Adolescent girls play an important role in influencing adolescent boys’ decisions about getting circumcised, new research suggests. An article on the HIV website Avert summarises the findings of a study among 90 adolescent girls living near health facilities offering voluntary medical male circumcision (VMMC) and 90 adolescent boys who had been circumcised in South Africa, Tanzania, and Zimbabwe. The study, which was published in a special supplement to the journal Clinical Infectious Diseases, found that the girls preferred their male partners to be circumcised for a number of reasons, including VMMC’s protective effect against HIV and a belief that having a circumcised penis makes a man more attractive. The adolescent boys suggested that encouragement from girls with whom they were romantically involved was one of the factors that motivated them to become circumcised. The results of this small, qualitative study may not apply beyond the participants, but they suggest that VMMC programmes should consider the influence of adolescent girls on adolescent boys’ decisions about VMMC (Avert, 17 April 2018).
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Traditional leaders expressed opposition to a bill proposed by the government of South Africa to prevent deaths and injuries at initiation schools, News 24 reports. The bill would require initiation schools to register with the government and keep up-to-date records or risk closure and possible prison terms. It would also establish a minimum age of 16 for traditional male circumcision and would require that traditional surgeons be registered with the government. According to government figures, botched circumcisions have claimed hundreds of lives and caused severe injuries in the past decade, particularly in Eastern Cape. The chairperson of the Eastern Cape House of Traditional Leaders is quoted as saying that he and his peers are “fundamentally opposed to this bill” because it seeks to regulate custom (News 24, 2018).
New HIV infections among adults in Kenya’s Siaya County have dropped by half since 2011, The Standard reports. An analysis of data from repeated household surveys involving 30,000 people in the subcounty of Gem, published in The Lancet, shows that new HIV infections declined from 11.1 per 1,000 person-years in 2011-12 to 5.7 per 1,000 years in 2012-16. The percentage of 15- to 34-year-olds living with HIV also fell by one-third. These declines occurred at a time when ART coverage among HIV-positive Kenyans increased from 7 percent to 57 percent and male circumcision prevalence in western Kenya, where Siaya is located, rose from 45 percent to 72 percent. In a commentary in The Lancet, Nelson K. Serwankambo of Makerere University writes that “although the declines did not reach the estimated threshold for HIV elimination of one case 1,000 person-years, the findings indicate positive progress and that elimination is possible” (The Standard, 11 April 2018).
Better counselling of younger clients is needed to ensure continued progress in reducing new HIV infections through voluntary medical male circumcision (VMMC), Healio reports. Researchers from Johns Hopkins University surveyed 33 providers and 12 facility managers at 12 VMMC sites in South Africa, Tanzania, and Zimbabwe from June 2015 to September 2016 to identify successes as well as areas for improvement. The study, which was published in a special supplement to the journal Clinical Infectious Diseases, found that older adolescents were more likely to receive HIV prevention counselling and sex education as part of VMMC services compared to younger clients. It also revealed that providers and counsellors lacked training in how to provide such information to boys and young men. The article quotes researcher Lynn van Lith as saying that despite success in “providing a positive circumcision experience, there is more we can do to set these young men on a path toward a healthy life free of HIV” (Healio, 6 April 2018).
The rate of new HIV infections has been reduced by 58 percent since 2011 in Uganda’s Rakai District, dropping from 3.97 per 100 person-years to 1.61 per 100 person-years, Aidsmap reports. Presenting at the Conference on Retroviruses and Opportunistic Infections (CROI 2018) on 6 March, investigator Joseph Kayaagi said that this reduction in HIV incidence came after large increases in antiretroviral treatment, viral suppression, and male circumcision. The data presented are from the Rakai Community Cohort Study, which involves annual surveys in 30 communities. The study results from 2011 to 2016 have been published; this presentation adds data from 2017. The investigators noted that their findings are among the first to show that combination HIV prevention can successfully reduce HIV incidence in a hyperendemic community (Aidsmap, March 2018).
Research on the safety and acceptability of voluntary medical male circumcision (VMMC) was presented in a poster session at the Conference on Retroviruses and Opportunistic Infections (CROI) on Tuesday, 6 March 2018. For links to the abstracts and posters from the session, click here.
A state-of-the-art mobile clinic is enabling Namibia’s Ministry of Health to bring male circumcision to men’s doorsteps, The Namibian reports. The only truck of its kind in the country, the mobile clinic has a fully equipped theatre devoted to performing voluntary medical male circumcision (VMMC) for HIV prevention. It was first dispatched to the Erongo and Ohangwena regions because they have large rural populations. The mobile clinic will remain in those regions until September, when it will be sent to other rural areas to improve access to VMMC (The Namibian, 18 January 2018).
KwaZulu-Natal’s top health official, Sibongiseni Dhlomo, committed to circumcising 1 million men in the province by April, The Citizen reports. He spoke at the homecoming centre for initiates who had been circumcised in Harry Gwala District. The Department of Health forged a partnership with the district’s traditional committee after realising that most male circumcisions were occurring as part of the initiation process for young men. The department works through EG Usher Memorial Hospital, which provides male nurses, health services such as HIV counselling and testing for the initiates, and sterilised surgical equipment, as well as medical observation of the initiates throughout the process (The Citizen, 10 January 2018).
