Keeping voluntary male medical circumcision high on the agenda

Champions for an HIV-Free Generation (Champions) continue to be actively engaged in promoting voluntary male medical circumcision (VMMC) in Africa, where effective prevention strategies are needed urgently to reduce the high rate of HIV infections.

In July 2012, during the 19th International AIDS Conference in Washington DC, U.S., the Champions, PEPFAR, UNAIDS, WHO and AVAC brought together African politicians and traditional leaders, as well as key figures in the international HIV response, to share their views on the challenges and solutions to VMMC.

The discussion was framed in the context of a five-year action framework, endorsed in December 2011 by UNAIDS, WHO, PEPFAR, BMGF, the World Bank and Ministries of Health from 14 priority countries, to accelerate the scale up of VMMC.

The 14 countries have some of the world’s more severe HIV epidemics and include Botswana, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland, Uganda, Tanzania, Zambia and Zimbabwe.

Following clinical trials in 2007 which showed that VMMC can reduce female-to-male transmission of HIV by 60 per cent, WHO and UNAIDS recommended that countries or provinces within countries with high HIV prevalence and low rates of male circumcision expand VMMC as part of a comprehensive package of HIV prevention services.

The Champions have worked tirelessly to increase acceptance and uptake of VMMC services among the 14 priority countries through in-country visits and advocacy at high-level meetings and international conferences.

“Over the next five year, enough men can be circumcised through VMMC to prevent 3.4 million new HIV infections and save billions in care and treatment costs,” said former President of Tanzania and one of the Champions, HE Benjamin Mkapa. “Scaling up this intervention is an urgent priority. Although it means an upfront investment, the results are significant long-term cost savings.”

Progress in implementation of VMMC has, however, been uneven, with some countries, like Kenya and Tanzania, making impressive progress and others struggling to move beyond the pilot phase.

The five-year framework’s immediate ‘catch-up’ phase is therefore designed to quickly achieve coverage of sexually active adolescent and adult males, and a second phase to integrate VMMC into infant healthcare services.

According to WHO , the results achieved so far show that reaching the ambitious target of 20.8 million males circumcised by 2016 can be reached. In 2013, 2.7 million men alone in the 14 priority countries underwent VMMC. This means that a total of 5.82 million males have been circumcised since 2008.

“I am proud of the men of Uganda for accepting the good science behind VMMC and stepping up for male circumcision,” said Dr. Speciosa Wandira former Vice President of Uganda and member of the Champions, when talking about her own country. “Women—in their roles as sisters, mothers, wives and partners—also play a pivotal role in supporting men to make this decision.”

WHO Progress Brief, July 2014, http://www.who.int/hiv/topics/malecircumcision/male-circumcision-info-2014/en/