Citation: Njoroge, Kezia (2014) Male circumcision and the shaping of masculinities in Muranga, Kenya: Implications for public health. A focused ethnographic study. Doctoral thesis, Northumbria University. This version was downloaded from Northumbria Research Link: http://nrl.northumbria.ac.uk/31706/ Northumbria University has developed Northumbria Research Link (NRL) to enable users to access the University’s research output. Copyright © and moral rights for items on NRL are retained by the individual author(s) and/or other copyright owners. Single copies of full items can be reproduced, displayed or performed, and given to third parties in any format or medium for personal research or study, educational, or not-for-profit purposes without prior permission or charge, provided the authors, title and full bibliographic details are given, as well as a hyperlink and/or URL to the original metadata page. The content must not be changed in any way. 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The full policy is available online: http://nrl.northumbria.ac.uk/policies.html MALE CIRCUMCISION AND THE SHAPING OF MASCULINITIES IN MURANGA, KENYA: IMPLICATIONS FOR PUBLIC HEALTH A FOCUSED ETHNOGRAPHIC STUDY K M NJOROGE PHD 2014 i Male circumcision and the shaping of masculinities in Muranga, Kenya: Implications for public health A Focused Ethnographic Study KEZIA MUTHONI NJOROGE A thesis submitted in partial fulfilment of the requirement of the University of Northumbria at Newcastle for the degree Of Doctor of Philosophy Research was undertaken in the School of Health and life sciences Department of Public Health and Wellbeing December 2014 ii Abstract The recent promotion of male circumcision as a public health strategy in settings with low circumcision rates is based on research evidence suggesting that male circumcision provides heterosexual men with 50 to 60 per cent protective benefit against HIV infection. For the Kikuyu people in Kenya, male circumcision is a cultural ritual and a rite of passage from childhood to adulthood. The study explored the male circumcision ritual and practices in Muranga, Kenya and their implications on public health. A qualitative research design underpinned by an Interpretivist paradigm was employed. Focused ethnographic methodology was used to capture the cultural context of the ritual and its meanings. Participants were recruited through purposive sampling method. Data were collected through in-depth interviews with 13 circumcision mentors, participant observations in three churches and written narratives with 43 male students from six schools. Data were analysed using thematic analysis. The findings suggest a changing circumcision ritual with women as key agents of change in a ritual considered a male arena. The church, hospital and urbanisation emerged as the drivers of the changes which women effected with the aim of protecting their sons from institutional bullying and the culture of pain in the era of HIV and AIDS. The latest change in the ritual feature boys getting circumcised and recuperating in hospitals. The changes in male circumcision practices are of significance to public health. The changes in sexual practices are likely to increase the risk of HIV infection counteracting the protective effect expected of circumcision. The study recommends a revision of policies especially the WHO policy on male circumcision for the effective impact on HIV prevention among the circumcising communities. Women can be engaged in mobilising changes in the circumcision ritual that are significant to the health of young men through institutions such as hospitals and churches. Key words: male circumcision, public health, focused ethnography, Kenya iii Table of Contents Abstract ................................................................................................................................. iii Table of Contents ..................................................................................................................iv List of table and figures ........................................................................................................ viii List of appendices ................................................................................................................ viii My academic rites of passage ................................................................................................ x Acknowledgement ................................................................................................................xv Declaration .......................................................................................................................... xvi Introduction ............................................................................................................................ 1 1.1. Chapter Introduction .................................................................................................... 1 1.2. History of male circumcision as a rite of passage ........................................................ 1 1.3. Male circumcision ........................................................................................................ 3 1.3.1. Male circumcision and HIV .................................................................................... 4 1.4. Why men? ................................................................................................................... 7 1.5. Study area and participants ......................................................................................... 9 The aim, objectives and research questions of the study ................................................. 10 Objectives and research questions ................................................................................... 10 1.6. Thesis Outline ........................................................................................................... 10 1.7. Conclusions ............................................................................................................... 12 Contextualising the Research .............................................................................................. 13 2.1. Chapter Introduction .................................................................................................. 13 2.2. Kenya ........................................................................................................................ 13 2.2.1. Muranga ............................................................................................................. 15 2.2.2. The Kikuyu people .............................................................................................. 15 2.3. Rites of passage in Kenya ......................................................................................... 16 2.3.1. Male circumcision among the Kikuyus ................................................................ 22 2.3.2. Current Male Circumcision practice among the Kikuyu ....................................... 27 2.3.3. Faith Based Organisations and churches ............................................................ 30 2.3.4. Common words used in the male circumcision ritual ........................................... 32 2.4. Conclusions ............................................................................................................... 33 Theoretical Background ....................................................................................................... 34 3.1. Chapter Introduction .................................................................................................. 34 3.2. Theoretical frameworks and models .......................................................................... 34 3.2.1. Gender Identity and Socialisation ........................................................................ 35 iv 3.2.2. Masculinities and health ...................................................................................... 43 3.2.3. Feminism ............................................................................................................ 52 3.2.4. Socio Ecological Model ....................................................................................... 56 3.3. Conclusions ............................................................................................................... 59 Male circumcision, HIV and AIDS ........................................................................................ 60 4.1. Chapter Introduction .................................................................................................. 60 4.2. Public health approaches to the prevention of HIV and AIDS .................................... 60 4.3. HIV and AIDS and public health policies ................................................................... 65 4.3.1. Male Circumcision and Prevention of HIV and AIDS ........................................... 70 4.3.2. Traditional male circumcision .............................................................................. 74 4.3.3. Kenya’s response to the WHO male circumcision policy ..................................... 76 4.4. Conclusions ............................................................................................................... 80 Research Design ................................................................................................................. 81 5.1. Chapter Introduction .................................................................................................