After decades of effort, the path toward an AIDS-free generation is becoming clear. Preventing new infections is a crucial step forward along this path, and voluntary medical male circumcision (VMMC) can play a pivotal role. The results of three randomized controlled trials show that VMMC reduces female-to-male HIV transmission by at least 60 percent. Cost and impact modeling studies show that rapidly scaling up VMMC to reach 80 percent of reproductive age men would avert an estimated 3.4 million new HIV infections and save US $16.5 billion in care and treatment costs by 2025. Jhpiego is at the forefront of this prevention intervention, and as a global leader in the battle against AIDS over the last 10 years, has translated groundbreaking Johns Hopkins research on VMMC into practical methods for combatting HIV in countries with the highest burden of disease.
Between 2003 and 2005, Jhpiego supported a demonstration project in Zambia to investigate whether male circumcision services could serve as an entry point to reproductive health services for men. As part of this pilot project, Jhpiego created the training package that eventually formed the backbone of Male Circumcision under Local Anaesthesia, the WHO/UNAIDS/Jhpiego reference manual and training package, which now stands as the international consensus document for VMMC surgical services. In 2010, the World Health Organization (WHO) and Jhpiego published a companion manual and training package, Early Infant Male Circumcision under Local Anaesthesia, which is a resource for countries that wish to introduce or standardize early infant male circumcision practices.
With the generous support of our donors, we have been able to assist 10 countries in the East and Southern Africa region to scale up VMMC as part of a comprehensive package of HIV prevention services. These 10 countries are Botswana, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Rwanda, South Africa, Tanzania and Zambia, This package includes STI screening and treatment, HIV testing, counseling and referral to care, condom promotion and HIV risk reduction counseling. Jhpiego is proud to have supported programs that have conducted over 600,000 VMMCs as of September, 2013, averting an estimated 75,000 future infections across 10 countries with high HIV prevalence.
Moving forward, Jhpiego continues to play a leadership role in efforts to expand access to high-quality VMMC services that are accessible and acceptable to communities with a high burden of HIV disease. Over the coming years, Jhpiego will continue to:
We are impatient optimists, and the growing momentum to avert infections motivates us to push the pace of change—without ceasing—to create an AIDS-free generation.
- Improve service delivery approaches to reach the unreached (e.g., by using geographic information system [GIS] mapping to identify communities that have not yet received VMMC services);
- Lead studies that hold promise for expanding choice in VMMC (e.g., introductory studies of the PrePexTM device in Botswana, Mozambique, Lesotho and Tanzania);
- Intensify efforts to ensure that men who test HIV-positive in VMMC settings are effectively linked to HIV care and treatment;
- Participate in global technical working groups to advance the state of the art in VMMC; and
- Introduce early infant male circumcision (EIMC) as a key element of maternal, newborn and child health services in high HIV prevalence settings to ensure that the next generation receives its protective benefit.