MMC Booklet
- 1. Circumcision for life ENGLISH MMC Medical Male Circumcision Soul City Institute NPC supported by:
- 2. How to use this book Bein a man This booklet has been written for all men and boys who want to know moregabout their bodies. Health issues can be complicated and sometimes we need help to work out the best I was taught to be a way to look after ourselves and our bodies. man, but no me how to one taught be a father. Men must talk to their sons about sex and Men often feel uncomfortable talking about sex and their bodies. This booklet gives us respect for women. information on Medical Male Circumcision (MMC), Traditional Male Circumcision (TMC), sex and our bodies. It explains how MMC can help reduce the risk of getting HIV and other STIs. It’s about men’s sexual health. If English isn’t your first language, some of the more difficult words are underlined and translated into Zulu, Xhosa, Sotho Men think tha is only for wo t a clinic men. and Afrikaans. Look out for these on every page: But there are many services tha t can benefit men too. What can I do to help preven t HIV? If you want to stay safe As a man, you from HIV, the must reduce re is a clear your risk and path ahead protect you for you. MM • Learn mo r partner. C is one ste re about HIV p. and talk abo • Have safer ut the issues. sex. • Educate you r friends and family about • Challenge HIV prevention gender role . s that cause men to treat women unf airly. issues gender role - izinkinga s - imisebenzi society - imiba ehlukaniswe - imisebenzi ngokobulili equality - ditaba ngokwesini - umphakathi 22 - seabo sa bon - ukulingana - kwessies g - uluntu - geslags- / - ulingano genderrolle - setjhaba - (die) samelew - tekatekano ing There are boxes that will help you to read the book. - geslags-/ge ndergelykheid The box below has information for you to talk about with your partner or friends: Talk about it! Who is in your sexual network right now? Who was your last partner? And who was their last partner? These boxes contain information that is These boxes mean that there is important important and that you might not have information that you must not forget. known about. ? Did you know? ! Remember Men who have sex with other men Medical male circumcision helps prevent are not protected by circumcision. HIV, but does not give 100 per cent Circumcision does not protect safety. You must still use a condom. people who are having anal sex. The characters in this book are taken from Soul City Television Series 11: Sis Noni (Florence Masebe); Rosie (Thandy Matlaila); Malusi (Dumisani Mbebe); Thabi (Mpho Modibedi); Sam (Robert Mpisi); Jabu (Sibusiso Radebe); Luyolo (Mangaliso Sauka); Mandla (Siyanda Sesimani); and the MMC and PMTCT groups.
- 3. Contents What is Medical Male Circumcision (MMC)? ........................................................... 2 MMC and your partner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 The procedure: what you need to know . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 HIV counselling and testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 What women and mothers need to know about MMC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Multiple concurrent partners and HIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 MMC in sexual networks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Traditional Male Circumcision (TMC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Making choices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Unsafe sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Safer sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Being a man . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Know your body . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Men’s sexual health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Sexually transmitted infections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Cancers that men get . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Your circumcision questions answered. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Places to go for help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 1
- 4. What is Medical Male Circumcision (MMC)? Ninjani gents. So... 1 you have decided on MMC. Why? I want to do it for protection, but I know I must still use condoms. 2 3 Will it be different after MMC? I enjoy sex more now and going to the toilet is easier. 2
