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In Rwanda, Circumcision Is All The Rage

The procedure is gaining popularity amongst young men who believe, erroneously, that it eliminates any risk of contracting HIV/AIDS.

 Circumcision is becoming a sign of "cleanliness" in Sub-Saharan Africa
Circumcision is becoming a sign of "cleanliness" in Sub-Saharan Africa
Alphonse Safari Byuma

BUGESERA - In Rwanda, circumcision has become trendy.

More and more young men have begun to have the procedure performed to limit the risks of HIV infection. The Ministry of Health launched its free male circumcision program in 2011, with a goal of medically circumcising 50% of men in two years as part of its HIV/AIDS prevention program.

Unfortunately there have been two drawbacks to this program. First, there is so much demand, that the Ministry of Health has been overwhelmed. In Rwanda, there are only two doctors for every 100,000 people. Second, it’s becoming apparent that many men do not know that being circumcised may only limit, not eliminate the risk, of being infected.

Prompted by the health and sex-related campaign, circumcision has also taken on a social appeal and status symbol. “We are always on the look-out, listening to the radio so we don’t miss announcements from the Rilima district board about the next circumcision campaign," says Kamanzi, a student from the Rilima school, in the eastern Rwandese town of Bugesera.

Since the operation is now free and performed by qualified government staff, there are so many candidates that demand can’t be met. "Some are going to neighboring provinces,” notes François Mutijima, another student.

Reducing risks

According to Gaspard Gasirabo, a health ministry representative for the Rilima district, workers from the ministry usually come on Thursdays, which is market day in the town. They try to convince teenagers and men to get circumcised by explaining how safe and simple the operation is.

Studies from the World Health Organization and UNAIDS have shown that circumcision can reduce the risk of HIV infection by more than half. Circumcision could prevent two million contaminations and 300,000 deaths over the next ten years in Sub-Saharan Africa.

“This active campaign has raised awareness among teenagers and young men. They are constantly asking me when the medical staff is coming back so that they can get circumcised for free,” explains Gaspard. Until then, they had to pay for the operation, and many went to traditional healers who performed it without respecting hygiene and safety standards.

However this newfound enthusiasm is also very risky, as it often results from a misinterpretation of the prevention message. Many teenagers and men wrongly believe that once they have the procedure, they do not need to wear a condom to protect themselves from HIV. Prevention is therefore still necessary to avoid sexually transmitted diseases, among men and women alike, as women can be infected by circumcised men.

How circumcision creates discrimination

Among young people, circumcision has actually become “fashionable.” Thanks to the Internet and television, they learned that in neighboring countries like the Democratic Republic of Congo and Uganda, circumcision was often a tradition, and not only for Muslims. For these young people, circumcision has become a sign of cleanliness.

And for those who do not follow fashion, life can become complicated. “I decided to pay 50,000 Rwanda Francs ($80) to get circumcised. I couldn’t stand being insulted by other students anymore. They called me a good-for-nothing, a kafiri (‘uncircumcised) or a bottleneck (referring to a non-circumcised male organ),” says François.

Three of his friends also admit they went through a similar experience. “Rwandese society still accepts uncircumcised men, but in some districts, they are sometimes frowned upon. And it’s even worse in high school, where they are discriminated against,” reveals Gaspard.

Among girls and women, circumcised men have also gained some prestige lately, in a country where the custom was not very common until now. Mrs Kanyange, a mother of three, thinks that despite its cost, circumcision has great advantages: “It ensures cleanliness, and the operation is also an esthetic one for men.”

For these reasons, men would like circumcision to be covered by their health insurance. Andrew Makaka, former National Health Insurance director, is more cautious on this issue: “Circumcision is a prevention surgery, and therefore it is not included in Health Insurance schemes. It would all the more difficult since the latest census reveals that more than 1.5 million men wish to get circumcised...”

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Coronavirus

Where Lockdowns For LGBTQ Meant Moving Back In With Homophobic Relatives

The confinement experience could turn brutal for those forced to live with relatives who would not tolerate a member of the family living their sexual orientation openly as a young adult. Here are stories from urban and rural India.

At a Rainbow pride walk in Kolkata, India

Sreemanti Sengupta

Abhijith had been working as a radio jockey in the southern Indian city of Thiruvananthapuram when the COVID-19 pandemic hit in March, 2020. When the government imposed a nationwide lockdown, Abhijith returned to the rural Pathanamthitta district , where his parents live with an extended family, including uncles, cousins and grandparents.

Eighteen months later, he recalled that the experience was "unbearable" because he had to live with homophobic relatives. "Apart from the frequent reference to my sexual 'abnormality', they took me to a guruji to 'cure' me," Abhijith recalled. "He gave me something to eat, which made me throw up. The guru assured me that I was throwing up whatever 'demon' was possessing me and 'making' me gay."


Early in 2021, Abhijith travelled back to Thiruvananthapuram, where he found support from the members of the queer collective.

Inspired by their work, he also decided to work towards uplifting the queer community. "I wish no one else goes through the mental trauma I have endured," said Abhijit.

Abhijith's story of mental distress arising from family abuse turns out to be all too common among members of India's LGBTQ+ community, many of whom were trapped in their homes and removed from peer support groups during the pandemic.

Oppressive home situations

As India continues to reel from a pandemic that has claimed more lives (235,524) in three months of the second wave (April-June 2021) than in the one year before that (162,960 deaths in March 2020-March 2021), the LGBTQ community has faced myriad problems. Sexual minorities have historically suffered from mainstream prejudice and the pandemic has aggravated socio-economic inequalities, instigated family and institutionalized abuse, apart from limiting access to essential care. This has resulted in acute mental distress which has overwhelmed queer support infrastructure across the country.

