Male Circumcision News
WHO seeks stakeholder input
The World Health Organization invites stakeholders to review the drafts of three related global health strategies, addressing HIV, viral hepatitis, and sexually transmitted infections, with a 30 April 2015 deadline. These 2016-2021 strategies will be finalized for consideration by the 69th World Health Assembly in May 2016. A letter (PDF, 281 KB ) from WHO provides links for accessing an online survey, as well as early drafts of the three strategies and other background documents.
Kenyan programme surpasses goal
Kenya’s national voluntary medical male circumcision (VMMC) programme has surpassed its target of providing service to 940,000 clients, said the VMMC programme manager of the National AIDS and STI Control Programme (NASCOP). Francis Ndwiga of NASCOP is quoted as saying that the programme has exceeded that goal by about 100,000. He attributes this success to coordination and support from the government and nongovernmental organisations, as well as acceptance of VMMC among communities that do not practice male circumcision culturally (Coast Week, 4 March 2015).
Ugandan study shows impact on HIV
An increase in the number of non-Muslim men who are circumcised has led to substantial reductions in new HIV infections among men in Rakai, Uganda, a study has found. Presented at the Conference on Retroviruses and Opportunistic Infections on 27 February, the study was conducted to assess the impact of scaling up medical male circumcision in Rakai District since 2007. The analysis of data from annual community surveys among men ages 15 to 49 excluded Muslims, who would have been circumcised anyway for religious reasons, and it controlled for the use of antiretroviral drugs by women over time. Circumcision coverage among non-Muslim men increased from 9 percent in 2007 to 26 percent in 2011, and every 10 percent increase in coverage was associated with a 12 percent reduction in new HIV infections (Aidsmap, 27 February 2015).
Initiative to boost male circumcision in South Africa
The Department of Health (DOH) of South Africa’s Western Cape Province and a managed care firm have joined forces to expand access to voluntary medical male circumcision (VMMC), Independent Online reports. Metropolitan Health Risk Management will cover the cost of VMMC services in employer-based medical schemes, and the Center for HIV and AIDS Prevention (CHAPS) will train general practitioners in those schemes to provide VMMC. This work is part of a public-private partnership among the national DOH, the US Agency for International Development mission in South Africa, Metropolitan Health Risk Management, and CHAPS to scale up VMMC services with $5 million funding from the US President’s Emergency Plan for AIDS Relief, according to a press release (Independent Online, 27 February 2015).
Zimbabwe launches new plan
A cabinet minister said that voluntary medical male circumcision could help Zimbabwe avert 220,000 new HIV infections and save US$1.3 billion in treatment costs, The Zimbabwe Mail reports. During a 30 January speech at the launch of the country’s VMMC operational plan for 2014-18, the minister of health and child care urged delegates to plan more creatively to help the programme reach a total of 1.3 million men with VMMC services. By the end of 2014, 400,000 men had been circumcised, or 30 percent of the goal. Younger men have responded enthusiastically, but older and married men appear reluctant to get circumcised (The Zimbabwe Mail, 2 February 2015).
Botswana at HIV “tipping point”
Botswana is one of the few countries that have reached the tipping point in the HIV epidemic, which means that for every person on treatment, less than one person is newly infected, a Voice of America branch manager reported. Speaking at an event in a district where HIV prevalence remains high (27.5 percent in 2013), he said that nationally, new HIV infections have dropped by 71 percent since 2001 and the rate of mother-to-child transmission — once as high as 40 percent — is now 2 percent. The VOA manager attributed these trends to Botswana’s policy of offering antiretroviral treatment free of charge to all eligible citizens, along with prevention of mother-to-child transmission and “a slow but steady increase” in the number of men accessing safe male circumcision services (Mmegi Online, 2 February 2015).
PrePex central to Rwanda strategy
The Rwandan Ministry of Health has decided to use the PrePex device for all voluntary medical male circumcisions (VMMCs) among men ages 18 and older except those who are medically ineligible. A commentary published in BMC Medicine reports that this decision is a key element of Rwanda’s VMMC strategy. The article describes how Rwanda is addressing the challenge of reaching 700,000 men with VMMC services in a country with limited resources and no tradition of male circumcision. By 2014, the Rwandan programme had reached less 10 percent of that goal (BMC Medicine, December 2014).
US guidelines on male circumcision proposed
The benefits of male circumcision outweigh the risks, according to guidelines proposed by the US Centers for Disease Control and Prevention (CDC), Reuters reports. They would recommend that US healthcare providers counsel all uncircumcised men and male adolescents who engage in heterosexual sex — as well as parents of boys — that the procedure provides men partial but substantial protection against acquiring HIV and several other sexually transmitted infections through penile-vaginal sex. Acknowledging that most of the evidence is from African countries with much higher rates of heterosexual HIV transmission than the USA has, the recommendations cite data suggesting that some US groups could benefit from male circumcision. Before finalising these guidelines, the CDC will consider the results of an external peer review and public comments submitted during a 45-day period that began on 2 December (Reuters, 2 December 2014).
Uganda president’s remarks spark controversy
At a World AIDS Day event in Uganda, President Yoweri Museveni spoke against promotion of safe male circumcision (SMC) and condom use, urging youth to "put padlocks on their private parts" and practice abstinence, reports the 2 December 2014 issue of the Daily Monitor. The Ugandan president is also quoted as saying that a person who acquires HIV has betrayed his or her family. The Red Pepper News Paper’s coverage quotes the minister of state for primary, who said that the Ministry of Health would continue to promote SMC and condom use because they are part of the national HIV prevention strategy. Representatives of civil society organisations demanded that the president apologise for his remarks, which they believe could undermine efforts to prevent HIV, The Independent reports.
