The Zambian government aims to circumcise 360,000 men and boys in 2019 as one of its interventions to reduce HIV infections, Zambian Eye reports. Speaking in Muchinga Province’s Chinsali District at the launch of an April campaign to promote voluntary medical male circumcision (VMMC), the province’s assistant secretary said VMMC is a cost-effective HIV prevention intervention. He called for market-oriented campaigns that address the factors that deter men from getting circumcised, such as fear of pain, perceived low risk of HIV, lack of partner or social support, and preference for traditional rites of passage. More than 2 million men and boys have been circumcised in Zambia since the VMMC programme began in 2007 (Zambian Eye, 2 April 2019).
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Zimbabwe’s national voluntary medical male circumcision (VMMC) programme circumcised more than 326,000 men and boys last year, meeting 90 percent of its goal of 350,000 VMMCs for 2018, reports Zimbabwe Daily. The health ministry’s VMMC director reported this progress at a meeting held to review the country’s new two-year VMMC strategy. He noted that the VMMC programme, which reached only about 2,000 clients annually in its early years, has been scaled up and has now circumcised a total of 1.4 million men and boys. Under the new strategy, the government aims to take over and decentralise the programme, which has largely been funded by donors (Zimbabwe Daily, 23 March 2019).
Providing door-to-door HIV testing and linkages to HIV care, treatment, and prevention services substantially reduced new HIV infections in a study involving more than 1 million people in Zambia and KwaZulu-Natal, South Africa, Aidsmap reports. The results of PopART, a community-randomised trial also known as HPTN 071, were presented at the 2019 Conference on Retroviruses and Opportunistic Infections (CROI 2019). In the study, the communities randomly assigned to receive door-to-door HIV testing and referrals to HIV treatment according to national guidelines had a 30 percent lower HIV incidence compared to those assigned to receive regular health services. The comprehensive HIV prevention services provided in the intervention communities also included support for adherence to antiretroviral treatment, retention in care, HIV prevention, screening for sexually transmitted infections, tuberculosis screening, and voluntary medical male circumcision (Aidsmap, 6 March 2019).
Findings on the impact of antiretroviral therapy and voluntary medical male circumcision (VMMC) on the rate of new HIV infections in Western Kenya were examined in a themed discussion and a poster presentation at the Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle, Washington, from 4–7 March 2019. Another poster presentation summarised the achievements of and gaps in the VMMC scale-up in Swaziland. Links to the abstracts of these presentations are available here.
A systematic review of 81 peer-reviewed studies and abstracts, published 31 January 2019 in Frontiers in Public Health, provides evidence that male circumcision is a powerful tool to reduce women’s risk of cervical cancer and several sexually transmitted infections (STIs). The researchers found that data from randomised controlled trials and other studies confirm that having a circumcised partner reduces a woman’s risk of cancer-causing types of human papillomavirus, Trichomonas vaginalis, bacterial vaginosis, and possibly genital ulcer disease; male circumcision did not protect against gonorrhea, and the evidence was mixed for other STIs. Co-author John Krieger, professor emeritus at the University of Washington, warns in a blog post that the declining prevalence of male circumcision could lead to global increases in cervical cancer (Postscript, 1 March 2019).
Voluntary medical male circumcision (VMMC) and an annual HIV test are the only regular health services recommended for men in Malawi, while women of childbearing age are advised to visit clinics dozens of times a year for family planning, maternal health, and other services, a study has found. An analysis of the study, originally published in The Conversation Africa, notes that the unintended consequences of focusing preventive health care on women can detract from gender equality for women as well as men’s health. They recommend revising health service guidelines to reduce the time burden placed on women and to include a focus on men’s health (AllAfrica, 19 February 2019).
Despite circumcising 2 million men and boys since 2010, Uganda has fallen short of its goals for safe male circumcision (SMC), Global Press Journal reports. The country’s policy, adopted in 2010, aimed to provide SMC services to 4.2 million men and boys ages 15 to 49 by 2016. Ugandans working on SMC who are quoted in the article attribute the shortfall to misconceptions about the procedure and reduced funding for SMC programmes. As funding has declined, programmes have begun to charge for SMC services; the article cites fees ranging from 10,000 to 50,000 shillings (US $2.66 to $13.30) and higher (Global Press Journal, 26 November 2018 ).