- 5. 5 6 They give you an injection before the operation at the hospital. They also give you pills to take home for pain. Does it hurt? What is MMC? MMC is medical male circumcision. It is when a man’s foreskin is removed by a medical procedure. One out of every three men is circumcised. Some men are Uncircumcised penis circumcised for religious or cultural reasons, others do it for health reasons and hygiene. Circumcision can be done in different ways: • using modern medical ways (MMC) to remove the whole foreskin • using traditional ways (TMC) where sometimes only part of the foreskin is removed. This is called partial circumcision. Partially circumcised Removing the foreskin means you remove some cells that get infected by HIV, but penis not all. You can still get HIV when you are circumcised. Always use a condom. Why should I have MMC? • MMC reduces your chances of being infected with HIV by 60 per cent. Circumcised penis • It makes it easier to wash your penis. • You have less chance of getting syphilis and herpes. • The female sexual partner of a circumcised man has less chance of developing cervical cancer. • It is free in clinics (where available). • Having MMC reduces your risk of getting penile cancer. ! Remember • MMC helps prevent HIV, but it does not give 100 per cent protection. You must still use a condom. • MMC does not stop HIV-positive men from passing HIV to their sexual partners. Always use a condom. foreskin procedure partial per cent - ijwabu - izindlela - ngaphelele - iphesenti - ijwabi - iinkqubo - engaphelelanga - ipesenti - letlalwana le ka pele - mokgwa wa tshebetso - ya karolo - phesente - voorhuid - prosedure - gedeeltelike - persent 3
- 6. MMC and your partner Talk to your partner MMC has many benefits for men and women. If you are married or you are in a relationship, then both you and your partner need to understand the procedure. Tell your partner when you decide to have MMC and talk about how it will benefit both of you. Visit a counsellor or health worker together to talk about it. Important points for women • Some women say they prefer to have sex with a man who has had MMC. They say it is more hygienic and they enjoy sex more. • If a woman’s sexual partner has had MMC, she is also less likely to develop cervical cancer. 1 My husband is talking about going to the clinic for MMC. relationship hygienic cervical cancer - ubudlelwano - nempilo - umdlavuza womlomo wesibeletho - unxulumano - isempilweni - umhlaza womlomo wesibeleko - setswalle - bophelo bo botle - kankere ya molomo wa popelo 4 - verhouding - higiënies / skoon - servikale kanker / kanker van baarmoedernek
- 7. 2 3 Did it change My boyfriend anything? Frank was cut in the clinic. 4 I think it’s cleaner and it’s easier to use a condom. Even the sex is better. ! Remember If a man has had MMC, he can still be HIV positive and he can pass HIV to his sexual partner. Use condoms every time you have sex and every round to protect against HIV. 5
- 8. The procedure: what you need to know The surgical procedure MMC is safe and it is free. You can get the service at clinics that are government approved. It is very unlikely that there will be any complications. Before surgery • Before surgery, you will get counselling. • If you have a sexually transmitted infection (STI) • You will be told what will happen during the or other infection, your health worker will treat surgery, and how to take care of yourself you. You will need to return when the infection afterwards. is completely cleared. • You can ask questions until you feel • Your health worker will also offer you an HIV comfortable about having MMC. test. • You will need to sign a form giving permission • Your health worker will examine you before for the HIV test and the operation. the operation. surgical complications surgery STI - yokuhlinzwa - izifo - ukuhlinzwa - izifo zocansi - lutyando lobugqirha - iingxaki - utyando lwezonyango - iiSTI - ya opereishene / ho buuwa - ho tota ha ho kula - opereishene / ho buuwa - STI 6 - sjirurgiese (operasie word verlang) - komplikasies - sjirurgie; operasie - SOI
- 9. After surgery • You will rest for a while at the clinic. This is to make sure there are no problems. • You will probably feel well enough to leave the clinic after about half an hour. • You can walk home or get a taxi, but DO NOT ride a bicycle! • 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. Do not have sex for at least 6 weeks. Visit your health worker after 6 weeks. They will check your penis is properly healed. ! Remember 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 from showering or bathing, or from rain or swimming. • You will be told how to wear special underpants and how to support your penis. Talk to your sex partner about not having sex for 6 weeks after MMC or until the wound is fully healed. permission dressing wound - imvume - ibhandishi - isilonda - imvume - izibopho - inxeba - tumello - diaparo - leqeba - toestemming - verbande - wond 7
- 10. HIV counselling and testing Deciding to have an HIV test At a government clinic they will ask you to have a free HIV test before you have MMC. 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. When you know your HIV status, you can make a good decision about MMC. Why is it important to have an HIV test? • 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 other people from becoming HIV positive. ! Remember When you are circumcised, whether you are HIV positive or not, you should still use condoms. responsibility HIV status pre-test counselling - umthwalo - isimo segciwane - ukwelulekwa ngaphambi - uxanduva lengculazi kokuhlolwa - boikarabelo - imo yeHIV - ingcebiso phambi kovavanyo 8 - neem verantwoordelikheid - boemo ba HIV - kgothatso ya pele ho teko - MIV-status - voor-toetsberading
