Health: Heterosexual males have less chance of contracting HIV after circumcision.
Health: Heterosexual males have less chance of contracting HIV after circumcision.

Doctors at one of the country's largest medical male circumcision projects said the news of the death of a four-year-old boy after a circumcision procedure in a private hospital last week has led to several cancellations at their circumcision sites across South Africa. 

The story appeared in the Star last Friday about the East Rand toddler who died a week after undergoing medical circumcision.

"People are taking a step back, saying that they want to reconsider having medical male circumcisions," said Centre for HIV and Aids Prevention Studies medical director Dino Rech. "This is going to undo a lot of good work in HIV prevention that was achieved by this programme." 

Gugulethu Mokalapa was reportedly put under general anaesthesia at the Medicross Medical Centre in Germiston ahead of the procedure, but he never woke up after the operation. He was declared braindead days after the surgery.

Rech said backlash from the report was almost instantaneous, and some patients cancelled appointments on the day the article was published.

"Mistakes happen. I'm sure the story I read in the paper also happened by mistake,  but what if that happens to me?" asked Sinethemba Zonke (24), who cancelled his appointment. "People are already dying in initiation schools; now I read about someone dying after getting circumcised in hospital."

Circumcision and HIV
Several research studies have shown that medical male circumcision – the removal of the entire foreskin of the penis – reduces a heterosexual male's chances of getting infected with HIV by up to 60%. 

The government launched a medical circumcision plan as part of its HIV prevention campaign in 2010. More than a million men between 15 and 49 have been circumcised to date, and no one has died, according to the health department.

Thobile Mbengashe, head of the health department's HIV programme, said the association of the toddler's death with his circumcision is damaging the circumcision drive. 

"We need a proper explanation of what happened," Mbengashe said. "We can't have men being unwilling to be circumcised because of this." 

Medicross director Oelie van Schalkwyk said this was the first circumcision-related death at the Germiston centre. Meanwhile, the boy's parents are waiting for the police to complete their investigations into the cause of death. 

Rech said it was unlikely that the boy's death was related to the circumcision. "The boy is rather likely to have had a bad reaction to the anaesthesia – which is used for all surgeries. He could have been undergoing any other procedure like having a wisdom tooth removed and also have died," Rech said. 

Risk of death "extremely low"
He said, although circumcision carries the risk of infection or bleeding, "the risk of death is extremely low".

"We have conducted 150 000 medical circumcisions since the start of our programme under local anaesthesia [where the patient is conscious] with no deaths or serious complications," said Rech. 

He said it was unsafe to circumcise children of Mokalapa's age because they have a limited medical history and could be suffering from underlying medical conditions. 

"Children younger than two months can be circumcised under local anaesthesia, whereas children older than two months but younger than 10 are put under general anaesthesia because they don't sit still and they panic during the procedure. This can lead to injuries," said Rech. "Because all of our surgeries are done under local anaesthesia, we only circumcise boys and men from 10 years and above at our centre."

The Children's Act allows for boys 16 or older to be circumcised, but makes exceptions for religions that require earlier circumcisions. In cases where a health practitioner ?recommends an earlier circumcision, it is also allowed. 

In Judaism, for instance, healthy Jewish boys are circumcised eight days after birth "as per biblical commandment", said David Saks from the South African Jewish Board of Deputies.

The circumcision, which is usually performed at home or in the synagogue without any anaesthesia, is carried out by a mahel who is medically trained to do this.

According to Islamic ruling, Muslim boys are circumcised seven days after birth if they are healthy. Shuaib Appleby from the Muslim Judicial Council said the circumcision is done according to medical guidelines by a doctor in a health facility.

But for Zonke, who cancelled his circumcision, data on safety and the training of circumcisers now provides little solace. "What if they make a mistake with me? What if they cut a muscle or a vein and it [my penis] stops working? How am I going to have children if I can't get it up?"