Voluntary medical male circumcision is widely recognised as an important and effective HIV prevention tool. Because HIV prevalence and male circumcision rates vary, policy-makers who wish to establish or scale up male circumcision services should first examine the evidence and assess the unique needs of their regional and/or national populations. Although creating a national policy on male circumcision is often an important step toward strengthening service delivery, a national plan is not critical as long as male circumcision services are broadly accessible and service guidelines are established.
Most of the priority countries in eastern and southern Africa have rolled out national policies or similar guidance to ensure that male circumcision is addressed within their comprehensive HIV prevention strategies. Fortunately, a growing number of tools are available for policy-makers, programme implementers, and those involved in planning and executing programmes that offer male circumcision as an HIV risk-reduction strategy. Some of the tools are described here. (Please contact us if there is a tool or guideline you cannot find but would like to access on this site.)
National policies on male circumcision
Since WHO’s 2007 announcement recognizing male circumcision as an important intervention to reduce the risk of heterosexually acquired HIV infection in men, several countries have formed national policies or guidance on male circumcision for HIV prevention. Although not every country has formed a national policy, health officials in many nations have created strategies that include male circumcision as one preventive measure in the fight against HIV/AIDS. Visit the country updates page to learn more.
Policies and programme guidance
Joint Strategic Action Framework to Accelerate the Scale-Up of Voluntary Medical Male Circumcision for HIV Prevention in Eastern and Southern Africa (2011, PDF, 257 KB) articulates a joint five-year framework for use among Ministries of Health and diverse country, regional and global stakeholders to accelerate the scale-up of voluntary medical male circumcision (VMMC) for HIV prevention in selected priority countries of eastern and southern Africa. It is intended to guide key stakeholders to collaborate and coordinate efforts for promoting country ownership, expanding coverage of this effective HIV prevention intervention, and contributing to “getting to zero” new infections.
Safe, Voluntary, Informed Male Circumcision and Comprehensive HIV Prevention Programming: Guidance for Decision-makers on Human Rights, Ethical and Legal Considerations (2008, PDF, 1.20 MB) provides guidance on the human rights, legal and ethical issues that decision makers may need to consider when they are deciding whether or not to initiate or expand male circumcision services in the context of comprehensive HIV programming.
WHO/UNAIDS' New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications (2007, PDF, 1.1 MB) provides guidance to policy makers and programme managers on what issues need to be considered and addressed when planning for programme scale-up. In March 2007, WHO/UNAIDS convened an international consultation including policy makers, programme managers, researchers, and AIDS and women's health advocates to examine the results of the three male circumcision clinical trials and other evidence and to determine the policy and programme implications. The participatory process ensured that the 11 conclusions and recommendations that were made covered critical issues such as partial protection, human rights, culture, communication, discrimination, gender, risk compensation, health systems constraints, and further research that needs to be done.
You may also read a summary version (2009, PPT, 89 KB) or full version (2009, PPT, 110 KB) of presentation material on New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications.
Monitoring and evaluation
Adverse Event Action Guide for Voluntary Medical Male Circumcision by Surgery, 2014 (2014, PDF, 476 KB). A collaborative work between Population Services International (PSI) and the College of Surgeons of East, Central and Southern Africa (COSECSA), together with contributions from numerous clinical and public health experts, this Guide is intended for use by programmes that are implementing VMMC under local anaesthesia in adolescent and adult males as part of a comprehensive HIV prevention
strategy. The Guide is meant to be used by providers of VMMC services, including those who conduct post-operative reviews of clients but do
not provide initial VMMC surgery.
SYMMACS, the Systematic Monitoring of the Male Circumcision Scale-up in Eastern and Southern Africa: Final Report of Results from Kenya , South Africa , Tanzania and Zimbabwe (2013, PDF, 1.65 MB). SYMMACS, the Systematic Monitoring of the Voluntary Medical Male Circumcision Scale-up, is the first systematic assessment of quality of services, surgical efficiencies, provider performance, and related aspects of VMMC service delivery in four countries: Kenya, South Africa, Tanzania, and Zimbabwe. This multi-country cross-sectional study, conducted in both 2011 and 2012, has identified strengths of these programs and areas for improvement, which have informed programming in all four countries. This report is also available on the Research to Prevention website.
The PEPFAR Guide to Monitoring & Reporting Voluntary Medical Male Circumcision (VMMC) Indicators (2013, PDF, 765 KB) and its accompanying appendices (1.30 MB) were developed as a resource for partners implementing VMMC programmes supported by the US President's Emergency Fund for AIDS Relief (PEPFAR), but they may also be useful to others seeking to improve the monitoring of VMMC services. Topics addressed include the PEPFAR VMMC indicators, target-setting, data collection and use, data tools and reporting systems, data quality assurance, and capacity-building. Sample forms are provided to help guide the collection and reporting of VMMC data.
A Guide to Indicators for Male Circumcision Programmes in the Formal Health Care System (2010, PDF, 1.53 MB) examines objectives common to all male circumcision programmes and presents indicators that programmes can use to monitor and evaluate progress toward achieving those objectives. Adaptable to different country situations, the guide includes indicators for the creation of demand for, and supply of, male circumcision services, as well as the maximisation of safer sex behaviour. Users are assumed to have prior knowledge of monitoring and evaluation and to know, for example, how to measure male circumcision status, but the guide provides extensive references to help users develop their understanding of such issues.
Strategic and operational planning
Developing a national strategy for scale-up, with a clear operational plan, is important because it serves as a means to coordinate efforts, work efficiently, and mobilize the necessary resources. A national strategy helps guide implementation and facilitates communication with stakeholders at various levels.
Operational Guidance for Scaling up Male Circumcision Services for HIV Prevention (2008, PDF, 837 KB) provides practical guidance to help operationalise the scale-up of male circumcision services efficiently and effectively. It also explains why communication at high levels is necessary to support advocacy efforts and to provide decision-makers and the general population with accurate information about male circumcision.
Male circumcision devices
Framework for Clinical Evaluation of Devices for Male Circumcision (2012, PDF, 345 KB)
Male circumcision devices have the potential to accelerate delivery of male circumcision programmes in resource-limited settings by reducing the time to perform the operation, by simplifying the procedure so that providers can perform it more easily and in some circumstances by making the procedure more acceptable to clients than a surgical approach. Devices are widely used for circumcision in infants and young boys, but experience in post-pubertal boys and adults is limited, particularly in the countries in the African region where rapid expansion of male circumcision programmes for HIV prevention is most urgent.The framework
focuses mainly on clinical requirements for assessing the suitability of a device for male circumcision within public health HIV prevention programmes in resource-limited settings and, secondarily, on regulatory and manufacturing considerations.
AIDSTAR-One HIV Prevention Knowledge Base Topic on VMMC