- 11. Having the HIV test It is important to speak to a counsellor or a health worker about having a test. What you need to know before the test • The person who will test you knows that you may be afraid or worried. They can give you support and help you prepare for the results. This is called pre-test counselling. • Ask the health worker any questions you have about the HIV test. They are there to help you and give you the information you need. • Your partner can go with you for counselling and testing. This will help them understand what you will go through and how they can help. We will help and And what support you. You if my test is can still live a long, positive? healthy life. ! 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. 9
- 12. What women and mothers need to know about MMC MMC is being promoted for HIV prevention. Men who have had MMC are less likely to get HIV. MMC is good for men, and good for their partners. Why is MMC good for women? MMC does not have any direct medical benefits for women. Women will not be protected from HIV. But there are other benefits: • Female partners of men who have had MMC are less likely to develop cervical cancer. • A partner who wants MMC, shows he trusts you and cares about his health and yours. ! Remember • Just because your partner is circumcised does not mean he is HIV negative. • Your partner can still get HIV, even if he is circumcised. • Women can get HIV from circumcised men and uncircumcised men. promoted benefits cervical cancer - gqugquzelwa - imihlomulo - umdlavuza womlomo wesibeletho - khuthazwa - iinzuzo - umhlaza womlomo wesibeleko - tumisitswe - melemo - kankere ya molomo wa popelo 10 - bevorder - voordele - kanker van baarmoedernek / servikale kanker
- 13. Role of women in MMC As a woman, there are some things you should know about MMC: • MMC involves surgery on a man’s body. It is his right to choose whether or not to get circumcised. You can encourage him, but in the end he has the right to decide for himself. • For babies and children, it is the parents’ right to make decisions about circumcision. • The sooner children are circumcised the better. When they are small babies, circumcision is quicker, easier and less painful. • If your son wants to be circumcised, support him. ? Did you know? Tips for women • In the days after MMC, a man must avoid getting his dressing wet. Remind him to be careful in the bath or shower. • Do not encourage your partner to have sex until his wound is healed. • Do not expect sex. A man must avoid sex for at least 6 weeks. You should support him in this. The difference between male and female circumcision Female circumcision is practised in some parts of Africa. Medical male circumcision is very different from female circumcision. Female circumcision is illegal. It is also dangerous and harmful, and has no benefits for women. surgery encourage dressing wound illegal - ukuhlinzwa - khuthaza - ibhandishi - isilonda - akukho emthethweni - utyando lwezonyango - khuthaza - izibopho - inxeba - engekhomthethweni - opereishene / ho buuwa - kgothaletsa - diaparo - leqeba - ha e molaong - sjirurgie / operasie - aanmoedig - verbande - wond - onwettig 11
- 14. Multiple concurrent partners and HIV What are multiple concurrent partnerships? 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. Sexual networks and HIV 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. That sexual network can be big. Talk about it! Who is in your sexual network right now? Who was your last partner? And who was their last partner? What is dangerous 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 just 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. multiple concurrent connected sexual network - abaningi - ngasikhathi sinye - xhumene - uxhaxha lwezocansi - iintlobo ezininzi - ngaxeshanye - unxulumene - uthungelwano lwezesondo - katiso - ka nako e le nngwe - hokahane - kgokahano ya thobalano 12 - veelvuldig - gelyktydig - verbind / skakel aan - seksuele netwerk
- 15. HIV and sexual networks DINEO 17 LULU 19 BEAUTY 27 (HIV positive) Once-off sex Lovers Transactional sex Chance encounter; drunk – no condom – no condom – no condom – no condom Married – no condoms ZAKES 19 ZIMELE 38 (FATHER) LEBO 36 (MOTHER) New relationship – no condom BULELA 17 (SON) sexual fluids viral load transactional chance encounter - uketshezi lwezitho zocansi - inani legciwane egazini - lwebhizinisi - ukuhlangana ngenhlanhla - amalwelo ezesini - umthwalo wentsholongwane - intengiselwano - ukugagana ngebhaqo - maro a motabo - sekgahla sa kokwanahloko - thobalano ka - kopano ya tshohanyetso - seksvloeistowwe - viruslading phapanyetsano - toevallige ontmoeting 13 - transaksieseks
