UNAIDS and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) launched a five-year action framework to accelerate scale up of voluntary medical male circumcision (VMMC) for HIV prevention at the 16th International Conference on AIDS and Sexually Transmitted Infections (STIs) in Africa (ICASA) Monday. The World Health Organization, UNAIDS, PEPFAR, the Bill & Melinda Gates Foundation and the World Bank, in consultation with ministries of health, developed the Joint Strategic Action Framework to Accelerate the Scale-Up of Voluntary Medical Male Circumcision for HIV Prevention in Eastern and Southern Africa. It calls for roll out and expansion of VMMC in 14 priority countries in eastern and southern Africa.
To date, scale-up of this evidence-based intervention that reduces the risk of a man contracting HIV infection during vaginal sex by more than 60 percent has been underwhelming. An estimated 550,000 men aged 15 to 49 have been circumcised in the 14 priority countries, representing only 2.7 percent of the estimated 20 million male circumcisions needed in order to reach the desired goals. The framework aims to circumcise at least 80 percent of the 14 to 49 year old males in the target countries, and to establish a “sustainable national program that provides medical male circumcision to all infants up to two months old and at least 80 percent of male adolescents.”
VMMC is cost-effective. Recent modeling commissioned by PEPFAR and UNAIDS found that reaching 80 percent coverage in the target countries would require performing about 20 million circumcisions at a cost of $1.5 billion, and would result in a net savings of $16.5 billion by 2025 due to averted treatment and care costs. An estimated 3.4 million new HIV infections could be averted through 2025.
The new framework calls for strategic and coordinated action among partners at the local, national and global levels to harness resources and encourages innovation in service delivery, human resource deployment and medical devices to improve efficiency in delivering services while encouraging demand.