hospital or other medical setting. Use the questions on each page to guide discussions after you watch the DVD and read the booklet. Tips for discussion Make sure that everyone: understands the topic feels comfortable to share freely feels comfortable with the languages used in the discussion is encouraged to share their thoughts has a chance to participate listens to and respects the views of other participants A Learning Tool You can use this discussion tool: as part of your community dialogues to trigger discussions and debate in a discussion group in your clinic or other formal learning settings to watch and talk about with family and friends. 1

WHAT IS MMC? Sam decides to go for medical circumcision. He goes to the clinic for counselling before the operation. He meets Nurse Jabu and some other young men who are planning to have MMC.

The procedure is done by a trained doctor or nurse.

3 WHAT IS MMC? Sam decides to go for medical circumcision. He goes to the clinic for counselling before the operation. He meets Nurse Jabu and some other young men who are planning to have MMC. They all have questions for Nurse Jabu. MMC is Medical Male Circumcision. MMC is when a man s foreskin is completely removed by a medical procedure, exposing the head of the penis. The procedure is done by a trained doctor or nurse. Reasons to have MMC: MMC reduces your chances of being infected with HIV as the penis is less likely to tear or get bruised during sex MMC makes it easier to keep your penis clean You have less chance of getting other sexually transmitted infections (STIs). MMC reduces your partner s risk of developing cervical cancer. How are the young men feeling? What are some of their questions about MMC? What does nurse Jabu tell the boys about MMC and what they can and can t do? What are the advantages of MMC? Imagine you are in the meeting with Nurse Jabu. Role play what questions you would ask the nurse? THE CIRCUMCISION PROCEDURE Sam goes to the clinic for MMC. He meets the doctor doing the circumcision. The doctor talks to Sam and explains exactly what will happen during the operation. MMC is safe and it is free. You can get MMC free at clinics that are government approved. It is very unlikely that there will be any complications. Before the procedure: Your health worker will examine you. If you have an STI or another infection, your health worker will treat you. You will need to return when the infection is completely cleared. Ask questions until you are happy that you know what you need to about the procedure. You will need to sign a form giving permission for the operation. What do you know about MMC? What don t you know and would like to find out? Is there anything about MMC that you are worried about? 2 3

4 TAKING CARE OF YOURSELF AFTER MMC While Sam is resting after the circumcision, a nurse talks to him about how to look after himself. He tells Sam to come back in 2 to 3 days to check whether the wound is healing properly. After half an hour Sam feels well enough to go home. After surgery: Your health worker will tell you when to remove the bandage and how to keep the wound clean. Ask your health worker when to come back for a check-up. If you have any problems or questions after the operation, go and ask for help at the clinic immediately. For the first few days after MMC: Do not do any heavy physical work. Tell your employer why not. Keep the dressing on your penis clean and dry. Do not let it get wet. You will be told how to wear special underpants to support your penis. Do not have sex or masturbate for at least 6 weeks after MMC, to ensure the wound heals properly. Visit your health worker after 6 weeks. They will check your penis is properly healed and tell you if it is safe to have sex. If you are married or you are in a relationship, you and your partner need to understand the procedure and what happens after MMC. Talk to your partner about how it will benefit both of you. Visit a counsellor or health worker together to talk about it. What does the nurse tell Sam about sex? Why? Imagine you have just been circumcised and need to explain to your girlfriend that you can t have sex for 6 weeks. What would you say? How can women help and support men after circumcision? BEING A MAN Sam s brother Mandla was also circumcised. His friend, Luyolo, encourages him to have sex afterwards. Now you are circumcised, he tells Mandla, there is no girl you can t get. It s time to test drive your new car. Mandla wants to prove he is a man and he has sex with Thabi. Often, society gives men mixed messages about what it means to be a man. Some people believe that a young man must cleanse himself after circumcision by having unprotected sex. This idea is often supported by the girlfriends or partners of young men. Unprotected sex is always dangerous and exposes men and women to STIs and HIV infection. Why does Luyolo tell Mandla that he can have any girl? Do you agree or disagree with Luyolo? Why? Why not? Why does Mandla listen to Luyolo? What do you think it means to be a man? 4 5

TALK WITH THOKO MANDLA MAKES MISTAKES Sam is worried about Mandla - he tries to talk to him about waiting until his wound is properly healed before he has sex.