- 16. MMC in sexual networks What can I do to stay safe? Some people have sex outside their relationship because they feel their partner cannot satisfy them sexually. • Work together to make sex interesting, and enjoy sex in your loving relationship. • Spend quality time together. • Talk to each other about both of your feelings and needs. satisfy quality time HIV status trust - anelisa - isikhathi esanele - isimo segciwane lengculazi - ethemba - yanelisa - ixesha elibalulekileyo - imo yeHIV - uthemba - kgotsofatsa - nako ya bohlokwa - boemo ba HIV - tshepa 14 - bevredig - kwaliteittyd - MIV-status - vertrou
- 17. ! Remember Know your status! It is important that you know your HIV status. This means that you need to go for a test regularly. You can go together as a couple. Protect each other • Couples who have been together for more than a few weeks often stop using condoms. • Remember, the best way to protect against HIV, STIs and unwanted pregnancy is to be sure that you use condoms correctly every time you have sex and every round. • Don’t think that because you trust someone, you won’t get HIV. Does circumcision protect me from HIV? Even if you are circumcised, you can still infect others in a sexual network if you are HIV positive. Every person in your sexual network is at risk of becoming HIV positive. ? Did you know? Some men, even married men, have sex with other men. Men who have anal sex with other men may not be protected by MMC. The only way to stop getting or giving HIV is to use condoms and a water-based lubricant. ! Remember Sex is a very important part of our lives. We all want sex to be fulfilling and fun. Having safer sex is sexy. at risk anal water-based lubricant fulfilling - engozini - kwembobo yendle - namafunda ancibilikayo emanzini - anelisayo - esichengeni - kumva - isithambisi esisekelwe emanzini - eyonalisayo - kotsing - sebono - senolofatsi se mongobo - ikgotsofatsa - loop gevaar - anale - watergebaseerde smeermiddel - bevredigend 15
- 18. Traditional Male Circumcision (TMC) What is traditional male circumcision? Many groups in South Africa practise traditional male circumcision (TMC). TMC is part of a rite of passage in some communities. It is sometimes called ‘going to the mountain’. A rite of passage is a cultural practice that marks change in a person’s life. It also changes how the person is seen by their community. With TMC, the rite of passage is about the change from being a boy to being a man. TMC can include education and special rituals. This education may be useful to the boy and his community. It can teach him to: • be responsible • protect his family • have respect for himself and others. traditional rite of passage rituals be responsible - bendabuko - isiko lolukhuliswa - amasik - nokuziphendulela - emveli - ilungelo lokukhula - iinkqubo zesithethe - ukuba nentembeko - ya botjhaba - moetlo wa kgolo - meetlo - ba le boikarabelo 16 - tradisionele - lewensgebeurtenis - rituele - om verantwoordelik te wees
- 19. How safe is TMC? There are many good things about the rituals that go with TMC. Sometimes, the actual cutting is done with instruments that may not be properly clean. Sometimes the conditions may not be hygienic. These days, in many traditional schools, doctors are doing the cutting with sterile instruments. It is better to have MMC done by someone with training who works in a health centre. Talk about it! Being a man is about respect. Respect for yourself and for others. And most important – respect for women. instruments hygienic sterile - izinto zokusika - hlanzekile - ngenamagciwane - izixhobo - ezicocekileyo - akukho zintsholongwana - ka disebediswa - bohlweki - bolaya dikokwanyana - instrumente - higiënies / skoon - steriel / skoon 17
- 20. Traditional Male Circumcision The challenges of TMC These challenges include: • Possible infection if equipment is dirty or conditions are unhygienic. • After TMC some men are encouraged to have unsafe sex with many women. Some men believe this cleanses them. How is MMC different from TMC? In TMC, sometimes the whole foreskin is not removed. It is only a partial circumcision. Uncircumcised penis Partially circumcised penis Circumcised penis ! Remember There is no evidence that TMC protects against HIV in the same way that MMC does. unhygienic partial evidence - ngenampilo - ngaphelele - ubufakazi - ezingacocekanga - engaphelelanga - ubungqina - eo eseng ya bophelo bo botle - ya karolo - bopaki 18 - onhigiëniese / vuil - gedeeltelike - bewyse
- 21. Making choices 1 I’m going to go I am going for to the mountains MMC. It is really like Dad. smart to protect. Let’s go to the clinic to find all the facts we need 2 It’s good to 3 to know. talk about it. Culture is the way we live and act. Our lives are influenced by the beliefs of our society. But culture changes all the time. It adapts when people find new ways to do things. Talk about it! What actions can communities take to help young men and women make healthy choices and keep safe from HIV? influenced adapts - wumphumela - zijwayeza - ziphenjelelwa - kuqheleka - tshwaeditswe - itlwaetsa - (word) beïnvloed (deur) - pas aan 19
