In the News
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).
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 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 inThe 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).
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).
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).