Background: Traditional male circumcision as a rite of passage is seen as critically important in some cultures in South Africa. It marks the right of passage from adolescence to manhood and occurs at ages between 15 and 20 years of age depending on the cultural group involved.
The study aimed at increasing the number of adolescent boys over a two year period who underwent initiation school training but opted to be circumcised by qualified medical practitioners and nurses to ensure the full removal of the foreskin as a HIV prevention measure.
Methods: The research was conducted on behalf of the National Department of Health (NDoH) by the Clinton Health Access Initiative (CHAI) and engaged accredited PEPFAR funded partners to offer circumcision services in collaboration with local chiefs, Traditional Leadership authorities and local traditional Fora representing medical professions within the traditional leadership. Data were collected and verified in accordance with national proscribed standards in Nkangala district where there were known to be initiation cycles taking place amongst adolescent males. Data focussed on the number of initiates in traditional camps and the number of initiates circumcised per year.
Results: Numbers were compared against agreed PEPFAR targets for each district over a two year period Financial years 2017 -18 and 2018 -19. The 2016 -17 financial year was used as a baseline to show the expansion in uptake of service.
Generally, initiation camps occur on a four year cycle and there were expectations that the numbers would decrease in a non initiation cycle year but instead have continued to climb.

YearAnnual TargetAnnual PerformanceInitiation Campaign TargetInitiation Campaign Performance
2016 - 17 (baseline)30,8526,18803,472
2017 - 1828,64944,50813,69719,964
2018 -1926,44543,3627,64539,777
[MMC undertaken in traditional initiation sites in Nkangala District]

Conclusions: Integration of traditional initiation and MMC techniques is possible
Engagement of traditional and cultural leadership and gender sensitive medical staff is key to a successful sustained MMC programme based in traditional initiation schools.
There is potential to increase uptake of MMC overall in districts outside of the traditional initiation time cycles
The provision of data collection teams that feed into the NDoH systems in initiation schools is key to monitoring and evaluating effective programmes