- 22. Unsafe sex Time to test- 1 drive the new Merc, bra. I need to show that I am a man. Later... I don’t have a 2 3 condom. It doesn’t matter, I am circumcised. Talk about it! Circumcision does not give you 100 per cent protection from HIV. Always use a condom when you have sex. 20
- 23. Safer sex What is safer sex? Safer sex is when you take steps to: • prevent HIV • prevent pregnancy • prevent sexually transmitted infections (STIs) The most common way STIs and HIV are passed on is through sex without a condom. Remember, you can be HIV positive or have another STI and not show any symptoms. But you can still infect other people. How to be safer • Use condoms during sex. Use them with everyone you have sex with. Use a new condom every time you have sex and every round. • Talk to your partner to make sure that you are both satisfied with your sex life. Don’t think you are protecting your partner by keeping other sex partners a secret. • Be sensible – drinking alcohol or taking drugs can make you take chances. • Avoid high-risk sex acts. These include very rough sex and dry sex. ! Remember Have a sexual health check-up, including an HIV test, early in a relationship. The best way to avoid HIV, STIs and unwanted pregnancy is to know your HIV status. You should also have safer sex with a trusted partner. STIs symptoms satisfied high-risk trusted - izifo zocansi - izinkomba - anelisekile - izenzo ezinobungozi - omethembayo - iiSTI - imiqondiso - wanelisekile - ingozi ephezulu - thembekileyo - STIs - matshwao - kgotsofetse - kotsi e phahameng - tshepilweng - SOI’s - simptome / tekens - tevrede - hoërisiko seksdade - wat jy vertrou 21
- 24. Being a man I was taught to be a man, but no one taught me how to be a father. Men must talk to their sons about sex and respect for women. Men think that a clinic is only for women. But there are many services that can benefit men too. What can I do to help prevent HIV? If you want to stay safe from HIV, there is a clear path ahead for you. MMC is one step. As a man, you must reduce your risk and protect your partner. • Learn more about HIV and talk about the issues. • Have safer sex. • Educate your friends and family about HIV prevention. • Challenge gender roles that cause men to treat women unfairly. issues gender roles society equality - izinkinga - imisebenzi ehlukaniswe ngokobulili - umphakathi - ukulingana - imiba - imisebenzi ngokwesini - uluntu - ulingano - ditaba - seabo sa bong - setjhaba - tekatekano 22 - kwessies - geslags- / genderrolle - (die) samelewing - geslags-/gendergelykheid
- 25. Men play an important role in HIV prevention. Often, society gives men mixed messages about what it means to be a man. sible gh Brave Know Take risks spon lots Tou Be re Prote about HIV D rink ct m y and m e Tell m at Have lots y h t and partn r tner w Be fi er Be a good pa o do of women thy t List heal husband and my en to father wo ma n Gender equality Gender equality means that men and women respect each other as equals. They each have power. In an equal relationship, partners talk to each other about their thoughts and feelings. They make decisions together. Gender inequality is when a man beats a woman. This hurts the woman, the community and our society. • It is wrong when a woman feels scared or vulnerable. Then she cannot look after herself. For example, some women are too scared to make their partner wear a condom. • Both men and women need to feel strong enough to protect their health and their partner’s health. This is called being empowered. Sexual violence Sexual violence is common in South Africa. It can take many forms, including beating, forced sex or rape. These are criminal actions and cause terrible suffering. • Men and women need to protect each other. • A real man will make sure that no woman is exposed to violence. • If you hear of violence in your family or community, you should report it to community leaders and to the police. inequality vulnerable empowered exposed - ukungalingani - ngenamandla okuzivikela - ukuhlonyiswa ngamakhono - sengcupheni - ukungalingani - ukuba sengozini - xhotyiswa - tyhilelwa - ho se lekane - ba ka hlaselwa - matlafatswa - pepesitswe - geslags- / genderongelykheid - kwesbaar - bemagtig - blootgestel 23
- 26. Know your body The male body Sometimes we think we know everything about sex and our bodies. But doctors and scientists are finding out new information all the time. Do you know the following about MMC? Men and women have parts in their body that help them have babies and sex. These parts of the body are called the reproductive system. The male reproductive system The penis is the male sex organ. It becomes hard when blood flows into it. This is called an erection. The scrotum contains the testicles (balls). It is outside the body to keep the testicles cool. It lies under the penis. The testicles make the semen that contains sperm. The foreskin is the skin that covers the end of the penis (the glans). It pulls back when the man has an erection. The prostate is inside the body, under the bladder. It is about the size of an apricot (see page 30). reproductive system erection testicles semen sperm - izitho zenzalo - ukuqina kwenduku - amasende - isidoda - isidoda - inkqubo yenzala - ukuvukelwa - amasende - amadlozi - imbewu yenzala - ditho tsa botona kapa botshehadi - ho qhanyelwa - marete - lero la botona - peo ya botona 24 - seks- / voortplantingsorgane - ereksie - testikels / saadballe - semen / saad - sperms
