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Research shows male circumcision scale-up successful

Wednesday, 7 May, 2014

Large-scale voluntary male medical circumcision (VMMC) programmes can be successfully implemented and impact positively upon new HIV infections in low-resource settings, according to a new series of research published in the PLOS Collection yesterday. The research focuses on the overall success of large-scale VCCM interventions in southern and eastern African countries, and the lessons learnt for going forward.

In 2005, scientific trials showed that male circumcision could reduce a man’s risk of becoming infected with HIV during heterosexual intercourse by up to 60 percent. These findings led to the decision by UNAIDS and the World Health Organisation (WHO) to recommended circumcision as an important new element of HIV prevention, particularly in areas with generalised HIV epidemics. Since the guidance, VMMC programmes have been rapidly scaled up across a number of African countries.

The new collection of research concentrates on this scale-up from 2008 in Kenya, South Africa, Tanzania, Lesotho and Zimbabwe. Whilst the scale-up has been largely successful, a number of challenges have emerged from these programmes, including creating demand for circumcision, particularly in areas where it is not culturally relevant to be circumcised; the quality of surgical services; lack of data collection about circumcision services; accounting for costs, and programme inefficiencies.

However, despite these challenges, Dr. Rhona MacDonald of PLOS stated: “at a time of constrained international resources to fight HIV and AIDS, voluntary medical male circumcision offers the advantage of its relatively low cost and one-time action to achieve continuous benefits over other prevention methods, such as pre-exposure prophylaxis and preventative Antiretroviral Therapy (ART).”

The research recommends that VMMC services can overcome some of the challenges of large-scale implementation by facilitating management change and by strategically targeting populations who could benefit from VMMC programmes. They state that continuing scale-up of VMMC is critical as a combination approach to HIV prevention, and to achieve an AIDS-free generation.

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