Parents embrace infant male circumcision
Kenya could expand provision of early infant male circumcision if a pilot project in the Nyanza region is successful, reports The Star. During the first 11 months of the 18-month project, 600 infants were circumcised at nine health facilities in western Kenya. Nyanza Reproductive Health Society staff members who are conducting the project say that more parents are opting to have their sons circumcised a few days after birth. At least 733,580 Kenyan men were circumcised from 2008 to 2013; a new focus on circumcising male infants during the first two months of life, when the risk of side effects is lowest, could reduce the children’s risk of HIV in the future (The Star, 1 December 2014).
Study finds reduced risk of syphilis
Being circumcised or having a circumcised partner was linked with a reduced risk of syphilis among men and women in a large prospective study conducted in Kenya and Uganda. Published in The Lancet Global Health, the study followed 4,176 HIV-serodiscordant couples (with one partner HIV-positive and one HIV-negative) for a median of 2.75 years. Male circumcision was associated with a reduced risk of new cases of syphilis of 42 percent among the men and 59 percent among the women. The authors of a commentary published in the journal called the study “one of the largest and most comprehensive analyses of syphilis incidence in men and women and the effect of male circumcision,” providing additional evidence of the medical benefits of male circumcision.
PrePex introduced in Uganda
Uganda’s Ministry of Health has introduced the PrePex device for performing adult male circumcision in hospitals and health centres in Mbale District, with plans to roll it out to other districts in the Elgon area next month, the Daily Monitor reports. The PrePex procedure does not require stitches or injectable anaesthesia. Based on pilot testing of PrePex, the national safe male circumcision (SMC) programme plans to add the device to the options available to men who wish to become circumcised across the country. The SMC national coordinator is quoted, cautioning that medical male circumcision reduces men’s chances of becoming infected with HIV but does not provide complete protection (Daily Monitor, 4 September 2014).
Mobile surgical theatres launched in South Africa
Two mobile surgical surgical theatres are traveling to communities in South Africa’s Western Cape Province as part of a campaign to promote voluntary medical male circumcision (VMMC), health 24 reports. Launched at a community soccer event in Stellenbosch at the end of August, the mobile units are part of the “Get Wise, Circumcise” campaign of the Worker Health Program (WHP) of the South African Clothing & Textile Workers’ Union. WHP has also partnered with the Desmond Tutu TB Center at Stellenbosch University to introduce VMMC services at nine clinics in the Winelands and Cape Town. A health official is quoted as saying that the campaign and its use of a cartoon character named “Clever Dick” are creative ways to encourage men to talk about health issues (health24, 1 September 2014).
Former president champions male circumcision
The former president of Botswana called on African governments to invest in voluntary medical male circumcision for HIV prevention (VMMC), citing a recent estimate that only half the funding needed to provide VMMC at nearly universal levels in southern and eastern Africa is available. In a column in The Namibian, former president Festus Gontebanye Mogae also called on community and religious leaders to encourage men to consider VMMC and to ensure that their decisions are based on scientific evidence. He noted that 5.8 million African men have already chosen VMMC, and half of them became circumcised in the past two years (The Namibian, 22 August 2014).
Call to ban unsterile male circumcisions
South African scientists and public health experts have called for a ban on unsterile traditional male circumcision practices, Cape Argus reports. In a letter published in the South African Medical Journal in August, scientists from the Human Sciences Council, the South African Medical Research Council, and the Wits Reproductive Health and HIV Institute noted that many initiates have died or suffered permanent disability as a result of such practices. In Eastern Cape, 38 deaths of initiates and 10 penile amputations were reported from May to July of this year. The chairman of the Eastern Cape House of Traditional Leaders warned scientists not to impose their medical views on traditional matters, saying that sterilisation has become standard for traditional circumcisions (Cape Argus, 11 August 2014).
VMMC associated with lower HIV rates among women
Young women (ages 15 to 29) in a South African community who had sex only with circumcised men had a 20 percent lower rate of new HIV infections compared to women who had some or only circumcised partners, the International AIDS Society reports. Among women ages 15 to 49, the HIV incidence was almost 17 percent lower among those who had sex only with circumcised men. This study, which was presented at the AIDS 2014 conference on 25 July 2014, modelled HIV incidence among 4,538 women in the community of Orange Farm. It was the first to show an association between roll out of voluntary medical male circumcision and reductions in new HIV infections among women (IAS, 28 July 2014).
Dramatic increase in male circumcision
The World Health Organization reported a dramatic increase in the number of African men choosing to be circumcised, the Swazi Observer reports. About 5.8 million men have become circumcised in 14 eastern and southern African countries since 2008, and nearly half of those procedures were conducted in 2013. Attaining and then maintaining 80 percent coverage of male circumcision in the 14 countries could prevent an estimated 3 million HIV infections and save more than $16 billion in future health care costs, but experts at the International AIDS Conference in Melbourne, Australia, warned of a shortfall of about $710 million in the funding needed through 2016 to achieve that goal (Swazi Observer, 24 July 2014).
Male circumcision does not promote risky behavior
Efforts to encourage male circumcision for HIV prevention are backed by new findings, published online in the journal AIDS and Behavior, that men are unlikely to engage in riskier sex after they have had the procedure, AFP reports. Researchers from the University of Illinois interviewed 3,186 Kenyan men — half of whom decided to get circumcised and half who remained uncircumcised — every six months for two years. During that period, sexual activity increased among both groups, but condom use also rose, particularly among the circumcised men, and risky sexual behaviors decreased. “Countries that have been holding back on implementing medical circumcision programs due to a lack of evidence regarding risk compensation should have no concerns about scaling-up programs," said the lead scientist in a press release from the university (AFP, 21 July 2014).
