Boys belonging to the Xhosa people engaged in the manhood ritual, a secret rite that marks the transition from boyhood to adulthood (Ulwaluko). After ritual circumcision the initiates (abakhwetha) live in isolation for up to several weeks, often in the mountains. During the process of healing they smear white clay on their bodies and observe numerous taboos. In modern times the practice has caused controversy, with over 300 circumcision- and initiation-related deaths since 1994, and the spread of sexually transmitted diseases including HIV via the practice of circumcising initiates with the same blade.