{"id":1000,"date":"2014-06-18T12:49:31","date_gmt":"2014-06-18T12:49:31","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=1000"},"modified":"2014-06-18T12:49:31","modified_gmt":"2014-06-18T12:49:31","slug":"the-roll-out-of-unaids-voluntary-medical-male-circumcision-programmes-in-sub-saharan-africa-is-it-working","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2014\/06\/18\/the-roll-out-of-unaids-voluntary-medical-male-circumcision-programmes-in-sub-saharan-africa-is-it-working\/","title":{"rendered":"The roll-out of UNAIDS voluntary medical male circumcision programmes in sub-Saharan Africa: Is it working?"},"content":{"rendered":"<p>Voluntary medical male circumcision (VMMC) has been demonstrated to reduce HIV acquisition by <strong>60%<\/strong> or more.\u00a0 WHO and UNAIDS have recommended that VMMC form a part of comprehensive HIV prevention programming in regions of high prevalence, such as sub-Saharan Africa.\u00a0 Mathematical modelling suggests that the achievement of <strong>80%<\/strong> VMMC coverage within 5 years in 14 countries in Eastern and Southern Africa would avert <strong>3.36m<\/strong> new HIV infections. In the light of this the UNAIDS Joint Strategic Action Framework (JSAF) has set out the goal of circumcising <strong>20.2 million<\/strong> men in five years across these countries. The challenges this represents on both the supply and the demand side are comprehensively discussed by <a href=\"http:\/\/sti.bmj.com\/content\/89\/5\/345.abstract?sid=c7cb5e3e-367f-4350-952d-48110944341f\">STI\/Gray &amp; Kigozi<\/a>.<\/p>\n<p>A recent PLoS &#8211; Medicine <a href=\"http:\/\/www.ploscollections.org\/article\/browse\/issue\/info:doi\/10.1371\/issue.pcol.v01.i22\">Collection<\/a> considers the progress thus far, and through to 2016, of this initiative.\u00a0 The <a href=\"http:\/\/www.ploscollections.org\/article\/info%3Adoi%2F10.1371%2Fjournal.pmed.1001641;jsessionid=F72D37DFFF17DBA99FED7F7F83E1C2ED\">Collection Review<\/a> (Sgaier &amp; Njeuhmeli (S&amp;G)) offers a useful survey. The year preceding the JSAF and the first two years of the initiative have seen yearly VMMC of <strong>0.88m<\/strong>, <strong>1.7m<\/strong>, and <strong>2.9m<\/strong> respectively. If we assume current rates of growth, this would give a cumulative total of <strong>17.5m<\/strong> circumcisions by 2016 &#8211; about <strong>3m<\/strong> short of the <strong>20.2m<\/strong> target; if we assume no growth, the cumulative total for this period would be <strong>13.7m<\/strong>.\u00a0 The scale-up of VMMC over the last three years has been impressive. Still, rates of year-on-year growth have fallen from <strong>109%<\/strong> (2011) to <strong>72%<\/strong> (2013).\u00a0 S&amp;G identify two factors impeding the achievement of the JSAF goal: first, insufficient funding, largely as a result of the failure of international donors to step in alongside the US President\u2019s Emergency Plan for AIDS Relief (PEPFAR) (which currently bears 80% of the cost); second, the lack of &#8211; or failure to create &#8211; sufficient <em>demand<\/em> for VMMC in the targeted countries, especially amongst the older element (i.e. aged 25+) of the population.<\/p>\n<p>The 13 papers in the collection deal with issues around <em>supply<\/em> of VMMC &#8211; such as maintaining quality of service during scale-up (<a href=\"http:\/\/www.ploscollections.org\/article\/info%3Adoi%2F10.1371%2Fjournal.pone.0079524;jsessionid=AA2C7F206C7C41F8C99EC3728D50EBC6\">Jennings &amp; Njeuhmeli<\/a>; <a href=\"http:\/\/www.ploscollections.org\/article\/info%3Adoi%2F10.1371%2Fjournal.pone.0080577\">Rech &amp; Bertrand<\/a>; <a href=\"http:\/\/www.ploscollections.org\/article\/info%3Adoi%2F10.1371%2Fjournal.pone.0084271\">Rech &amp; Njeuhmeli<\/a>) and optimizing efficiency in service delivery (<a href=\"http:\/\/www.ploscollections.org\/article\/info%3Adoi%2F10.1371%2Fjournal.pone.0084271\">Rech &amp; Njeuhmeli<\/a>; <a href=\"http:\/\/www.ploscollections.org\/article\/info%3Adoi%2F10.1371%2Fjournal.pone.0082911\">\u00a0Mahvu &amp; Bertrand<\/a>; <a href=\"http:\/\/www.ploscollections.org\/article\/info%3Adoi%2F10.1371%2Fjournal.pone.0084215\">Perry &amp; Bertrand<\/a>).