A study found that the introduction and expansion of combination HIV prevention services, including HIV testing, voluntary medical male circumcision (VMMC), and antiretroviral therapy, led to significant decreases in new HIV infections in four Ugandan fishing villages heavily affected by HIV, Healio reports. The authors of the study write in The Lancet HIV that “to our knowledge this is the first report of prospectively observed declines in overall HIV incidence with rapid scale-up of combination HIV interventions in HIV-hyperendemic communities.” HIV incidence dropped from 3.43 per 100 person-years in 2011 to 1.59 person-years in 2017 as the number of people benefiting from combination prevention increased. VMMC coverage increased from 35 to 65 percent, and circumcised men had a lower risk of incident HIV compared to uncircumcised men. Despite surpassing the 90-90-90 targets for HIV testing, treatment, and viral suppression, however, these villages still have an HIV incidence 15 times higher than the rate needed for epidemic control (Healio, 30 September 2019).
News & Events
Zimbabwe recorded declines in new HIV infections of 9 percent among adults and 27 percent among children from 2015 to 2018, The Herald reports. A government official, speaking at the launch of a two-week review of the national HIV programme, attributed these gains and a 60 percent reduction in AIDS-related deaths from 2010 to 2017 to the collective efforts of the government and the private sector. Interventions the government has instituted include voluntary medical male circumcision, pre-exposure prophylaxis, condom promotion and provision, HIV testing, prevention of mother-to-child transmission of HIV, prevention and management of sexually transmitted infections, and provision of antiretroviral therapy. The review will identify gaps in these programmes and generate recommendations to help Zimbabwe achieve the goal of ending the epidemic by 2030 (The Herald [Zimbabwe], 17 September 2019).
To achieve the goal of providing 25 million voluntary medical male circumcisions (VMMCs) by 2020, programmes in southern and eastern Africa would need to reach an additional 15 million men and adolescent boys, according to the 2019 Global AIDS Update from the Joint United Nations Programme on HIV/AIDS (UNAIDS). Avert reports that the VMMC goal is one of the many global HIV targets unlikely to be met by 2020. Reductions in the annual number of new HIV infections appear to have stalled, and the resources available for the global response to HIV declined for the first time in 2018, from $19.6 billion in 2017 to $19 billion in 2018 (Avert, 9 August 2019).
A new mobile health clinic is allowing rapid expansion of voluntary medical male circumcision (VMMC) services in the hills of Tanzania’s Morogoro Region, reports the Daily News. The article feature Joseph Anthony, a 21-year-old brick maker who lives in a village outside the clinic. Previously unable to access male circumcision because of financial constraints, Joseph is now one of more than 800,000 Tanzanian men who have been circumcised at no cost since 2015. The clinic also offers free HIV counselling and testing, tuberculosis treatment, and family planning education (Daily News [Tanzania], 4 August 2019).
On the first World Patient Safety Day on 17 September 2019, the World Health Organization launched a global campaign to create awareness of patient safety and urge people to show their commitment to making healthcare safer. Campaign materials and information about improving patient safety are available here. For information on the safety of voluntary medical male circumcision (VMMC) services and resources to help programmes assure and improve the quality of VMMC services, see the Clearinghouse’s Quality assurance and Safety research pages.
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).
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).