“In it to save lives”

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(From the left) Dr. Caroline Ryan of the Office of the U.S. Global AIDS Coordinator, Dr. Emmanuel Njeuhmeli from USAID, Buck Buckingham from the U.S. Peace Corps and Dr. Catherine Hankins of UNAIDS discuss voluntary medical male circumcision.

To the sound of a ticking metronome, Dr. Caroline Ryan of the Office of the Global AIDS Coordinator gave an update on the scale up of voluntary medical male circumcision in sub-Saharan Africa Wednesday morning at the premiere of the new short film “In It to Save Lives: Scaling Up Voluntary Medical Male Circumcision for HIV Prevention for Maximum Public Health Impact.”  

The metronome was timed to tick once for each of the five new HIV infections that occur every minute worldwide, 3.5 of which occur in sub-Saharan Africa, Ryan said. During her ten-minute talk, fifty people around the world became infected, and of the 35 infections that would occur among those in sub-Saharan Africa, 12 could be averted through the scale up of voluntary medical male circumcision (MC), she said at the end of her presentation.

Clinical trials have shown MC to provide men 60 percent more protection from acquisition of HIV through vaginal sex than their uncircumcised counterparts. The one-time, relatively simple procedure is inexpensive and cost-effective, and governments in sub-Saharan Africa are encouraging men to get the procedure by offering it for free or very little cost with the help of funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and other programs.

Dr. Caroline Ryan of the Office of the U.S. Global AIDS Coordinator gives the opening remarks at Tuesday's premiere of the film "In It to Save Lives."

Dr. Ryan joined with other HIV/AIDS experts at the panel discussion and premiere of the film, produced by AIDSTAR-One with support from PEPFAR, which tells the story of how Kenya and Swaziland are turning the tide of the HIV/AIDS epidemic by embracing voluntary medical MC as prevention. Scale up was especially tricky in Kenya’s Nyanza province where Luo elders, the “custodians of culture” in the province, had to be convinced that the procedure was of benefit to its people. According to the film, assuring the elders that the procedure was voluntary was key to winning their approval.

Panelists also discussed how governments and programs are getting creative in order to increase demand for the procedure — engaging ministries of labor, agriculture and others in an “all hands on deck” approach with a detailed action plan targeting the public and private sectors. With the help of a grant in Zimbabwe, they now have the money to target and circumcise more than 150,000 uniformed forces in the country.

In Kenya, they are increasing the number of circumcised men encouraging others to get the procedure by offering 50 to 100 Kenyan schillings, t-shirts and reflective jackets to those who recruit willing uncircumcised men. Dr. Ryan was clear to point out that PEPFAR does not support offering incentives to those getting the procedure – incentivizing is for “mobilizers” only, she said.

During the question and answer session, an audience member asked why some countries are so far behind others in terms of scale up of MC. “The adoption of policy, development of implementation plans and provision of services did not happen simultaneously across countries,” said Emmanuel Njeuhmeli, MD, MPH from the U.S. Agency for International Development (USAID). “So different countries are at different places in scale up.”

Progress toward achievement of 80 percent coverage of voluntary medical male circumcision in 14 target countries in sub-Saharan Africa.

According to mathematical models, by circumcising 80 percent of males in 14 target countries in sub-Saharan Africa (approximately 20.3 million men) over the next five years, 3.4 million HIV infections would be averted by 2025. While this endeavor would cost about $1.5 billion in the next five years, it would save approximately $16.5 billion in the long-term, Njeuhmeli said.

Science Speaks asked the panel about rumors of lack of demand for the procedure (despite an increase in service provision) in Swaziland, where PEPFAR recently launched an accelerated saturation initiative to circumcise 80 percent of men 15 to 49 years old in less than two years.

“We have already circumcised 28,000 men to date – and that’s in a country with a population of less than one million people,” said Ayanda Nqeketo from the Swaziland Ministry of Health. “We are not at the level of [demand that] the government expected in this ‘urgent’ scale up, but the numbers are beginning to go up in the past few months thanks to the collaboration of the U.S. and Swazi governments,” he said.

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