Study examines incentives for male circumcision
Offering men incentives in the form of food vouchers modestly increased the likelihood that they would become circumcised within a few months, according to a study published in the Journal of the American Medical Association and presented at the AIDS 2014 conference. About 1,500 uncircumcised men in Kenya were randomly assigned to be offered vouchers worth different amounts or no compensation. Research had found that men were often deterred by the lost wages from time away from work and the cost of traveling to and from health facilities to have the operation. Nine percent of the men offered vouchers worth US$15 and 6.6 percent of the men offered an $8.75 voucher became circumcised, compared to 1.6 of those offered no voucher. The increase in uptake of male circumcision was higher among older and married men and those at highest risk of HIV infection (AFP, 21 July 2014).
Namibian men slow to embrace circumcision
In Namibia, the government’s hopes of having at least 80 percent of eligible men circumcised by the end of next year are dwindling, the Namibian Sun reports. Since voluntary medical male circumcision (VMMC) services were launched in 2009, only 16,341 men (5 percent) have been circumcised. The country’s health minister noted that a rapid scale up of the VMMC programme is needed, particularly in the northern and northeastern regions, which have the highest rates of HIV infection and the lowest rates of male circumcision. He urged men and boys to take advantage of the VMMC services available in all 33 district hospitals and called on women to support their sons, boyfriends, male friends, and husbands to go for circumcision (Namibian Sun, 22 June 2014).
Millions allocated for safer traditional circumcision
South Africa’s government has set aside 180 million rand for safe male circumcision in an effort to end fatalities at initiation schools, according to a government news release published by AllAfrica.com. The support will include providing health screening for all initiates at approved initiation schools, medical consumables, and transport for initiation monitoring. The government has also contracted with 21 general practitioners who provide medical male circumcision at legal initiation schools. Four deaths of initiates have been reported so far during this year’s initiation school season, and the government has established a hotline for reporting illegal initiation school or untrained traditional “surgeons” (AllAfrica.com, 13 June 2014). An Associated Press article about the prevalence and consequences of botched traditional circumcisions in South Africa says that Congress of Traditional Leaders of South Africa has announced a partnership with the state and medical professionals to educate villagers about safe circumcision (US News & World Report, 4 June 2014).
Botswana reports progress
About 35 percent of the men in Botswana have been circumcised as part of a national strategy to prevent the spread of HIV infection, reports Agence Africaine de Presse. The national coordinator of the Ministry of Health’s Safe Male Circumcision (SMC) project said in an interview that 132,696 men ages 15 to 29 have been circumcised so far. However, the project aims to circumcise 80 percent of the men in this age group by 2016, and low turnout has been a challenge. The ministry plans to convene stakeholders to discuss the results of the project rollout and plan continued scale up of SMC services (Agence Africaine de Presse, 9 June 2014).
Study finds Kenya women prefer circumcised men
Three-quarters of the women interviewed in a small qualitative study in Kenya said they preferred circumcised to uncircumcised partners, Aidsmap reports. Investigators conducted in-depth interviews with 30 women living in Kisumu, the capital of the region that has the country's highest HIV prevalence at 15 percent, and published the results in PLoS ONE. They found that the women generally had a good understanding of the partial protection against HIV provided to men by male circumcision, and that many participants also perceived circumcised men as being more hygienic and taking longer to ejaculate compared to uncircumcised men. “Women will likely have a significant influence on acceptability and uptake of MC [male circumcision] as it is scaled up in western Kenya and elsewhere in sub-Saharan Africa,” the authors concluded (Aidsmap, 6 June 2014).
Male circumcision rates rise in Kenya
After Kenya adopted a programme to promote voluntary medical male circumcision (VMMC), the proportion of men who are circumcised climbed significantly, from 85 percent in 2007 to more than 91 percent in 2012, the International AIDS Society reports. Results of national surveys, published in the Journal of Acquired Immune Deficiency Disorders, show that male circumcision rates rose particularly strongly in populations the programme sought to reach, including men in Nyanza Province and Nairobi, men of the traditionally non-circumcising Luo tribe, and men ages 15 to 44. In Nyanza, where the programme began, male circumcision rates rose by 18 percent. “The gains made in VMMC coverage over the past 5 years can be attributable to adoption of focused strategies for scaling up VMMC,” the authors wrote (International AIDS Society, 9 May 2014).
Some protection seen for women with circumcised partners
A study in South Africa found that women with circumcised partners are less likely to have HIV infection and no less likely to use condoms, AIDSmap reports. These findings from the township of Orange Farm provide the first convincing evidence that male circumcision also offers a degree of protection to men’s female partners. The rate of reduced risk was small, at 15 percent, but statistically significant. The authors believe that this reduced risk observed among women with only circumcised partners is probably due to decreased HIV prevalence among circumcised men rather than a direct effect on HIV transmission to women. The prevalence of condom use during extramarital sex was about 38 percent with both circumcised and uncircumcised men, and 55 percent of women thought condom use was easier for a circumcised man (Aidsmap, 20 March 2014).
Zimbabwe to train nurses
At least 8,000 nurses in Zimbabwe will be trained to perform male circumcision and determine when adults or children with HIV should initiate antiretroviral treatment, The Herald of Zimbabwe reports. The government recently approved the training of nurses to perform the surgical procedure to improve access to voluntary medical male circumcision. The nurses will receive training and mentoring in HIV prevention, treatment, and care under a US$ 65-million project funded by the United States President’s Emergency Plan for AIDS Relief (PEPFAR). The five-year project will be implemented in 21 districts by the Zimbabwe Association of Church Related Hospitals and the International Training and Education Centre for Health (The Herald, 10 February 2014).
