An opportunity and a challenge
Advocacy groups have reacted to the finding 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 in HIV prevention, expand couples counselling, and build or strengthen programmes that seek to transform sexual and gender norms. Historically, it has been difficult to bring men into health services for HIV education and frank conversations about 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 is critical that voluntary medical 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 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. Community groups working on HIV/AIDS prevention, treatment, and care 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 men's sexuality. This work is closely linked to other ongoing efforts to expand the resources available for combination prevention and to increase access to HIV testing, pre-exposure prophylaxis, and treatment.