Speaking to queer collective representatives across India, I learned that the heightened levels of distress in the community was due to longstanding factors that were triggered under lockdown conditions. Family members who are intolerant of marginalized sexual identities, often tagging their orientation as a "disorder" or "just a phase", have always featured among the main perpetrators of subtle and overt forms of violence towards queer, trans and homosexual people.

Calls from lesbians and trans men to prevent forced marriages during lockdowns.

Sappho For Equality, a Kolkata-based feminist organization that works for the rights of sexually marginalized women and trans men, recorded a similar trend. Early in the first wave, the organization realized that the existing helpline number was getting overwhelmed with distress calls. It added a second helpline number. The comparative figures indicate a 13-fold jump in numbers: from 290 calls in April 2019-March 20 to 3,940 calls in April 2020-May 2021.

"Most of the calls we have been getting from lesbians and trans men are urgent appeals to prevent forced marriages during lockdowns," said Shreosi, a Sappho member and peer support provider. "If they happen to resist, they are either evicted or forced to flee home. But where to house them? There aren't so many shelters, and ours is at full capacity."

Shreosi says that the nature of distress calls has also changed. "Earlier people would call in for long-term help, such as professional mental health support. But during the pandemic, it has changed to immediate requests to rescue from oppressive home situations. Often, they will speak in whispers so that the parents can't hear."

Lack of spaces

Like many of his fellow queer community members, life for Sumit P., a 30-year-old gay man from Mumbai, has taken a turn for the worse. The lockdown has led to the loss of safe spaces and prolonged residence at home.

"It has been a really difficult time since the beginning of the lockdown. I am suffering from a lot of mental stress since I cannot freely express myself at home. Even while making a call, I have to check my surroundings to see if anybody is there. If I try to go out, my family demands an explanation. I feel suffocated," he said.

The pandemic has forced some queer people to come out

Sumit is also dealing with a risk that has hit the community harder than others – unemployment and income shortage. He's opened a cafe with two other queer friends, which is now running into losses. For others, pandemic-induced job losses have forced queer persons from all over the country to return to their home states and move in with their families who've turned abusive during this long period of confinement.

Lockdowns force coming out

According to Kolkata-based physician, filmmaker and gay rights activist Tirthankar Guha Thakurata, the pandemic has forced some queer people to come out, succumbing to rising discomfort and pressure exerted by homophobic families.

"In most cases, family relations sour when a person reveals their identity. But many do not flee home. They find a breathing space or 'space out' in their workspaces. In the absence of these spaces, mental problems rose significantly," he said.

Not being able to express themselves freely in front of parents who are hostile, intolerant and often address transgender persons by their deadname or misgender them has created situations of severe distress, suicidal thoughts and self-harm.

Psychiatrist and queer feminist activist Ranjita Biswas (she/they) cites an incident. A gender-nonconforming person died under suspicious circumstances just days after leaving their peer group and going home to their birth parents. The final rites were performed with them dressed in bangles and a saree.

"When a member of our community asked their mother why she chose a saree for someone who had worn androgynous clothes all their life, she plainly said it was natural because after all, the deceased 'was her daughter,'" Biswas recalls.

The Indian queer mental health support infrastructure, already compromised with historical prejudice, is now struggling

David Talukdar/ZUMA

"Correctional" therapy

In India, queer people's access to professional mental healthcare has been "very limited," according to community members such as Ankan Biswas, India's first transgender lawyer who has been working with the Human Rights Law Network in West Bengal.

"A large majority of the psychiatrists still consider homosexuality as a disorder and practice 'correctional therapy'. It's only around the big cities that some queer-friendly psychiatrists can be found," Biswas said. "The pandemic has further widened the inequalities in access to mental health support for India's LGBTQ community."

Biswas is spending anxious days fielding an overwhelming amount of calls and rescue requests from queer members trapped in their homes, undergoing mental, verbal and even physical torture. "We don't have the space, I just tell them to wait and bear it a little longer," he said.

Medical care is dismal

Anuradha Krishnan's story, though not involving birth family, outlines how the lack of physical support spaces have affected India's queer population. Abandoned by her birth family when she came out to them as a trans woman in 2017, Anuradha Krishnan (she/they), founder of Queerythm in Kerala who is studying dentistry, had to move into an accommodation with four other persons.

Isolation triggered my depression

"I am used to talking and hanging around with friends. Isolation triggered my depression and I had to seek psychiatric help." Living in cramped quarters did not help with quarantine requirements and all of them tested positive during the first wave.

What is deeply worrying is that the Indian queer mental health support infrastructure, already compromised with historical prejudice, is now struggling, placing more and more pressure on queer collectives and peer support groups whose resources are wearing thin.

During the 10 months of the first wave of the pandemic in India in 2020, Y'all, a queer collective based in Manipur, received about 1,000 distress calls on their helpline number from LGBTQ+ individuals. In May 2021 alone, they received 450 such calls (including texts and WhatsApp messages) indicating a telling escalation in the number of queer people seeking help during the second wave.

As India's queer-friendly mental health support infrastructure continues to be tested, Y'all founder, Sadam Hanjabam, a gay man, says, "Honestly, we are struggling to handle such a large number of calls, it is so overwhelming. We are also dealing with our own anxieties. We are burning out."

Sreemanti Sengupta is a freelance writer, poet, and media studies lecturer based in Kolkata.

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