Ugandan army conducts medical outreach
Voluntary medical male circumcision and other HIV prevention measures are part of a public health drive marking National Army Week in Uganda, AFP reports. "Circumcision is a proven method to reducing the risk of HIV/AIDS, and we think that by doing that our people will reduce the risk of infection,” a spokesperson for the Uganda People’s Defense Force is quoted as saying, adding that army doctors had in recent days performed 330 circumcisions, provided 630 HIV tests, and distributed 43,500 condoms. Once heralded for its response to the AIDS epidemic, Uganda has seen HIV prevalence rise from 6.4 percent in 2004-5 to 7.3 percent in 2011 (News 24, 4 February 2014).
Uganda plans PrePex rollout
Implementation of a new male circumcision procedure that does not require conventional surgery and is considered bloodless will begin next month in Uganda, New Vision reports. The national safe male circumcision coordinator (SMC) at the health ministry is quoted as saying that use of the PrePex device for performing male circumcision will begin mid-February, with the aim of circumcising 10,000 men. The first phase of implementation, however, will involve 1,000 men, and the pace of subsequent rollout will depend on demand for the PrePex-assisted procedure. The new method is expected to complement the use of the conventional surgical procedure for male circumcision by trained health care providers in the SMC programme (New Vision, 26 January 2013).
Clinic reaches older men
A nondescript clinic in an industrial area of Lesotho's capital offers men who work in the area easy access to discreet HIV prevention services, including voluntary medical male circumcision (VMMC), reports Jhpiego. Since it opened in Maseru in June 2013, the Apex Clinic has served 1,900 men. It has proved popular with men older than 25, who have been reluctant to participate in VMMC programmes, citing concerns about attending clinics that primarily serve younger clients as well as the procedure. The Maternal and Child Health Integrated Program (MCHIP) opened the clinic in partnership with the Ministry of Health to address some of these concerns. The clinic is one of 13 health facilities to offer a comprehensive package of services that includes free VMMC, the offer of HIV counselling and testing, and both group and individual counselling about a range of health topics.
Rwanda rolls out PrePex
Rwanda became the first country to begin nationwide use of a device for performing adult male circumcision, The New Times reports. Minister of Health Agnes Binagwaho said scaling up use of the PrePex device would help the national programme achieve its goal of circumcising 700,000 men by 2016. PrePex-assisted male circumcision does not required local injection of anaesthesia or sutures, and it can be performed by nurses in a clean, non-sterile setting. The PrePex device was pre-qualified by the World Health Organization in May 2013 after a clinical and regulatory evaluation (The New Times, 27 November 2013).
Creating a new norm
Ethiopia has one of the highest rates of male circumcision in sub-Saharan Africa, but until recently people in one region have viewed the procedure with suspicion, IPS reports. The dominant ethnic groups in Gambella Province considered male circumcision alien to their culture, but attitudes toward the procedure have begun to change since the launch of a voluntary medical male circumcision programme in 2009. When the programme began, less than 47 percent of men in Gambella were circumcised and the province had an HIV prevalence rate three times the national average. To date, the programme has served more than 32,000 clients (Inter Press Service, 25 November 2013).
Ugandan provider has circumcised 13,000
His peers say that clinical officer George Mwidu Lyavala has circumcised more men than anyone else in Uganda. In an interview with New Vision, Mwidu described his work as a health care provider and trainer for Uganda’s voluntary medical male circumcision programme (VMMC), which aims to reach about 4.2 million men by 2015. Mwidu has circumcised some 13,000 men, or about 3 percent of the 418,223 Ugandans who have received VMMC services to date. Circumcising men makes him happy, Mwidu told New Vision, because “I feel like I’m directly contributing to the fight against HIV” (New Vision, 21 November 2013).
POZ analyzes circumcision debates
Major studies support male circumcision as HIV prevention in Africa, but a small yet vocal group argues the science is flawed, POZ Magazine reports. The article analyzes the arguments in this debate, quoting proponents and opponents of male circumcision for HIV prevention and providing links to publications written from both points of view (POZ Magazine, October 2013).
Safer traditional male circumcision promoted
Provincial health authorities in South Africa’s Western Cape will provide sterile male circumcision kits to traditional circumcisers, reports IOL News. Under an agreement signed by the province’s health minister and the traditional leader of the greater Robinson area, initiates are to be circumcised in a more sterile environment and receive health support services, such as post-operative and HIV counseling. The agreement is designed to support safer traditional circumcision while respecting the initiation process. It applies only to the greater Robinson area, but the provincial health minister said it was “a forerunner” of agreements with traditional leaders in other parts of the province (IOL News, 23 September 2013).
Community-based study shows impact
A male circumcision programme in South Africa was associated with a community-wide reduction in HIV prevalence, Medpage Today reports. A study conducted in Orange Farm from 2007 to 2011 found that in the first three years of the programme, the percentage of men who were circumcised rose from 12 percent to 53 percent. Without these circumcisions, the researchers estimate, HIV prevalence would have been 19 percent higher in Orange Farm, site of an earlier clinical trial of male circumcision for HIV prevention. This follow-up study of male circumcision’s impact in a “real-world” setting also found no evidence that male circumcision was accompanied by an increase in risky sexual behavior, such as not using a condom or having multiple partners (Medpage Today, 7 September 2013).