\u00a0 But, more interestingly, they also deal with the problem that S&amp;G identify as one of the two main obstacles to achieving the JSAF goal &#8211; that of creation of <em>demand<\/em> (<a href=\"http:\/\/www.ploscollections.org\/article\/info%3Adoi%2F10.1371%2Fjournal.pone.0083998\">Macintyre &amp; Bertrand<\/a>; <a href=\"http:\/\/www.ploscollections.org\/article\/info%3Adoi%2F10.1371%2Fjournal.pone.0083642\">Ashengo &amp; Njeuhmeli<\/a>).\u00a0 This important issue will be covered in my next blog.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Voluntary medical male circumcision (VMMC) has been demonstrated to reduce HIV acquisition by 60% or more.\u00a0 WHO and UNAIDS have recommended that VMMC form a part of comprehensive HIV prevention programming in regions of high prevalence, such as sub-Saharan Africa.\u00a0 Mathematical modelling suggests that the achievement of 80% VMMC coverage within 5 years in 14 [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/sti\/2014\/06\/18\/the-roll-out-of-unaids-voluntary-medical-male-circumcision-programmes-in-sub-saharan-africa-is-it-working\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2611,2785,2800,1694],"tags":[],"class_list":["post-1000","post","type-post","status-publish","format-standard","hentry","category-circumcision","category-implementation-research","category-programme-science","category-sti-prevention-and-surveillance"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>The roll-out of UNAIDS voluntary medical male circumcision programmes in sub-Saharan Africa: Is it working?  - Sexually Transmitted Infections<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/sti\/2014\/06\/18\/the-roll-out-of-unaids-voluntary-medical-male-circumcision-programmes-in-sub-saharan-africa-is-it-working\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The roll-out of UNAIDS voluntary medical male circumcision programmes in sub-Saharan Africa: Is it working?  - Sexually Transmitted Infections\" \/>\n<meta property=\"og:description\" content=\"Voluntary medical male circumcision (VMMC) has been demonstrated to reduce HIV acquisition by 60% or more.\u00a0 WHO and UNAIDS have recommended that VMMC form a part of comprehensive HIV prevention programming in regions of high prevalence, such as sub-Saharan Africa.\u00a0 Mathematical modelling suggests that the achievement of 80% VMMC coverage within 5 years in 14 [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/sti\/2014\/06\/18\/the-roll-out-of-unaids-voluntary-medical-male-circumcision-programmes-in-sub-saharan-africa-is-it-working\/\" \/>\n<meta property=\"og:site_name\" content=\"Sexually Transmitted Infections\" \/>\n<meta property=\"article:published_time\" content=\"2014-06-18T12:49:31+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2014\\\/06\\\/18\\\/the-roll-out-of-unaids-voluntary-medical-male-circumcision-programmes-in-sub-saharan-africa-is-it-working\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2014\\\/06\\\/18\\\/the-roll-out-of-unaids-voluntary-medical-male-circumcision-programmes-in-sub-saharan-africa-is-it-working\\\/\"},\"author\":{\"name\":\"\",\"@id\":\"\"},\"headline\":\"The roll-out of UNAIDS voluntary medical male circumcision programmes in sub-Saharan Africa: Is it working?\",\"datePublished\":\"2014-06-18T12:49:31+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2014\\\/06\\\/18\\\/the-roll-out-of-unaids-voluntary-medical-male-circumcision-programmes-in-sub-saharan-africa-is-it-working\\\/\"},\"wordCount\":406,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#organization\"},\"articleSection\":[\"Circumcision\",\"Implementation research\",\"Programme Science\",\"STI prevention and surveillance\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2014\\\/06\\\/18\\\/the-roll-out-of-unaids-voluntary-medical-male-circumcision-programmes-in-sub-saharan-africa-is-it-working\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2014\\\/06\\\/18\\\/the-roll-out-of-unaids-voluntary-medical-male-circumcision-programmes-in-sub-saharan-africa-is-it-working\\\/\",\"name\":\"The roll-out of UNAIDS voluntary medical male circumcision programmes in sub-Saharan Africa: Is it working? 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