Voluntary medical male circumcision (VMMC) is part of a national strategy to reduce the annual number of new HIV infections among adults in Kenya by 75 percent in 2019, Xinhua reports. A new report from the National AIDS Control Council describes how Kenya will use a combination of interventions, including antiretroviral treatment, pre-exposure prophylaxis, and VMMC, to achieve that goal. The government also aims to increase domestic financing to cover 50 percent of the cost of the national response to HIV. Kenya’s VMMC programme surpassed its goal in 2017, when 239,001 men and boys opted to get circumcised (Xinhua, 24 November 2018).
Two young men in Namibia are posting videos of their experiences with voluntary medical male circumcision (VMMC) as part of a social media campaign to encourage men to get circumcised, New Era Live reports. Using the hashtag #doitwithafriend and posting on Facebook and other platforms videos that will follow the men through the six-week healing period, the campaign will address some of the fears and misconceptions that uncircumcised men have about VMMC. The national strategy aims to reach 80 percent of, or 300,000, men and boys ages 10 to 49 with VMMC services by 2021 (New Era Live, 19 November 2018).
A mobile clinic launched to increase access to voluntary medical male circumcision (VMMC) in Cape Town, South Africa, will be able to provide up to 40 male circumcisions a day, Times Live reports. A joint initiative of the Western Cape Department of Health and the nonprofit organisation Jhpiego, the mobile clinic will also provide screening for HIV and prostate cancer. Its launch was timed to coincide with the “Movember” moustache-growing campaign that raises awareness of men’s health issues, particularly cancer. The launch event featured a DJ, an exhibition by a stunt car driver, gaming stations, and an appearance by an actor who serves as champion for VMMC by speaking publicly about his own decision to get circumcised (Times Live, 15 November 2018).
The acceptability and uptake of voluntary medical male circumcision (VMMC) and its role in encouraging HIV testing were among the topics examined in five posters presented at the HIV Research for Prevention conference in Madrid from 21-25 October 2018. A schedule and links to the conference programme are available here.
Photo credit: HIVR4P/Leon Gutierrez
The US President’s Emergency Fund for AIDS Relief (PEPFAR) supported the voluntary medical male circumcisions (VMMCs) of more than 15 million men and boys in 14 countries in sub-Saharan Africa from 2007 to 2017, Aidsmap reports. The article, which summarises a paper published in BMJ Open, also cites a World Health Organization estimate that the 15,269,720 PEPFAR-supported VMMCs represent 84 percent of all the VMMCs performed in the 14 countries. The programme originally prioritised men and teenage boys ages 15 to 29, but in 2017, 48 percent of VMMC clients were ages 15 to 29 and almost as many — 45 percent — were ages 10 to 14. The authors of the BMJ Open article conclude that although the VMMC programme has achieved rapid scale-up, new approaches may be needed to meet the UNAIDS goal for 2020, which is reaching an additional 25 million men and boys (Aidsmap, 26 September 2018).
Ten lessons learned during the scale-up of voluntary medical male circumcision (VMMC) could help speed expanded access to oral pre-exposure prophylaxis (PrEP) for HIV prevention, write the authors of an article published in the International Journal of STDs & AIDS. Noting that efforts to scale up VMMC and oral PrEP services face many of the same challenges, the authors outline lessons from VMMC programmes and explain how they could be applied to oral PrEP rollout. The challenges addressed in these lessons include local ownership, demand creation, safety surveillance, complex supply chains, sustainability, and leveraging programs as gateways for other services (Journal of STDs & AIDS, 16 August 2018).
Voluntary medical male circumcision (VMMC) for HIV prevention was highlighted in three presentations and 32 posters at the 22nd International AIDS Conference (AIDS 2018) in Amsterdam from 23 to 27 July 2018. For a schedule of the VMMC presentations and links to summaries of the abstracts, click here.
Two million men and boys have been circumcised in Zambia since the government’s voluntary medical male circumcision (VMMC) programme began in 2007, the Lusaka Times reports. In a speech read at the 3 August launch of a national VMMC campaign, a Ministry of Health official said that the 170,000 VMMCs performed this year as of 30 June represent 44 percent of the goal of 400,000 for 2018. He added that the VMMCs performed in Zambia so far have prevented about 17,000 new HIV infections; by meeting its goals for VMMC, the programme can avert an estimated 225,000 new HIV infections by 2030 (Lusaka Times, 3 August 2018).