He knows Mandla is drinking and going out late every night. He is worried that Sam is having unsafe sex. One night Mandla tells his friend, Luyolo, that there is white stuff coming out of his penis.

5 TALK WITH THOKO MANDLA MAKES MISTAKES Sam is worried about Mandla - he tries to talk to him about waiting until his wound is properly healed before he has sex. But Mandla doesn t want to hear what Sam has to say. Mandla tells Sam: Relax I m circumcised. Sam tells Mandla he is being stupid. But Sam still worries about Mandla. He knows Mandla is drinking and going out late every night. He is worried that Sam is having unsafe sex. One night Mandla tells his friend, Luyolo, that there is white stuff coming out of his penis. He is worried and wonders what to do. Luyolo tells him, Relax your penis will be fine in a few days. Why does Mandla have sex so soon after being circumcised? Why does Mandla not use condoms? Who would you go to for advice: Sam or Luyolo? Why? What do you think is wrong with Mandla? Why? A caller phones Talk with Thoko on the radio. He has just been to the mountains and he wants to talk about sex after circumcision. Thoko asks, Do you use a new condom every time you have sex? Yes! the caller answers. And every round? she asks. He says, One hundred percent! No sex for 6 weeks and after that no rubber, no action!" The most common way STIs and HIV are passed on is through sex without a condom. You can be HIV positive or have another STI and not show any symptoms. But you can still infect other people. Remember that removing the foreskin means you remove some cells that get infected by HIV, but not all. You can still get HIV when you are circumcised. Always use a condom. Why must you use condom? What are challenges using condoms for boys? What are the challenges using condoms for girls? Role Play Talk with Thoko. Someone plays the radio host at the station and others call in with questions and comments about circumcision, condoms, and safe sex. 6 7

SAFER SEX Safer sex is when you take steps to prevent HIV, STIs and pregnancy. How to have safer sex: Use a new condom every time you have sex and every round.

Don t think you are protecting your partner by keeping other sex partners a secret. Drinking alcohol or taking drugs can make you take chances. Avoid high-risk sex acts.

6 SAFER SEX Safer sex is when you take steps to prevent HIV, STIs and pregnancy. How to have safer sex: Use a new condom every time you have sex and every round. Use condoms with all your sexual partners. Have only one sexual partner at a time. Talk to your partner to make sure that you are both satisfied with and enjoy your sex life. Don t think you are protecting your partner by keeping other sex partners a secret. Drinking alcohol or taking drugs can make you take chances. Avoid high-risk sex acts. These include very rough sex, anal sex and dry sex. MANDLA GOES TO THE CLINIC Mandla is worried about his penis. Sam advises Mandla to go to the clinic. At the clinic, Mandla sees a health worker. The nurse asks him to describe what is wrong with his penis. Then he asks Mandla some questions and does some tests. He tells Mandla that he has an STI. He also advises Mandla to have an HIV test. It is very important to consult a health care professional who can give you proper advice, counselling and treatment if you are worried about your sexual health. Heath care workers and doctors at clinics are trained to treat you and to help you understand how to care for your sexual health and your general health. To stay in excellent health, visit your clinic as soon as you notice a problem and make sure you know your HIV status. Can sex be fun if you practice safe sex? Yes? No? How? Are there any disadvantages to using condoms? How can you overcome these? What do you think about having more than one sexual partner at a time? What would you like to tell your partner to improve you sex life? How do you think Mandla felt when he went into the clinic? What do you think of the nurse who treated Mandla? Do men prefer to be seen by a male health care worker? Why do you say so? What can we do to ensure that young men and women seek advice and help from trained health care professionals? 8 9

