DURBAN, South Africa – The 11.7 million medical circumcisions delivered to prevent HIV since research in Kenya and Uganda definitively proved the 60 percent protective value of the one time intervention in 2007, will have prevented an estimated 335,000 HIV infections by 2025.
“That’s if stopped now,” Julie Samuelson of the World Health Organization said in a pre-opening session Monday.
No one here thinks that’s going to happen, but a slight decline in both supply of resources and demand for the procedure is causing concern. And, presenters at a session dedicated to updates on the intervention usually referred to as VMMC (for voluntary medical male circumcision)* emphasized that continued uptake of medical circumcision remains an essential component to reach a 75 percent reduction in new infections by 2020, as well as sustained control of the pandemic.
The session highlighted modeling exercises presented by Katharine Kripke of the U.S.-based Avenir Health seeking to identify age groups, and geographic locations that could be reached respectively with the most immediate, efficient, and cost-effective benefits.
An approach that focused on reaching men 20 to 34 years old would require the least effort and in that way be the most efficient, according to modeling matching infection rates to factors affecting uptake of the intervention. Considerations included how infections could be averted according to age group. Reaching boys and young men from 15 to 24, however would have the greatest magnitude of impact. With infections averted over a lifetime, an approach reaching boys and men aged 15 to 34 would be the most cost-effective. Efforts to compare cost-effectiveness of one location over another, on the other hand didn’t yield statistically significant data, showing, Kripke said, no reason to prioritize one location over another.
*Science Speaks uses just “medical circumcision, feeling that “male” is redundant, as no other kind of medical circumcision exists, and will specify “involuntary” if a program of involuntary medical circumcision is launched.