Nearly 5 million men and boys were medically circumcised by programmes supported by the US Centers for Disease Control and Prevention (CDC) in 12 countries in southern and eastern Africa from 2013 to 2016, according to an article published in the 1 December issue of the Morbidity and Mortality Weekly Report. The annual number of voluntary medical male circumcisions (VMMCs) performed by these programmes increased from 2013 to 2015 but declined by 13 percent in 2016 compared to 2015. Almost nine in 10 of the VMMC clients opted to get tested for HIV, with the percentage testing positive in each country ranging from 0.1 to 4.4 percent, and more than seven in 10 returned for a follow-up assessment within 14 days after the procedure (MMWR, 1 December 2017)
Increased uptake of voluntary medical male circumcision (VMMC) and other HIV prevention measures was one of the benefits of an HIV self-testing initiative now being expanded to South Africa, Swaziland, and Lesotho, IOL News reports. In South Africa, more than 2 million test kits will be distributed to improve access to HIV testing and increase the percentage of people who are aware of their HIV status. In Malawi, Zambia, and Zimbabwe, this initiative demonstrated that first-time testers, young people, and more men could be reached with self-testing, and 60 to 90 percent of people in rural areas took up the offer to self-test. Many who tested positive were successfully referred for treatment, and men who tested negative were more likely to use HIV prevention services, such as VMMC (IOL News, 27 September 2017).
Bill and Melinda Gates praise Kenya’s voluntary medical male circumcision (VMMC) programme and recent rollout of pre-exposure prophylaxis in a new report, The Star reports. In Goalkeepers 2017, the first in a series of annual reports on progress toward the United Nations Sustainable Development Goals, they cite Kenya’s use of two of the most effective prevention methods available and say that “other countries can learn a lot from Kenya’s experience.” The country’s VMMC programme reached 71 percent of its national goal for VMMCs performed by 2013 but surpassed its VMMC target for the priority region of Nyanza, where most of the implementation took place (The Star, 14 September 2017).
Traditional leaders were hailed for their support of medical male circumcision at a graduation ceremony for young Tshangani initiates in Chiredzi, Zimbabwe, The Chronicle reports. More than 2,400 Tshangani men and boys were circumcised in one-and-a-half months as part of a traditional initiation programme; a local member of Parliament also became circumcised. Tshangani doctors and nurses trained by Population Services International (PSI) performed the procedures. PSI works with traditional leaders throughout the country to incorporate medical male circumcision in initiation programmes. More than 960,000 men and boys in Zimbabwe have been circumcised since 2009 toward a goal of 1.3 million by the end of 2018 (The Chronicle, 14 September 2017).
Local champions and mapping software are helping a nongovernmental organization reach more men with voluntary medical male circumcision (VMMC), Bhekisisa reports. The HIV nonprofit Right to Care used specially designed software to plot VMMC uptake against the number of men eligible for circumcision in an area and the local health facilities providing VMMC services. Working with community mobilisers and local leaders, Right to Care uses mapping to find and reach eligible men; the organisation’s health care workers performed 40 percent more circumcisions in 2017 compared to 2016 (Bhekisisa, 29 August 2017).
Swaziland has almost reached the 90-90-90 goals for HIV testing, treatment, and viral suppression set for 2020, Medpage Today reports. Nationally representative household surveys found that in 2016, almost 85 percent of Swazi adults had been tested for HIV, more than 87 percent of those who had tested positive were on antiretroviral therapy (ART), and nearly 92 percent of those on ART had viral loads suppressed to undetectable levels. HIV incidence was almost halved, falling from 2.48 percent in 2011 to 1.39 in 2016. These results were reported in a presentation at the 9th International AIDS Society Conference on HIV Research (IAS 2017) in Paris, France, on 24 July 2017. The Medpage Today article describes how reaching more people with HIV testing, treatment, and prevention services — including more than doubling the number of men who had received voluntary medical male circumcisions from 2011 to 2016 — helped the country achieve these milestones (Medpage Today, 27 July 2017).
Women who reported that their most recent male sex partner was circumcised were less likely to have HIV and genital herpes than women whose last partner was not circumcised in a study in South Africa, Aidsmap reports. This study, which was presented at the 9th International AIDS Society Conference on HIV Research (IAS 2107) in Paris, France, on 25 July, analysed data on 4,766 women from consecutive household surveys conducted in two subdistricts of KwaZulu Natal, comparing rates of HIV and other sexually transmitted infections among the women with circumcised partners with the rates among the women with uncircumcised partners. In a multivariate analysis that attempted to control for other differences between the two groups of women, those with circumcised partners were about 30 percent less likely to have HIV and about 20 percent less likely to have herpes simplex virus 2 (Aidsmap, 26 July 2017).