- 27. Erectile dysfunction Erectile dysfunction or ED is when: • you can’t keep an erection • you can keep an erection sometimes but not at other times • you can keep an erection only for a short time. ED can be a result of medical conditions such as diabetes, heart and blood vessel disease, and kidney and liver failure. It can also be caused by: • brain disorders • side effects of some medicines • hormone problems • depression • alcoholism • anxiety (feeling nervous about sex) • drug abuse • stress Low libido Low libido is when you are less interested in sex. Low libido can be due to: • physical or psychological problems (such as anxiety and depression) • medical illness (such as diabetes and high blood pressure) • some medicines (including some anti-depressants) • low levels of the hormone testosterone. Ejaculation problems • Premature ejaculation occurs before or soon after penetration. It is very common in men. It often happens when a man feels nervous about how well he will perform during sex. • Sometimes ejaculation can take a long time to happen. Many sexual problems can be corrected with treatment. Talk to your health worker for more advice. prostate erectile dysfunction anxiety libido ejaculation - indlala yasesinyeni - ukungaqini kwenduku - uvalo - umdlandla wocansi - ukuchitha - idlala lobudoda - ingxaki yokungavukelwa - ixhala - inkanuko - ukukhupha amadlozi - nama e ka tlase ya - bohloko ba ho qhanyelwa - takatso - thahasello ya thobalano - hasa peo botona - erektiele disfunksie - angs / stress - libido / seksdrang - ejakulasie 25 - prostaatklier
- 28. Men’s sexual health MMC and sexual health By making the decision to have MMC, you are helping to protect your sexual health. Afterwards you will find it easier to wash your genitals. You will be less likely to get some STIs. You will also have some protection from HIV. Men must protect themselves and others. 26
- 29. ! Remember If you think you have an STI or you have any questions about sexual health, ask a health care worker. If you are thinking about having MMC, remember the following: • It takes 6 weeks after MMC for the penis to heal completely. You must not have sex for at least 6 weeks after MMC. Visit your health worker after 6 weeks. He or she will check to see if your penis is properly healed. • It does not mean that you do not have HIV or that your partner is protected from HIV. Do not stop using condoms because you have had MMC. • If you have any problems with healing, or any questions, go back to a government- approved clinic for advice. General sexual health • Take care of your body. Eat healthy foods, have exercise and get enough rest. • Look after your sexual and reproductive health and have regular check-ups at the clinic. • Both men and women should have an HIV test before thinking of having a baby. Read about having an HIV test on pages 8 and 9. ! Remember MMC gives you some protection from HIV, but it is not complete protection. You must still do these things: • Use condoms every time you have sex. • Do not have more than one sexual partner at the same time. • Have regular HIV tests and other sexual health check-ups. genitals reproductive - izitho zangasese - zokuzala - amalungu angasese - enzala - ditho tsa mmele - tsa botona kapa botshehadi - geslagsdele - voortplantingsorgane 27
- 30. Sexually transmitted infections Finding out about STIs Sexually transmitted infections (STIs) are infections that are passed on during sex. You can get an STI during vaginal, anal and oral sex. You don’t even need to have sex to get an STI. You can get some STIs if you and your sex partner touch your sexual parts together when you are both naked. Common signs of STIs • Discharge from the penis • Burning pain when passing urine • Sores, blisters or warts on the penis • Painful swollen glands in the groin at the top of the legs Talk about it! If you and your partner want a baby, remember to check for STIs. • Some STIs can affect a foetus or a newborn baby. • Syphilis can cause serious problems during pregnancy. The baby could become paralysed or even die. • Gonorrhoea (the drop) and chlamydia damage the eyes of babies as they are born. ! Remember Many people with STIs do not have any symptoms. STIs oral naked discharge groin - izifo zocansi - lomlomo - nqunu - uketshezi - imbilapho - iiSTI - ngomlomo - nize - ubhobhozo - kumphakatho - STIs - lehano - tsotse - lero - tshwelesa 28 - SOI’s - orale - kaal / naak - afskeiding - lies