Male circumcision findings reported at conference
Three studies on voluntary medical male circumcision (VMMC) were presented at the 6th South African AIDS Conference, reports the Aidsmap newsletter HIV & AIDS Treatment and Practice. One study examined the sexual practices of circumcised men after the procedure, another compared the outcomes of VMMC for HIV-positive and HIV-negative men, and a third found high acceptance of VMMC among secondary school students. The first study found that 76 percent of the circumcised men observed the recommended six weeks of sexual abstinence during wound healing. Reported condom use during last sex declined from almost 66 percent before male circumcision to 52 percent 12 months after the procedure. In the second study, none of the HIV-positive men developed wound infections after circumcision, but five of 648 HIV-negative men did (HIV & AIDS Treatment and Practice, 9 September 2013).
Male circumcision uptake rises in Zimbabwe
More than 50,000 men were circumcised in Zimbabwe during the first half of this year, surpassing the total number of men reached in 2012, NAM News Network reports. The country’s voluntary medical male circumcision (VMMC) programme, which aims to reach 1.3 million men by 2017, circumcised 11,000 men in 2010, 36,000 in 2011, and 40,000 last year. The article quotes Brian Nachipo, AIDS and TB Unit advocacy and communications officer, saying that after reaching 50,348 men in the first six months of 2013, the VMMC programme “has since continued to witness an increase in males circumcised as more doctors, nurses, and other team members are trained to provide safe medical services” (NAM News Network, 5 September 2013).
Regulation of traditional circumcision urged
Medical methods of male circumcision should be integrated with traditional practices, advocates an editorial in South Africa’s Mail & Guardian. Noting that traditional circumcision has caused almost 100 deaths this past initiation season and left other boys without penises or with mutilated penises, the editorial says that “the ceremony that was supposed to give them manhood has, in fact, deprived them of it.” Based on an article about the dangers of traditional circumcision in South Africa, the editorial also calls for training and regulation of traditional circumcisers. It recommends using the health department’s medical circumcision programme as a resource for initiation schools (Mail & Guardian, August 2013).
Review examines sex after male circumcision
A review found that the most rigorous studies of the effects of male circumcision on sex show no adverse impact on male sexual function, sensitivity, sexual sensation, or satisfaction, reports The Daily Telegraph. The researchers identified 2,675 articles on the subject, but only 36 met the study criteria of presenting original data. Of the 36, the 23 rated as high-quality or well-conducted studies (according to the Scottish Intercollegiate Guidelines Network grading system) uniformly found no adverse effects; 10 of the 13 low-quality studies reported a negative effect on one or more measures of sexual function or satisfaction. In the highest-quality studies, however, most men who had been circumcised as adults reported that sex was more enjoyable after circumcision (The Daily Telegraph [Australia], 15 August 2013).
Chief champions male circumcision
Risking impeachment by members of his tribe, a Zambian chief became circumcised at age 47 after learning of the health benefits of the procedure, The Washington Post reports. Chief Jonathan Eshiloni Mumena is one of a growing number of men getting circumcised in Zambia, where 17 percent of adults are infected with HIV. His tribe does not traditionally circumcise young men, so the chief was surprised when his son declared that he planned to go for the procedure. Now the chief, who is also a lay preacher, has become an advocate for medical male circumcision (The Washington Post, 2 August 2013).
Male circumcision acceptable in Papua New Guinea
A significant number of men in Papua New Guinea (PNG) are willing to be circumcised once they learn that the procedure can reduce the risk of HIV infection, reports IRIN. Complete male circumcision is uncommon in PNG, but almost half the men there have undergone some type of penile cutting. (It is unknown whether partial removal of the foreskin protects against HIV.) A survey of 860 men found that 71 percent of those with no penile cut would get circumcised if it reduced their risk of HIV, as would 84 percent of those who had already had their penises partially cut. In another study, men cited four main reasons for agreeing to be circumcised: prevention of HIV and sexually transmitted infections, improved penile health and hygiene, cultural acceptance, and increased sexual pleasure (IRIN, 22 July 2013).
Save the date: Devices for Adult Medical Male Circumcision for HIV Prevention: What's the Current Situation? What's Next?'
Hosted by PEPFAR, this webinar is the third in a series of five focused on VMMC. The webinar will be hosted from 8:00–10:00 a.m. US EDT on 21 August.
To join, click here, enter your name as a GUEST and type the pasword 1776. For more information, For more information, contact Emmanuel Njeuhmeli at or Tigistu Adamu Ashengo.
Uganda to launch national programme
The Ugandan government will begin a nationwide male circumcision programme in July as part of its HIV prevention strategy, reports IRIN news service. Dr Alex Opio, assistant commissioner for health services in the Ministry of Health, told IRIN that male circumcision will be available in national referral hospitals, district hospitals, and county-level health centres that have the capacity to conduct minor surgeries. He added that male circumcision is not a “magic bullet,” but an additional tool in the country’s prevention arsenal. The government started drafting its male circumcision policy in 2008 and says it now has the funding and plans in place to begin the programme (IRIN, 29 June 2013).
South Africa to pilot PrePex
The South African health department will consult with traditional leaders about the possibility of training traditional circumcisers to use PrePex, a device for performing male circumcision that was recently “prequalified” by the World Health Organization, reports the Mail & Guardian. The government seeks to make traditional circumcision safer following the deaths of 35 boys in one month after they were circumcised during initiation ceremonies. The health department will also test the feasibility of introducing the device as part of its medical circumcision campaign, with eight pilot sites offering the option of PrePex-assisted circumcision or conventional surgery set to launch in Gauteng, Mpumalanga, and North West provinces in the next two months (Mail & Guardian, 18 June 2013).
Male circumcision and sexual function
Male circumcision is unlikely to have an adverse effect on men’s sexual function, concludes a study published online 10 June 2013 in the Asian Journal of Andrology. Researchers from Sichuan University conducted a meta-analysis of 10 studies that described a total of 9,317 circumcised men and 9,423 uncircumcised men who were evaluated for an association between male circumcision and sexual function. There were no statistically significant differences between the two groups in sexual desire, pain during intercourse, premature ejaculation, erectile dysfunction, or difficulties achieving orgasm. The authors caution, however, that well-designed prospective studies are needed to better understand this topic.
