On World AIDS Day, Highlighting Prevention Efforts Through Report on Voluntary Medical Male Circumcision

As the world observes World AIDS Day 2017, the CDC is highlighting prevention efforts through a report on voluntary medical male circumcision (VMMC) services for HIV prevention in 12 Southern and Eastern African countries.

Today, approximately 36.7 million people worldwide are living with HIV, of which approximately 1.8 million were newly infected in 2016, according to data from the CDC. In the US in 2014, there were an estimated 1.1 million people living with HIV, and 85% were aware of their infection.

Countries in Southern and Eastern Africa have the highest prevalence of HIV worldwide, with the 2 regions accounting for 52% (19 million) of all people living with the disease in 2012.

Global efforts to curtail the prevalence of AIDS have been launched, such as the Joint United Nations Program on HIV/AIDS (UNAIDS) strategy to end AIDS by 2030. A crucial element of the strategy is voluntary medical male circumcision (VMMC), which decreases the risk of heterosexually acquired HIV infection among males by 60%.

The effort began 10 years ago with the World Health Organization and UNAIDS’ recommendation to increase the amount of VMMCs for HIV prevention in 14 Southern and Eastern African countries with HIV epidemics and low circumcision rates. During 2008 to 2016, approximately 14.5 million VMMCs were performed on males aged 15 to 49.

The authors of the report analyzed the 2013 to 2016 period, which accounted for 5 million VMMCs in 12 countries: Botswana, Ethiopia, Kenya, Malawi, Mozambique, Namibia, Rwanda, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. The service package includes:

• Male circumcision
• An offer of HIV testing services and access to care and treatment for men with HIV
• HIV risk-reduction education
• Condom provision
• Screening and treatment or referral for sexually transmitted infections

Data were extracted from site-level VMMC client registers. For 2013 to 2014, participant age was reported as either younger than 15 or 15 years or older, and during 2015 to 2016 age was reported as younger than 15, aged 15 to 29 years, and 30 years or older.

The annual number of VMMCs increased during 2013 to 2015, and the proportion of VMMC participants younger than 15 increased continuously throughout the 3 years from 31.7% to 47.6%. However, the rates of VMMC for participants aged 15 to 29 declined from 48.4% in 2015 to 45.6% in 2016. There are several reasons for this decline, according to the authors, including the slowing of service in several countries following the recognition of tetanus as a rare but severe complication of VMMC, because many males in Southern and Eastern Africa were never fully immunized.

The multi-country analysis also showed that, during the 3-year period, 89.3% of participants utilized the HIV testing services, and among those tested, 0.8% to 1.3% tested positive.

To optimize service delivery, VMMC programs are offering delivery on days and times that best fit participants’ needs, using mobile outreach, and incorporating medical innovations that could enhance acceptability of VMMC.

To increase demand, the programs are addressing specific concerns of people who have been hesitant to undergo VMMC, linking VMMC with prevention activities for women, and engaging with community stakeholders to become VMMC advocates.

“Reaching and maintaining high male circumcision coverage in countries with high prevalence of HIV infection remains a critical component of achieving an AIDS-free generation,” concluded the authors.