Voluntary Medical Male Circumcision

Abstract

As the science demonstrating strong evidence for voluntary medical male circumcision (VMMC) for HIV prevention has evolved, the President’s Emergency Plan for AIDS Relief (PEPFAR) has collaborated with international agencies, donors, and partner country governments supporting VMMC programming. Mathematical models forecast that quickly reaching a large number of uncircumcised men with VMMC in strategically chosen populations may dramatically reduce community-level HIV incidence and save billions of dollars in HIV care and treatment costs. Because VMMC is a 1-time procedure that confers life-long partial protection against HIV, programs for adult men are vital short-term investments with long-term benefits. VMMC also provides a unique opportunity to reach boys and men with HIV testing and counseling services and referrals for other HIV services, including treatment. After formal recommendations by WHO in 2007, priority countries have pursued expansion of VMMC. More than 1 million males have received VMMC thus far, with the most notable successes coming from Kenya’s Nyanza Province. However, a myriad of necessary cultural, political, and ethical considerations have moderated the pace of overall success. Because many millions more uncircumcised men would benefit from VMMC services now, US President Barack Obama committed PEPFAR to provide 4.7 million males with VMMC by 2014. Innovative circumcision methods—such as medical devices that remove the foreskin without injected anesthesia and/or sutures—are being rigorously evaluated. Incorporation of safe innovations into surgical VMMC programs may provide the opportunity to reach more men more quickly with services and dramatically reduce HIV incidence for all.

Implementing voluntary medical male circumcision using an innovative, integrated, health systems approach: experiences from 21 districts in Zimbabwe

“…During implementation, ZAZIC also partnered with local government leaders to support service delivery with periodic community-adapted campaigns, demonstrating a collaborative, contextual approach to implementation in line with guidance for HIV-related differentiated care. Employing this model, overall ZAZIC performance these first years appears similar to early VMMC productivity from other predominantly vertical programs including Kenya, Tanzania, and South Africa [24,50] and appears to exceed output in early program years of other predominantly vertical programs in Botswana, Malawi, and Mozambique [18,51]. Within Zimbabwe, the ZAZIC approach outpaces earlier achievements by the vertical model [30,31].…”

“…Vertical delivery systems also allow for greater control over program design, management and implementation. For one-time interventions like VMMC, some assert that stand-alone programs may be more efficient at reaching numbers during the intensive, scale-up phase to reach 80% coverage of VMMC through 2016 [24]. …”

Responding to changes in HIV policy: Updating and enhancing the Families Matter! curriculum

“…These include new evidence for the effectiveness of anti-retroviral therapy (ART) (Cohen et al, 2011) and voluntary medical male circumcision (VMMC) (Reed et al, 2012) as prevention strategies; dramatically increased access to ART, VMMC, HIV testing and counseling (HTC), and related services; and growing awareness of the scale of gender-based violence (GBV), including child sexual abuse (CSA), and of its role in increasing vulnerability to HIV infection (Andersson et al, 2008). In addition, Violence Against Children (VAC) surveys have documented the extent of physical, sexual and emotional violence suffered by children, demonstrating the need both to prevent it and to mitigate its impacts (e.g., UNICEF Tanzania et al, 2011; Reza et al, 2007).…”

Rapid, minimally invasive adult voluntary male circumcision: A randomised trial

“…[2][3][4] Male circumcision is a priority preventive intervention for the World Health Organization (WHO) [5] and the US President's Emergency Plan for AIDS Relief (PEPFAR). [3] The ideal time to perform circumcision is in the newborn period, when it can be done with local anaesthetic, does not require sutures and is very safe. [6] However, newborn circumcision is generally not practised in SSA and the challenge is to develop simple, safe and minimally traumatic techniques for circumcising boys and men.…”