PrePex studies continue
The World Health Organization announced on 31 May that it has “prequalified” the PrePex device for performing circumcision on adult men, but safety and acceptability studies of the device continue because prequalification does not replace countries’ own regulatory processes, reports Africa Science News. The article quotes Dr. Walter Obiero, Nyanza Reproductive Health Society director, who is a co-investigator on a PrePex implementation study his organization is conducting with the Male Circumcision Consortium and the National AIDS and STD Control Programme in Kenya’s Nyanza Province. Dr. Obiero says this research will provide the information the Ministry of Health needs to decide whether to add PrePex to the national voluntary medical male circumcision programme (Africa Science News, 9 June 2013).
Join AVAC's 11 June Webinar on Non-surgical Devices
Please join AVAC for a global advocates’ webinar on VMMC devices Tuesday, 11 June at 10am US Eastern time (4pm Johannesburg / 5pm Nairobi time) and discussion of the recent news that the WHO prequalified the PrePex device. This webinar, "VMMC Non-Surgical Devices: WHO pre-qualification and beyond," is designed to help advocates understand the pre-qualification process, recent events and next steps for rollout. It will include brief presentations followed by a moderated discussion.
Advance questions are welcome at firstname.lastname@example.org.
PrePex first device to “prequalify”
The World Health Organization has “prequalified” a device for performing circumcision for adult men based on a review that included studies conducted in Rwanda, Uganda and Zambia, reports the Science Speaks blog. PrePex™ became the first such device to achieve prequalification, which indicates that the device meets international standards but does not replace countries’ own regulatory processes. A statement from the U.S. Office of the Global AIDS Coordinator announced that the President’s Emergency Plan for AIDS Relief (PEPFAR) will provide immediate support to help countries evaluate the device for their local settings (Science Speaks, 31 May 2013). For information about the prequalification process and the status of pre-qualification applications for PrePex and other male circumcision devices, click here.
Study may help explain protective effect
Changes in the bacteria living on and around the penis may be partly responsible for male circumcision’s protective effect against HIV infection, a study suggests. Scientists conducted a detailed genetic analysis of the microbial inhabitants of the coronal sulcus, the groove behind the head of the penis, among a group of Ugandan men ages 15 to 49 years who participated in a randomised clinical trial of male circumcision for HIV prevention. After 12 months, the circumcised men harbored dramatically fewer bacteria that survive in low-oxygen conditions compared to the uncircumcised men. The researchers suspect that in uncircumcised men, these anaerobic bacteria may provoke an inflammatory response that favors HIV infection. In an article published in the journal mBio, they call for more research to understand how reductions in anaerobic bacteria may contribute to the reduced risk of HIV acquisition conferred by male circumcision (Los Angeles Times, 15 April 2013).
Campaign aims to reach university students
The University of KwaZulu-Natal has launched a medical male circumcision campaign to inform students about the benefits of male circumcision and behaviours that promote good sexual health, SABC News reports. A provincial health official performed two male circumcisions to mark the launch of the programme. Saying that he is circumcised, he urged other men to go for the procedure. The university’s HIV/AIDS programme coordinator said that the campaign also includes HIV testing and counselling and information about how to practice safe, healthy sex (SABC News, 11 April 2013).
Youth respond to Malawi campaign
While the voluntary medical male circumcision (VMMC) programme in Malawi aims to reach men ages 15 to 49, most of its clients have been 15 to 25 years of age, Capital FM of Malawi reports. PSI has established VMMC clinics in government health centres in Blantyre and Thyolo districts and hopes to provide VMMC services to 16,500 men ages 15 to 49 by September of this year. At one of the clinics, PSI had to erect tents and bring in more surgeons to meet a demand of more than 50 clients per day. Factors contributing to the age discrepancy have yet to be elucidated (Capital FM, 9 April 2013).
Why adults seek or avoid male circumcision
A perception that male circumcision is inappropriate after puberty, and particularly after marriage, may keep men from going for the procedure, suggests a study involving 16 focus group discussions with 142 men and women in Iringa and Njombe, Tanzania. Reaching men 20 years and older is a priority for Tanzania’s programme, but 85 percent of the 110,000 men circumcised in these regions were ages 10 to 19. Other barriers to circumcision among men older than 19 included being ashamed to seek services in facilities also serving boys, concerns about marital infidelity during the post-operative period of sexual abstinence and loss of income, and fear of pain associated with post-surgical erections. But male circumcision is viewed as a desirable procedure. Factors encouraging men to get circumcised include awareness of its HIV-prevention benefit and perceptions of cleanliness and enhanced attractiveness to women (Global Health: Science and Practice, 21 March 2013).
PrePex study launched in Kenya
A study in Kenya is the first to assess the safety and acceptability of the PrePex device for performing adult male circumcisions in routine health care settings, Jaluo.com reports. Launched by the National AIDS/STI Control Programme (NASCOP) and the Male Circumcision Consortium, the study will enroll 425 men ages 18 to 49 who seek VMMC services. “Our study will provide the information that the Ministry of Public Health and Sanitation needs to decide whether to add PrePex to the national programme on voluntary medical male circumcision,” says Dr. Peter Cherutich, NASCOP director for HIV prevention and co-investigator for the study (Jaluo.com, 22 February 2013).
