ID docs say it’s time to up the ante on medical male circumcision

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Implementing an aggressive medical male circumcision (MC) scale-up program in countries with high HIV prevalence and low rates of MC could save millions of lives and significant resources.

Two boys in Zambia wait at a medical male circumcision clinic for the procedure, one holding his permission form.

That’s according to a new report issued by leading infectious diseases scientists in global health at the Center for Global Health Policy. Medical MC is a one time, low-cost intervention proven to reduce a man’s chance of acquiring HIV through vaginal sex by up to 60 percent. What’s more, the powerful prevention method is ready for roll out, and not waiting for confirmatory evidence as are pre-exposure prophylactics from the CAPRISA 004 and iPrEx studies. Some efforts to quickly and extensively bring MC services to countries in sub-Saharan Africa are already underway, but only in a limited capacity.

The report, “Medical Male Circumcision as HIV Prevention, Follow the Evidence: The case for aggressive scale up,” calls on more initiatives to be implemented, and quickly.

The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is funding one such Accelerated Saturation Initiative in Swaziland, which could start as early as January with a goal of circumcising 80 percent of men 19 to 49 years of age, or approximately 150,000 HIV-negative men, in just 12 months. The HIV-ravaged nation has a population of only 1 million, but estimates of people living with HIV there are as high as 200,000. Government officials expect the initiative to prevent as many as 88,000 new adult HIV infections by 2025, ultimately saving the Swazi government approximately $650 million in HIV care and treatment costs and reducing HIV incidence there by 75 percent.

Mathematical models were also used to predict the effects of scaling-up MC to reach 80 percent of the population over five years in other high HIV prevalence countries, revealing:

  • Zimbabwe could see a decrease in HIV incidence of 42 percent by 2025, averting nearly 800,000 new infections.
  • South Africa could reduce HIV incidence by 19 percent, and prevent more than 1.2 million new HIV infections by 2025.
  • Scaling up MC to reach 80 percent of adult and newborn males in 14 African countries targeted by the U.S. Agency for International Development by 2015 could potentially avert more than 4 million adult HIV infections by 2025, and save $20.2 billion by 2025.

In countries where community education about the benefits of medical MC has occurred, interest in the intervention has been high. “I feel this is important for my son. I don’t want him to be another statistic testing HIV-positive, as I am,” said Miriam Banda, a member of the Community of Zambian Women Living with HIV/AIDS. “As a feminist I support medical male circumcision, because in fact it benefits everyone. We must urgently scale up access not only to MC, but all other prevention measures here in Zambia and elsewhere in the region.”

The report can be found on the Center for Global Health Policy website.

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