Integrating Male Circumcision with Broader HIV Prevention

An opportunity and a challenge

Advocacy groups have reacted to the news that male circumcision can reduce men's risk of acquiring HIV from their female partners with both enthusiasm and a range of important concerns that stem from years of experience with advocacy and implementation of proven prevention strategies.

There is a strong recognition that male circumcision presents an opportunity to engage men around HIV prevention, to expand couples counselling, and to build and/or strengthen programmes that seek to transform sexual and gender norms. Historically, it has been difficult to bring men into the health services for HIV education and frank conversations around sex and sexuality, and in this sense the enthusiasm surrounding male circumcision is a positive development that could lay the foundation for innovative programming.

In order to seize this opportunity, it's critical that male circumcision be offered as part of a package of services and interventions, both for the man himself and — where possible — for his sexual partners. As the World Health Organization/UNAIDS document New Data on Male Circumcision and HIV prevention: Policy and Programme Implications (March 2007, PDF, 128 KB) states: "Male circumcision should always be considered as part of a comprehensive HIV prevention package, which includes the provision of HIV testing and counselling services; treatment for sexually transmitted infections; the promotion of safer sex practices; and the provision of male and female condoms and promotion of their correct and consistent use."

This guidance is an excellent starting point for developing programmes that situate male circumcision in the context of other biomedical and behavioural prevention options. There is a critical need for country governments, donors and programme implementers to support creation of such comprehensive offerings. In every instance, community groups working on HIV/AIDS prevention, treatment and care and/or on sexual and reproductive health have a role to play in shaping these programmes, advocating for sufficient resources, and following up on their long-term outcomes. Several of the civil society groups that have developed positions on male circumcision for HIV prevention have noted the importance of situating it as part of a comprehensive response, and of addressing women's concerns as well as the impact on male sexuality.

This work is closely linked to other ongoing efforts to expand the resources available for proven prevention strategies and to increase rates of access to male and female condoms, prevention of parent-to-child transmission and other strategies. The following are links to key resources related to this broader advocacy effort.

Resources

Global HIV Prevention Working Group Report. Bringing HIV Prevention to Scale: An Urgent Global Priority (2008, PDF, 669 KB)

Global HIV Prevention Working Group. Behavior Change and HIV Prevention:
(Re)Considerations for the 21st Century (2008, PDF, 217 KB)

The Search Must Continue. AVAC Report 2008

Part 1: Introduction; Chapter 1: The Whole Wide World: Global priorities around HIV prevention research (PDF, 2.13 MB)

Part 2: Chapter 2: What's (Y)our Position?: Where we stand in the post-STEP era (PDF, 615 KB)

Part 3: Chapter 3: What We Know for Sure: Lessons to be learned from the STEP study; Chapter 4: Moving Forward, Looking Back: Studying the IAVI model (PDF, 1.17 MB)

Part 4: Science Snapshot: Quick takes on next steps in the search for an AIDS vaccine; The Search Continues (PDF, 527 KB)