- 31. Name of STI Symptoms Description Protection Treatment from MMC? HIV • Many people show no symptoms • The human Partial • There is no cure for HIV or AIDS. for months or years. immunodeficiency • Anti-retroviral treatment (ART) can • The only way to know if someone virus (HIV) is the virus keep a person healthy for a long has HIV is to have a test. that causes AIDS. time. • There are several stages of HIV • Getting tested early is important. infection. • Early stages may include some flu-like symptoms. Syphilis • A single sore may appear on the • An infection caused None • Antibiotic treatment can cure the genitals, rectum or mouth. by bacteria that infection if caught early, but it • Some symptoms appear later, like spreads throughout cannot undo damage already done. a rash on the hands or under the the body. • Both partners must be treated at feet. Also on other body parts. • Syphilis spreads the same time. through direct contact with syphilis sores. Gonorrhoea • Most people have no symptoms. • A common bacterial None • Antibiotics can cure the infection. (or the drop) • Pain when passing urine. infection of the • Both partners must be treated at genital area or throat the same time. • White, yellow or green discharge (though oral sex). from the penis. • Both partners must abstain from unprotected sex until the infection is gone. Chlamydia • Most people have no symptoms. • It can harm your None • Antibiotics can cure the infection. • Discharge or pain when passing body if you have • Both partners must be treated at urine. it for many years the same time. without knowing. • Both partners must abstain from unprotected sex until the infection is gone. Human • Most people have no symptoms. • A viral infection Partial • There is no cure. papilloma • Some HPV infections cause with more than 100 • The warts can be treated. This virus (HPV) genital warts. These are small different types. includes creams or ways to remove bumps on the penis. • 40 of these can them or freeze them. infect the genitals. • Even with such treatments, the virus may remain. Herpes • Most people have no symptoms. • A viral infection of Partial • There is no cure. • Some people get cold sores and the genital area. • Medicine can reduce the pain or blisters on the mouth, or genital • It can also infect other symptoms. sores or blisters. the area around the • Some people get flu-like mouth. symptoms such as fever, headache and swollen glands. Trichomoniasis • There are often no symptoms. • A parasitic infection None • Antibiotics can cure the infection. • Men may have a discharge from of the genital area. the penis. foetus paralysed genitals rectum abstain - umbungu - khubazeka ngokomzimba - izitho zangasese - imbobo yendle - ukuzithiba - usana olungekazalwa - ukushwabana amalungu - amalungu angasese - kumva - ukuzikhwebula - senamane - holofala - ditho tsa mmele - mohlamu - ho nena thobalano - fetus - verlam - geslagsdele - rektum - wegbly 29
- 32. Cancers that men get Prostate cancer Bladder What is the prostate? Prostate The prostate is one of the male sex gland glands. It helps store male sex fluids and pumps them out when the man ejaculates. Penis As you get older, the prostate grows bigger. This is normal, but a very Anus big prostate can slowly squeeze the urethra. This is the tube that takes urine from the bladder to the penis. A lot of men have prostate problems, Scrotum but they can be treated. Inflammation of the prostate gland Sometimes the prostate gets infected. This is called prostatitis. It causes lower back pain or can make it hard to pass urine. Treatment will make it less painful and easier to pass urine. ? Did you know? • Prostate cancer is one of the leading causes of death among older men. When a man reaches the age of 50, he should go to the clinic to check his prostate. • It occurs when cancer cells start to grow in the prostate gland. This causes the gland to get bigger. It can press on the urethra and make it hard to pass urine. • Other symptoms of prostate cancer include pain and problems during sex. • Sometimes the symptoms are not noticed and the cancer can spread into other parts of the body. This makes treatment more difficult. prostate glands ejaculates urethra - indlala yasesinyeni - izindlala - chama - umthambo womchamo - idlala lobudoda - amadlala - ekhupha amadlozi - umbhobho ohambisa - nama e ka tlase ya botona - ditshwelesa - lokolla peo ya botona umchamo 30 - prostaatklier - kliere - ejakuleer - tselana ya peo - uretra
- 33. Cancer of the testicles The testicles (testes or balls) are found in the scrotum. They produce the sperm that can make a woman pregnant. Testicles can also get cancer. This is most common in men between 15 and 40 years. A man can find out if he has cancer of the testicles by checking them regularly for lumps. How to check your testicles You must examine your testicles once a month for any lumps or swelling. Knowing what your testicles Penis normally feel like will help you notice any changes. • Take a warm bath or shower so that the scrotum is relaxed. • Cup your scrotum in the palm of your hand. • Use your fingers and thumb to gently feel each testicle for lumps or swellings. • Look for changes in the shape or size of your testicles. Scrotum • If you notice anything odd, see your doctor as soon as possible. Other warning signs • A feeling of heaviness in the testicle • The testicle is getting bigger • Change in how the testicle feels • A dull pain or swelling in the groin (top of legs) ! Remember Cancer of the testicles can be dangerous. If the disease is found early, it can be treated and even cured. inflammation symptoms testicles lumps swelling - isishiso - izinkomba - amasende - izigaxa - ukuvuvukala - ukukrala - imiqondiso - amasende - amaqhuma - ukudumba - kgohleho / thosholeho - matshwao - marete - borurusi / dikotolwana - ho ruruha - inflammasie - simptome; tekens - testikels / saadballe - knoppe - swelsel 31