Scale-up slow despite health benefits
Progress toward increased prevalence of voluntary medical male circumcision (VMMC) in sub-Saharan Africa remains slow, reports an Aidsmap article about presentations given at two sessions of the 20th Conference on Retroviruses and Opportunistic Infections (CROI 2013) on 4 March. This slow pace is due as much to men’s concerns about the procedure as it is to resource constraints, despite low rates of complications of VMMC. Links are provided to abstracts presented at the sessions, including ones on the cost-effectiveness of VMMC, its health benefits to women in Rakai, Uganda, and the safety of the procedure in Nyanza, Kenya (Aidsmap, 7 March 2013).
Services expand access to STI screening
Voluntary medical male circumcision services (VMMC) services offer an opportunity to diagnose and treat or refer clients with HIV and other sexually transmitted infections, write the authors of an abstract presented at the 20th Conference on Retroviruses and Opportunistic Infections (CROI 2013) on 4 March. A review of data on 33,854 clients ages 15 and older who sought VMMC services in Tanzania’s Iringa and Tabora regions found that 1.37 percent tested positive for HIV. The prevalence of all STIs was 1.66 percent, including 1,296 confirmed cases of HIV and 310 cases of other STIs. Almost three-quarters of the STI clients were self-referred to VMMC services, and none had been referred by STI clinics.
Infant male circumcision in Botswana
Ninety-three percent of 547 mothers surveyed at three Botswana maternity wards said they wanted their newborn sons circumcised, but only 55 percent (302) took their sons to have the procedure, researchers reported in an abstract presented at the 20th Conference on Retroviruses and Opportunistic Infections (CROI 2013) on 4 March. Mothers who said that they made the decision alone were more likely to have their sons circumcised; conversely, infant sons were less likely to get circumcised if their fathers made the decision. The researchers concluded that education about infant male circumcision should be directed toward mothers, fathers, and maternal grandmothers, who are all likely to participate in decision-making about the procedure.
Canadian paediatricians to change policy
The Canadian Paediatric Society is poised to change its policy on infant male circumcision, based on recent evidence of health benefits, the Ottawa Citizen reports. The current policy, issued in 1996, opposes routine circumcision of newborns. The new statement is expected to be more neutral, balancing the “potential role of the avoidance of infection" against the risks of a surgical procedure. A new study suggests that half of expectant parents in Canada would consider circumcision if they had a son and the single most important factor in that decision is whether the father is circumcised (Ottawa Citizen, 4 March 2013).
PEPFAR Webinar, March 19
A webinar about voluntary medical male circumcision (VMMC) by the President's Emergency Plan For AIDS Relief (PEPFAR) will include discussion of PEPFAR technical considerations and revised VMMC indicators, data quality assessment and reporting, continuous quality improvement, and external quality assessment. This session will be the first of a series of PEPFAR VMMC webinars.
When: March 19, all day
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Results of device trial promising
A randomised trial in Rwanda found that male circumcision was performed much faster with the PrePex device, but the healing time was longer, the International AIDS Society reports. The trial among 217 men compared male circumcision performed with Prepex, a procedure that does not require stitches, with conventional male circumcision surgery. The average time to complete the procedure was 3.1 minutes with PrePex, compared to an average of 15.4 minutes for traditional surgery; time to complete healing was seven days longer for PrePex-assisted surgery. The reported rate of complications with PrePex was 2.7 percent. In an article in the Journal of Acquired Immune Deficiency Syndromes, the authors conclude that PrePex takes significantly less time than conventional surgery, is safe and bloodless, and seems suitable for nurses to perform.
Evidence favors infant male circumcision
The benefits of infant male circumcision (IMC) outweigh the risks, and the procedure should be available to families who choose to circumcise their sons, a group of US pediatricians has concluded. Previously the American Association of Pediatricians had taken a neutral stance towards IMC. The updated policy, published 27 August in the journal Pediatrics, is based on a review ofrecent evidence on the benefits of IMC. Voice of America reports that the policy does not recommend routine circumcision of infant boys, but it does say that health insurance should cover the procedure. A study published in the Archives of Pediatrics and Adolescent Medicine estimates that in the United States, a 20-year decline in the prevalence of IMC from 79 percent to 55 percent — which has coincided with decreased insurance coverage for the procedure — has already cost up to $2 billion in health care costs (VOA, 29 August 2012).
Criticisms of trials refuted
The scientific evidence of male circumcision’s protective effect against male-to-female transmission of HIV is “solid, consistent and beyond a reasonable doubt,” experts from leading universities and other institutions conclude in an article published in the Australian.Journal of Law and Medicine. The authors provide a comprehensive overview of the evidence that male circumcision reduces men’s risk of acquiring HIV through vaginal sex by about 60 percent. Aiming to “put science back at the core of the debate,” they also evaluate each claim made in an article published in JLM in December, demonstrating how its authors used flawed statistical analyses, outmoded evidence, selective reporting of studies, data from non-peer-reviewed sources and misleading statements to question the effectiveness of male circumcision for HIV prevention (JLM, 5 September 2012).
Taking services to the streets
Rather than wait for clients to come to their clinics, providers of voluntary medical male circumcision have taken their services to the streets of Nairobi. The providers say that pitching tents in the central business district of Kenya’s capital each day has enabled them to serve men who otherwise would not have been reached. The large tents serve as health information and counseling centers for men and women; men who decide to get circumcised are referred to a nearby clinic. In the first three months, 1,000 men who accessed services through the information tents became circumcised (Coastweek,30 August 2012).
Musician advocates for male circumcision
One of Zimbabwe’s most influential musicians has joined a campaign to encourage men to get circumcised to prevent HIV infection, New Zimbabwe reports. Musician Oliver Mtukudzi became an advocate for HIV prevention after the AIDS-related deaths of four members of his band, including his younger brother, in 1996. In an interview before a concert in London, he hailed the success of Zimbabwe’s efforts to reduce HIV transmission but said more needs to be done. “If we are to have an HIV-free generation, it has to start with this generation,” he said (New Zimbabwe, 16 August 2012).
