Mapping male circumcision for HIV prevention efforts in sub-Saharan Africa

Abstract

Background: HIV remains the largest cause of disease burden among men and women of reproductive age in sub-Saharan Africa. Voluntary medical male circumcision (VMMC) reduces the risk of female-to-male transmission of HIV by 50-60%. The World Health Organization (WHO) and Joint United Nations Programme on HIV/AIDS (UNAIDS) identified 14 priority countries for VMMC campaigns and set a coverage goal of 80% for men ages 15-49. From 2008 to 2017, over 18 million VMMCs were reported in priority countries. Nonetheless, relatively little is known about local variation in male circumcision (MC) prevalence. Methods: We analyzed geo-located MC prevalence data from 109 household surveys using a Bayesian geostatistical modeling framework to estimate adult MC prevalence and the number of circumcised and uncircumcised men aged 15-49 in 38 countries in sub-Saharan Africa at a 5 × 5-km resolution and among first administrative level (typically provinces or states) and second administrative level (typically districts or counties) units. Results: We found striking within-country and between-country variation in MC prevalence; most (12 of 14) priority countries had more than a twofold difference between their first administrative level units with the highest and lowest estimated prevalence in 2017. Although estimated national MC prevalence increased in all priority countries with the onset of VMMC campaigns, seven priority countries contained both subnational areas where estimated MC prevalence increased and areas where estimated MC prevalence decreased after the initiation of VMMC campaigns. In 2017, only three priority countries (Ethiopia, Kenya, and Tanzania) were likely to have reached the MC coverage target of 80% at the national level, and no priority country was likely to have reached this goal in all subnational areas.

PrEP reminds me that I am the one to take responsibility of my life: a qualitative study exploring experiences of and attitudes towards pre-exposure prophylaxis use by women in Eswatini

“…The widespread provision of antiretroviral therapy (ART) and behavioural interventions such as promoting partner reduction and condom use have been insufficient for HIV epidemic control, even when coupled with biomedical prevention interventions such as male circumcision [ 6 – 9 ]. In 2015, the World Health Organization (WHO) recommended PrEP for people at high risk of HIV acquisition, defined as groups with incidence above 3 per 100 person-years [ 10 ], following several studies demonstrating its effectiveness in reducing HIV infections among high-risk populations [ 11 , 12 ].…”

A Comparison of the Prevalence of Sexually Transmitted Infections Among Circumcised and Uncircumcised Adult Males in Rustenburg, South Africa: A Cross-Sectional Study

“…The two interventions, condom use and male circumcision, if combined, may provide a greater protective effect against both STIs and HIV. However, in South Africa, condom use has remained suboptimal (40) while the prevalence of male circumcision varies from a low of 25% to a high of 75% between districts (41). The results of our study suggest a strong need to increase coverage of voluntary male circumcision.…”

Community Engagement for the Voluntary Medical Male Circumcision (VMMC) Program: an Analysis of Key Stakeholder Roles to Promote a Sustainable Program in Zambia

“…By consulting with the most relevant stakeholders, and considering community needs in programme development, the VMMC programme may be able to leverage the community structures and systems to reduce long term demand generation costs for VMMC and increase the acceptability and frequency of male circumcision. Introduction HIV remains a global reproductive health issue and the largest cause of disease burden in sub-Saharan Africa (1). In 2017, it was approximated that 25.9 million people were living with HIV in sub-Saharan Africa, with over one million newly infected in that year (2).…”

“…HIV remains a global reproductive health issue and the largest cause of disease burden in sub-Saharan Africa (1). In 2017, it was approximated that 25.9 million people were living with HIV in sub-Saharan Africa, with over one million newly infected in that year (2).…”