- 34. Your circumcision questions answered Will MMC give me 100 per cent protection from HIV? No, MMC does not give 100 per cent protection against HIV. Scientists say that a man who has had MMC is around 60 per cent less likely to get HIV than an uncircumcised man. What is the difference between traditional circumcision (TMC) and medical male circumcision (MMC)? With TMC, the person removing the foreskin may not be trained. The equipment used may not be good or clean. MMC is much safer than TMC. Does female genital mutilation also help protect against HIV? No, female circumcision is dangerous and violates women’s rights. HIV cannot be prevented with female circumcision. When can I have MMC? At any age – as a small baby, a growing boy or an adult. Men can benefit from MMC right through to the end of their life. Does MMC hurt? You will be given an injection before the operation and you won’t feel any pain. There will be some pain in the days after the circumcision, but it will soon pass. You will be given medicine to help with this pain. Speak to your health worker if the pain is bad. Should an HIV-positive person have MMC? If you are HIV positive, there is no evidence that MMC reduces the chances of transmitting HIV to your partner. If you already have HIV, you need to practise safer sex all the time. Men with weak immune systems might get complications after surgery. HIV-positive men who want to be circumcised must talk to a health worker to make an informed choice. Does MMC protect men who have anal sex? There is no evidence at the moment to show that MMC provides protection from HIV during anal sex with either a woman or another man. mutilation violates immune systems informed anal - ukucwiywa - aphula - amasosha omzimba - nolwazi - kwembobo yendle - ukulimaza - waphula - amajoni omzimba - esekelwe elwazini - kumva - ho tloswa - e tlola - masole a mmele - ya boimamelo - sebono 32 - mutilasie / skending - skend - imuunstelsels - ingeligte - anale
- 35. Places to go If you want to have MMC, ask at your nearest government hospital or health centre, or phone the AIDS Helpline on for help 0800 012 322. Male circumcision centre EASTERN CAPE LIMPOPO KWAZULU-NATAL Bophelo Pele 041 373 5157 015 290 9000 033 341 4000 079 891 8733/071 051 444 2580 031 240 5308 MPUMALANGA 079 605 9859 013 766 3319/3040 GAUTENG LIMPOPO Cancer Association of 011 648 2340 NORTH WEST 015 290 9196/9061 South Africa 011 624 1765 018 397 2600/2605 MPUMALANGA NATIONAL OFFICE KWAZULU-NATAL NORTHERN CAPE 013 766 3275/3418/3442/3255 011 616 7662 031 205 9525 053 830 0706 Toll Free: 0800 22 66 22 NORTHERN CAPE Provincial VCT coordinators WESTERN CAPE 053 830 0621/0524 FREE STATE / NORTHERN CAPE NATIONAL VCT UNIT 021 483 5751 051 444 2580 012 312 0124 STI Provinical offices NORTH WEST 012 395 8000 NATIONAL OFFICE 018 397 2600/2605 MPUMLANAGA 012 401 9600/70/71 013 741 5441/2 EASTERN CAPE WESTERN CAPE 012 395 8000 040 609 3577 021 483 6138/3116 NORTH WEST EASTERN CAPE FREE STATE South African Sexual 014 533 0694 040 609 3937/3943 051 409 8496/87 Health Association FREE STATE LIMPOPO GAUTENG 0860 100 262 051 409 8486 015 297 3459/1268 011 355 3024/29 051 408 1413 National Department WESTERN CAPE KWAZULU-NATAL GAUTENG of Health 021 689 5347 033 395 2111 011 355 3344 012 395 8000 Acknowledgements Author: Thomas Scalway Photography: Suzy Bernstein all photographs Content input: Soul City Institute partners and stakeholders; Soul City Institute: Sue Goldstein and Bongani Ndlovu Editorial: Jenny Button and Russell Clarke Illustrations: Johns Hopkins Health and Education in South Africa: pp 3 & 18; Julia du Plessis: pp 24, 30 & 31 Layout and Design: Jacana Media Research: Agnes Shabalala, Que Nsimbini and Thuli Shongwe All Soul City Institute staff played a critical role in the production of this book through their administrative support, research and editorial input. Their dedication and expertise is appreciated. Thanks also to research fieldwork teams and focus group participants. © Soul City Institute, 2011 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying recording or otherwise, without the prior permission of the copyright holder. To order any Soul City materials please call: 0860 11 5000 or email: orders@soulcitydistribution.co.za Print date: November 2011 ISBN: 978-1-920352-48-6 001649 Join the conversation on Facebook and Twitter @SoulCityItsReal. 33