Male circumcision a PEPFAR priority
President Barack Obama has committed the US President’s Emergency Plan for AIDS Relief (PEPFAR) to providing 4.7 million men and boys with voluntary medical male circumcision (VMMC) by 2014, according to an article published in the 15 August supplement to the Journal of Acquired Immune Deficiency Syndromes. The article summarises the scientific evidence for male circumcision for HIV prevention, describes the public health benefits of expanding access to VMMC services, and reviews progress to date, presenting Kenya’s programme as a case study of successful scale-up. The challenges faced in scaling-up VMMC are greatly outweighed by the benefits of its impact on the HIV epidemic, the authors conclude.
Protective effect sustained
Study results from South Africa and Kenya presented at the AIDS 2012 conference on 24 July offer further evidence of the protective effect of male circumcision against HIV infection. In Orange Farm, South Africa, an increase in the prevalence of male circumcision from 17 percent to 54 percent coincided with a drop in HIV prevalence from 15.4 percent to 12.3 percent. Providing free voluntary medical male circumcision along with condoms and counseling about the need for circumcised men and their partners to continue taking precautions against HIV infection prevented an estimated 1,040 HIV infections in the township from 2008 to 2011. In Kenya, continued follow-up of 1,500 men who had participated in the randomised controlled trial of male circumcision in Kisumu revealed that getting circumcised reduced men’s risk of acquiring HIV by more than half after five-and-a-half years. The article notes that male circumcision offers men partial, but not complete, protection from HIV (ScienceNews, 25 July 2012).
South Africans embrace HIV prevention measures
More South Africans are getting tested for HIV, using condoms and becoming circumcised, the National HIV Communication Survey has revealed. The survey found that more than half of South African men are circumcised, and almost 1 million men were considering getting the procedure done in the next year to help protect themselves from HIV. In a telephone interview, Health Minister Aaron Motsoaledi said that skeptics had feared that promoting male circumcision would reduce condom use. “Eight-five percent of men who are circumcised know they must use condoms, which shows that fear was misplaced," he said (BusinessDay, 25 July 2012).
Chief champions male circumcision
Shocked at first when his son said he wanted to get circumcised, the chief of a non-circumcising clan in Zambia learned about the benefits of the procedure and risked community censure by agreeing to his son’s request. Chief Jonathan Mumena then decided to get circumcised himself, to serve as an example to his people, and he has worked with health centres to mobilise hundreds of men in his chiefdom to seek voluntary male circumcision services. “Culture is very important, but the number one priority is to keep our people healthy and alive,” he says (Mail & Guardian, 20 July 2012).
Zimbabwean MPs to be circumcised
25 June update!
Zimbabwe MPs Get Circumcised, Tested for HIV
A total of 106 members of Parliament were tested for HIV and more than 40 male MPs were circumcised in an HIV prevention initiative among lawmakers and high-ranking government officials that was the first of its kind in Africa. After receiving HIV counseling and testing at a mobile clinic in Harare, the deputy prime minister, speaker of the House of Assembly and seven MPs revealed that they had tested negative for HIV prevention. Speaker Lovemore Moyo that said by going public about their testing and circumcision, the lawmakers were "leading by example." Several officials discussed the experience and urged others to come forward for HIV testing and male circumcision (Newsday [Zimbabwe], 25 June 2012, AFP, 23 June 2012).
Friday, 22 June 2012 — Male members of Zimbabwe’s Parliament are getting counseled, tested for HIV and circumcised at a temporary clinic set up in the Parliament House in Harare, the BBC News reports. About 120 men from the 175-member body are expected to receive these services to set a public example and reduce their risk of HIV infection. In May The Telegraph (UK) reported that the MPs had formed a group, Zimbabwe Parliamentarians against HIV and AIDS, and they planned to disseminate information about HIV to their constituents in an effort to reduce the country’s 15 percent HIV prevalence rate (BBC News, 22 June 2012; The Telegraph, 20 May 2012).
Botswana’s new pitch for male circumcision
Botswana’s government has enlisted the help of popular musicians and has launched an advertising campaign touting the benefits of safe male circumcision, AFP reports. In the past three years the country’s male circumcision programme has circumcised only 7 percent of the 460,000 men it aims to reach. Male circumcision programmes in other countries in southern Africa, the region hardest hit by HIV, are also falling short of their goals. The article notes that Botswana has no tradition of male circumcision, “giving the government a tough sales pitch — even for a procedure done with local anesthetic, taking only a few minutes and requiring only a few days recovery.” Popular musicians Odirile Vee Sento and Oliver Mtukudzi have teamed up to compose a song in English about male circumcision that is being broadcast across southern Africa (AFP, 14 May 2012).
Safety assessed in rural outreach settings
A study of male circumcision performed at Marie Stopes International mobile outreach sites in Kenya’s Nyanza and Western Provinces in 2008 found low rates of complications and high rates of client satisfaction. A total of 240 men and boys were circumcised over three months by registered nurses, surgical technicians, or nurse aides. Complications occurred in just three (1.3 percent) of the 240 procedures. At the follow-up visits on days three and seven, more than 91 percent of clients were capable of resuming their daily activities; by day 30, all could do so. The majority of patients (99 percent) reported being satisfied with the procedure, counseling, and information received. “Male circumcisions can be delivered safely and successfully by mid-level providers in rural settings with high client satisfaction, thereby increasing access to HIV prevention services” the authors concluded (HIV AIDS [Auckl.], 10 April 2012).