A report released at the IAS 2019 conference in Mexico City documents dramatic reductions in HIV incidence and mortality achieved in six different settings, Africa Science News reports. Lower rates of new HIV infections and HIV-related deaths have been attributed to campaigns to encourage HIV testing, free access to treatment at the time of diagnosis with HIV, and scale-up of evidence-based HIV prevention, such as voluntary medical male circumcision, pre-exposure prophylaxis and harm reduction. Chris Collins, president of Friends of the Global Fight Against AIDS, Tuberculosis and Malaria, is quoted as saying the report shows that “ending the epidemic isn’t an insurmountable challenge but a question of putting the evidence to work and scaling access, particularly for those most at risk” (Africa Science News, 23 July 2019).
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The rate of new HIV infections dropped by about 30 percent in three studies of intensive HIV interventions, but they did not achieve the larger reductions in incidence that had been expected, The New York Times reports. The studies, conducted in five African countries among almost 1.5 million people, assessed the impact of testing everyone in a community for HIV and providing antiretroviral treatment (ART) to those who test positive. In all three studies, communities were randomly assigned to receive either their country’s standard of care or the “test-and-treat” approach combined with other services, such as testing and treatment for TB and sexually transmitted infections, counseling, condoms, prenatal care, and voluntary medical male circumcision. The standard of care in the countries changed during the studies to expand access to ART, making it difficult to measure the effect of combination HIV prevention (The New York Times, 17 July 2019).
Linking men to HIV services is a major challenge, reports South Africa’s Times Live, citing the latest Global AIDS Update from the Joint United Nations Programme on HIV/AIDS (UNAIDS). Times Live covered the release of the report in the Kwazulu-Natal town of Eshowe, where a project run by Doctors Without Borders has achieved the UNAIDS goals of 90-90-90 a year ahead of the 2020 deadline. In Eshowe, 90 percent of people living with HIV know their status, 94 percent of those who know they are HIV-positive are on antiretroviral treatment, and 95% of those on treatment have a suppressed viral load. But reaching men has proved difficult, despite initiatives such as a male clinic at a taxi rank and transport to and from weekend VMMC camps (Times Live, 13 July 2019).
Many parents in South Africa's Limpopo Province have lost faith in the traditional way of circumcising boys and are turning to voluntary medical male circumcision (VMMC), Health-e News reports. Several parents who had taken their sons for VMMC cited concerns about the safety, hygiene, and cost of the traditional rite of passage. A general practitioner from a health centre in the village of Mokgoloboto is quoted as saying that 150 boys have been circumcised at the facility (Health e-News, 27 June 2019).
Registration is open for a 22 May webinar on approaches to sustaining voluntary medical male circumcision (VMMC) services, including recommendations from the World Health Organization and examples of countries’ steps toward sustainability in VMMC leadership, systems, financing, and strategic information.
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).
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).