In a study in Tanzania, men and women generally supported male circumcision; however, cultural values that the procedure is most appropriate before adolescence, shame associated with being circumcised at an older age, and concerns about the post-surgical abstinence period have led to low uptake among older men.
To meet UNAIDS’ 90–90–90 treatment goals, effective approaches to HIV testing services (HTSs) are urgently needed. In 2015, a cross-sectional study was conducted to evaluate effectiveness and feasibility of partner notification for HTS in Tanzania. Men and women newly diagnosed with HIV were enrolled as index clients, listed sexual partners, and given options to notify and link their partners to HTS. Of 653 newly diagnosed individuals, 390 index clients were enrolled, listed 438 sexual partners, of whom 249 (56.8%) were successfully referred. Of 249 partners reaching the facilities, 96% tested for HIV, 148 (61.9%) tested HIV+ (all newly diagnosed), and 104 (70.3%) of partners testing positive were enrolled into HIV care and treatment. Results showed good acceptability, feasibility and effectiveness, as evidenced by high uptake of partner notification among newly diagnosed individuals, over half of listed partners successfully referred, and a very high positivity rate among referred sexual partners.
SummaryBackgroundMale circumcision reduces men’s risk of acquiring HIV and
some sexually transmitted infections from heterosexual exposure, and is
essential for HIV prevention in sub-Saharan Africa. Studies have also
investigated associations between male circumcision and risk of acquisition
of HIV and sexually transmitted infections in women. We aimed to review all
evidence on associations between male circumcision and women’s
health outcomes to benefit women’s health programmes.MethodsIn this systematic review we searched for peer-reviewed and grey
literature publications reporting associations between male circumcision and
women’s health outcomes up to April 11, 2016. All biomedical (not
psychological or social) outcomes in all study types were included. Searches
were not restricted by year of publication, or to sub-Saharan Africa.
Publications without primary data and not in English were excluded. We
extracted data and assessed evidence on each outcome as high, medium, or low
consistency on the basis of agreement between publications; outcomes found
in fewer than three publications were indeterminate consistency.Findings60 publications were included in our assessment. High-consistency
evidence was found for five outcomes, with male circumcision protecting
against cervical cancer, cervical dysplasia, herpes simplex virus type 2,
chlamydia, and syphilis. Medium-consistency evidence was found for male
circumcision protecting against human papillomavirus and low-risk human
papillomavirus. Although the evidence shows a protective association with
HIV, it was categorised as low consistency, because one trial showed an
increased risk to female partners of HIV-infected men resuming sex early
after male circumcision. Seven outcomes including HIV had low-consistency
evidence and six were indeterminate.InterpretationScale-up of male circumcision in sub-Saharan Africa has public health
implications for several outcomes in women. Evidence that female partners
are at decreased risk of several diseases is highly consistent. Synergies
between male circumcision and women’s health programmes should be
explored.FundingUS Centers for Disease Control and Prevention and Jhpiego
Hally Mahler and colleagues evaluate a six-week voluntary medical male circumcision campaign in Iringa province of Tanzania, providing a model for matching supply with demand for services and showing that high-volume circumcisions can be performed without compromising client safety.
Kelly Curran and colleagues conducted a program review to identify human resource approaches that are being used to improve voluntary medical male circumcision volume and efficiency, identifying several innovative responses to human resource challenges.
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