"Just relax, it won’t be very painful," are the last words Maqhawe Tsela hears before the nurse plunges a large needle into the base of his penis.
As the anaesthetic takes effect and the doctor readies his scalpel, 33-year-old Tsela prepares to join the ranks of a new generation of circumcised men in Swaziland, where the government has launched a mass circumcision drive to combat the world's highest HIV infection rate.
Clinical trials have suggested circumcision could halve men's chances of contracting HIV. Three studies on the practice have been so successful they were stopped early because researchers considered it unethical not to circumcise the control group.
Circumcision programmes are under way in a number of African countries, including Kenya, South Africa, Tanzania and Zimbabwe, but Swaziland's $15-million (about R105 million) drive to circumcise 160,000 men and teenage boys within a year is the first nationwide campaign.
Time is of the essence
One in four adults is HIV positive and 2% of the country's 1.2 million people die every year of the disease.
"If you are able to do this in a short period of time, that impact is felt more dramatically," said Jennifer Albertini, country director for the United States Agency for International Development, which is funding the programme.
Health officials hope the campaign will prevent 88,000 new infections.
"Once we save those people, we will be able to shift our focus to other health priorities," said Ayanda Nqeketo, who coordinates the programme on behalf of the Swazi government.
As the programme gathers momentum, teams of community workers or "recruiters" will be deployed nationwide, their message backed up by a huge advertising campaign.
The circumcisions will either be performed at clinics or in mobile surgical units housed in tents.
"It is all hands on deck," said Nqeketo. "We have 100% political commitment behind us, from the prime minister down."
Everyone, that is, but King Mswati III, the polygamous monarch of the tiny southern African kingdom, who has yet to give his public support to the campaign.
"We met with the king last year and he was supportive at that time," said Albertini.
Circumcision can be a tough sell in this deeply Christian society, where it is not traditionally practiced.
"Swazis feel it is not the custom of their forefathers, they have biblical concerns and they want to know what we do with their foreskins," said Mncedisi Dlamini of Population Services International, a non-profit organisation helping with the campaign.
Misconceptions about circumcision
Misconceptions about circumcision are not easily dispelled. A joke on a local TV soap opera last year led to the widespread belief that foreskins were being sold on the streets and used to make a herbal spice mixture.
A particularly dangerous misconception is that circumcision provides 100% protection from HIV.
In a sprawling shantytown known as White City outside Swaziland's commercial centre, Manzini, a team of circumcision recruiters combs the streets, persuading Swazi men to volunteer for surgery.
One man boasts that he got circumcised because it is "nice to have sex without condoms" drawing a furious reaction from the recruiters.
"That is NOT what he was told at the clinic!" exclaims Mbogniseni Ndzimandze, the leader of the recruitment team.
"What am I going to do when God asks me, 'Where is your foreskin?'" demands another man.
It is a question the recruiters are used to answering.
"Why do you cut your hair?" says Mzwandile Shongwe. "God could ask you that too."
(Sapa, Jinty Jackson, February 2011)
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