The crisis of medicalised modernity: meanings of voluntary medical adult male circumcision for HIV prevention in South Africa

Since research has shown voluntary medical adult male circumcision (VMAMC) in Sub-Saharan Africa to offer significant protection against HIV infection, South Africa has initiated staggered rollouts of this HIV prevention intervention across the country. However, a large proportion of the South African population practices traditional circumcision as a cultural rite that is believed to imbue young men with masculine qualities and shifts them from childhood into adulthood. Furthermore, a number of other cultural groups in South Africa regard non-circumcision as being a signifier of adult masculinity and identity. This intersection between tradition and medicine presents critical public health psychologists and researchers with a site for empirical investigation into the meanings that men in urban Johannesburg assign to VMAMC. As part of a larger study, a Straussian grounded theory approach was utilised to identify and unpack the theoretical categories that underpin the tension between tradition, urbanisation, and medicine within the context of VMAMC and HIV prevention in South Africa. Repeat semi-structured interviews with thirty adult men from Alexandra revealed a crisis of medical modernity as participants identified a tension in meanings of traditional male circumcision and VMAMC. This crisis is made possible by a necessity to maintain and uphold traditional practices that denote the cultural meanings of masculinity and adulthood with traditional male circumcision or non-circumcision, which is tensioned against a personal desire to embrace novel prevention efforts given the ongoing concern of HIV prevalence in South Africa. The ways in which this tension is negotiated has bearing on public responses to VMAMC for HIV prevention and the uptake thereof. This study highlights the complexity of seemingly simple solutions to HIV prevention interventions through once-off body directed strategies such as VMAMC to underscore the importance of critical public health psychology to the advancement and implementation of such interventions in South Africa.