Yesterday, the open-access medical journals PLOS ONE and PLOS Medicine published a new collection of research studies on the role of voluntary medical male circumcision (VMMC) in the fight against HIV in sub-Saharan Africa.
Drawing on evidence from five countries, the studies describe how safe, high-quality VMMC services are being successfully scaled-up in resource-limited settings, helping millions of adolescent and adult males protect themselves and their partners from becoming infected with HIV.
By the end of 2013, an estimated six million males had received VMMC procedures in 14 sub-Saharan countries. This figure indicates a dramatic increase in the number of males seeking VMMC - from just 120,000 in 2009 to 880,000 in 2011 to an estimated 2.9 million in 2013.
Studies conducted in 2011 suggest that if 14 priority African countries achieved the target of circumcizing 20 million boys and men within five years, 3.4 million new HIV infections could be prevented and an estimated $16 billion in treatment costs could be averted in over 15 years.
What makes VMMC such a powerful HIV prevention tool? There are two key reasons:
- Research has shown that VMMC can reduce a male’s chance of acquiring HIV infection by 60 percent, making it one of the best available strategies to reduce transmission to males and – by extension – their wives and partners.
- Unlike other prevention methods, VMMC is a one-time procedure that delivers a lifelong prevention benefit, making it extremely cost effective.
The PLOS studies, which explore issues related to demand creation and the efficiency, cost, and quality of VMMC services, offer great insight into the factors that affect VMMC scale up. For example, they highlight that outreach messages should be tailored to different age groups and cultural norms. Messages also need to go beyond simple HIV messaging and present the broader benefits of VMMC, including hygiene, attractiveness to partners, peer group norms and the prevention of cervical cancer in women. Other findings demonstrate that VMMC programs offer a unique way to connect men to a broad range of sexual health services, including HIV testing, care, and treatment.
VMMC programs in sub-Saharan Africa continue to face challenges related to funding and service capacity. As a result, the studies advise programs to:
- Prioritize outreach to males who are most at risk of acquiring HIV;
- Increase VMMC service supply in areas where demand is highest; and
- Introduce innovations in technology and program design that can accelerate scale up using currently available resources.
By itself, VMMC is not the answer to Africa’s HIV crisis. There is no magic bullet when it comes to designing and delivering effective HIV prevention, and experts have long recognized that people are more likely to use prevention when they have access to a wide array of options. This means that the world must stay focused on developing other prevention products, including women-initiated methods that can simultaneously protect women and girls from HIV, other sexually transmitted infections and unintended pregnancy.
Nonetheless, what has been achieved in just a few years is truly amazing, and it confirms that VMMC can play a vital role in changing the trajectory of HIV in Africa. Today’s news should give us confidence that we are starting to realize its life-saving potential.