Living with a chronic illness is tough but imagine carrying that weight while you go through the life-changing rite of passage of initiation. For boys living with HIV, especially in cultures tied to traditional circumcision, the struggle is real.
They face the cruel sting of stigma and the isolation of trying to fit into a world where being a man is all about strength and silence. It’s like walking around with a thorn in your heart – constant, painful, and impossible to ignore.
Health support for HIV initiates
Dr Mthembeni Tebelele, a medical doctor, the founder of Aphile Communications, and life coach from Gqeberha, explains that before boys embark on the journey of initiation school, they are required to undergo a full health check-up.
He explains that, as part of the health screening, HIV is included. For those living with HIV, their CD4 count must be checked to ensure it is stable, along with STI screening and treatment where needed.
Tebelele says a full examination is conducted, with specific attention to the penis/prepuce to check if the foreskin is retractable, the location of the urethra, and frenulum release, as well as identifying any warts or infections. Based on this, a decision on fitness is made, along with any necessary precautions or recommendations, he adds.
“HIV stigma is not only aimed at them but can be worsened during this period, with them being mocked, bullied, and made to feel less of a man.”
Dr Mthembeni Tebelele
“They may be labelled for using their pills, knowing how critical adherence is, with derogatory names like ‘undizile’ or ‘ufotyele’ to make them feel empty, useless, or still a boy.”
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Education is crucial
Tebelele emphasises that there is a need to normalise clear and undiluted communication about the importance of adherence, especially during the initiation period, noting that the strain and stress of the procedure can take a toll on the CD4 count and predispose the initiate to secondary infections.
“Parents must equip ikhankatha [initiate caregiver] and provide them with strict treatment schedules, following the ‘dots’ strategy to ensure the initiate takes their pills, just like any other treatment for conditions like asthma, diabetes, or epilepsy.”
According to Tebelele, “We can only encourage parents to twin these initiates in the forest with a trusted fellow initiate who can keep their confidentiality, allowing them to take their medication freely without any fear of ‘mjojo’ [shame].”
He also highlights that imbizos in deep traditional or rural areas are vital to educating communities about HIV complications that can arise from treatment interruptions or missed doses.
Tebelele further warns that even after initiation school, risks persist due to harmful myths, such as the belief that initiates must engage in raw sex upon leaving initiation school to “remove ifutha/ingceke,” which exposes them to sexual infections and unplanned pregnancies.
A focus on health and confidentiality
The founder of Somagwaza Institute and traditional surgeon (ingcibi), Sikelela Zokufa, based in Cape Town, says caregivers (amakhankatha) and surgeons are trained every season and understand how to keep the medical information of initiates confidential.
“We are not allowed to disclose any medical conditions of the initiates, other than ensuring they take their treatment as usual, just like at home.”
Traditional surgeon Sikelela Zokufa
He explains that, as a member of the traditional council, they work with the government to raise community awareness about the health safety of initiates.
“Before each initiation season, we hold community consultation meetings to educate people on all possible diseases and health risks, not just one virus. We talk about HIV, asthma, diabetes, epilepsy, and more.”
Equal treatment without stigma
He says, “We treat all initiates equally, whether they have a disease or not. Once they are in the bush, they follow the same process, and we ensure no diseases are spread among them.”
Zokufa adds that when an initiate has prescribed treatment, they ensure he continues taking it as normal. This applies to all initiates, regardless of what medication they are on.
“During one-on-one consultations, the initiate must disclose his health status so the surgeon can take necessary precautions. Other initiates are not allowed to touch anyone’s medication. Only parents, caregivers, and the surgeon are permitted to handle it.”
He notes that disclosing an initiate’s HIV status without his consent is illegal, and anyone who does so can be prosecuted.
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