7 TALK WITH THOKO: THE ONELOVE CAMPAIGN Multiple means more than one. Concurrent means happening at the same time. So a multiple concurrent partnership is any relationship where a man or a woman has more than one sexual partner at the same time. MANDLA GETS SUPPORT Mandla is HIV positive. Sis Noni arrives home after work to find Sam and Mandla together quietly. Mandla tells his Mom he is HIV positive. I m scared, Mandla tells his mother. Of course you are, she answers, but with good care and support you can do anything. HIV cannot be cured but with correct treatment, care and support HIV positive people can live a long, happy and fulfilled life. Visit your clinic regularly and follow your health care workers instructions. Remember, if you had unprotected sex in the past 6 weeks, the HIV virus may not show up in the first test. Wait 3 months and then go for another HIV test. How do you think Mandla feels? Drama: Act out a scene where one person is a nurse and the other is the patient. The nurse tells the patient they are HIV positive. How can you ensure that HIV positive people find care and support in your community? What can others do? Having more than one lover or sexual partner at the same time is dangerous. It means that you are connected to all the partners of the people you are having sex with. You are in a sexual network. What is risky about a sexual network? The problem with having many partners is that HIV spreads from person to person quickly. When a person is first infected with HIV, the virus grows very quickly inside of them. There is a lot of HIV in their blood and sexual fluids. We say this person has a high viral load. The viral load is highest a few days after a person gets infected with HIV. If you don t use condoms, it is very likely that your partner will also be infected. HIV can spread very quickly in a sexual network, as more of the partners get high levels of virus in their blood or sex fluids. The situation is made worse because in the first few weeks of infection, HIV may not show up on the HIV test. So the people in the sexual network will not know that they are being infected and passing on HIV until it is too late. Who is in your sexual network right now? Do you know? Who was your last partner? And who was their last partner? What can our society do to stop people having multiple concurrent partners? Plan a campaign

8 Places that can help THE HIV TEST Nurse Jabu recommends that all the boys have a free HIV test before they have MMC. He explains to them that they will be counselled before the HIV test and again when they get the results. It can be difficult to decide to have an HIV test. But doing it means you are taking responsibility for yourself and the people you love. You don t have to have and HIV test to be circumcised, but when you know your HIV status you can make better life choices. Why test for HIV? Having an HIV test is the only way to know if you are HIV positive or not. You need to know your HIV status so you can get the right treatment. If you know your HIV status, you will be able to protect yourself and your partner from getting HIV. When you are circumcised, whether you are HIV positive or not, you must still use condoms every time you have sex. How do you think the boys feel about having an HIV test? What are the advantages of testing for HIV? Are there any disadvantages in knowing your status? Imagine someone you know is too nervous to go for an HIV test. What advice would you give them? AIDS Helpline Department of Health. Directorate of Maternal, Child and Women s Health and PMTCT (012) Department of Social Development. National HIV/AIDS Co-ordinator (012) Mothers2Mothers (021) Treatment Action Campaign (021) Community AIDS Response (CARE) (011) Médecins Sans Frontiers (021) Parent Line South African Depression and Anxiety Group (SADAG) (toll free) To order this tool contact: Soul City Distribution Centre: or orders@soulcitydistribution.co.za (from outside South Africa) For information:

Musa is HIV positive and expecting her ﬁrst child. She and her husband Jimmy are very excited.

Then Musa s mother-in-law arrives with ideas of her own.

MEDICAL MALE CIRCUMCISION A discussion tool CDC/PEPFAR DISCLAIMER This discussion tool was partially

9 Musa is HIV positive and expecting her ﬁrst child. She and her husband Jimmy are very excited. But they are also scared. They join a PMTCT programme and plan everything very carefully. Then Musa s mother-in-law arrives with ideas of her own. Can they stick to their plan and will their baby be born HIV-free? MEDICAL MALE CIRCUMCISION A discussion tool CDC/PEPFAR DISCLAIMER This discussion tool was partially supported by Cooperative Agreement Number 1U2GGH from Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.

Safe Male Circumcision

Ministry of Health Safe Male Circumcision Discussion Set FACILITATOR S GUIDE This guide will help you use the Safe Male Circumcision (SMC) Discussion Set to provide basic information on the benefits of