Scaling up Male Circumcision in Kenya

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This post is by the Global Center’s Christine Lubinski, reporting from the International AIDS Conference in Vienna. This is a summary of a report released at a session on Thursday by E. Odoyo-June and colleagues.

Kisumu is the third largest city in Kenya and was the site of one of the three critical clinical trials that demonstrated the efficacy of male circumcision (MC) to prevent acquisition of HIV infection in men.  The trial results were widely reported in the community and triggered a national committee to scale up circumcision.

The results of a random household survey on male circumcision and HIV in men and women 15-49 years old found that 32 percent of the men had been circumcised, but 59 percent of the men who were not circumcised expressed an interest in being circumcised.  The uncircumcised men who were interested in circumcision did believe it would provide them with some protection from HIV, but 25 percent also thought it would make condom use less necessary.  Only 15 percent of the circumcised men thought condom use was less necessary.  These findings demonstrate the importance of the prevention counseling accompanying circumcision.

Seventy-three percent of women surveyed indicated a preference for a circumcised partner. Kenya’s comprehensive Voluntary Medical Male Circumcision (VMMC) program, launched in 2008

The government of Kenya launched the Voluntary Medical Male Circumcision program in 2008, which is committed to circumcising 860,000 men over the next four years. One half of these men live in the Nyanza province, which has the highest HIV rate and the lowest MC rates in the country.  With only 40,000 men circumcised in the last year, a “rapid results initiative” in 11 districts in Nyaza aimed at circumcising 30,000 men in 30 working days. They engaged in public education, aggressive community outreach, and pushed referrals to MC services from other health services. They sponsored processions through villages promoting MC services. At the end of the time period, they had circumcised 36,077.

Forty-five percent of the males who were circumcised were 15 years old and under.  They faced some challenges in regard to whether mature minors could self consent to circumcision which need to be addressed.

Some of the lessons learned were the need to keep client volume up to keep costs down, the importance of community mobilization, and the ability to offer MC services in a variety of settings.  The authors suggested that a toolkit based on Kenya’s scale up experience should be developed for use by other countries.

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4 thoughts on “Scaling up Male Circumcision in Kenya

  1. Restoring Tally

    Now that men are being circumcised, is a followup study planned to verify that male circumcision is as efective as thought? By this time enough men have been circumcised for long enough that trending data should be available. In real life, are circumcised men not being infected by HIV?

  2. Mark Lyndon

    Circumcision is a dangerous distraction in the fight against AIDS. There are six African countries where men are *more* likely to be HIV+ if they’ve been circumcised: Cameroon, Ghana, Lesotho, Malawi, Rwanda, and Swaziland. Eg in Malawi, the HIV rate is 13.2% among circumcised men, but only 9.5% among intact men. In Rwanda, the HIV rate is 3.5% among circumcised men, but only 2.1% among intact men. If circumcision really worked against AIDS, this just wouldn’t happen. We now have people calling circumcision a “vaccine” or “invisible condom”, and viewing circumcision as an alternative to condoms. The South African National Communication Survey on HIV/AIDS, 2009 found that 15% of adults across age groups “believe that circumcised men do not need to use condoms”.

    The one randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised btw.

    ABC (Abstinence, Being faithful, and especially Condoms) is the way forward. Promoting genital surgery will cost African lives, not save them.


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