Annual numbers of male circumcisions
PROGRESS BRIEF
WHO PROGRESS BRIEF
VOLUNTARY MEDICAL MALE CIRCUMCISION FOR HIV PREVENTION IN 14 PRIORITY COUNTRIES IN EAST AND SOUTHERN AFRICA JUNE 2016
Key highlights of voluntary medical male circumcision (VMMC) programmes: • Nearly 11.7 million cumulative VMMCs were performed through 2015. Since 2008, 11 685 591 VMMCs had been performed for HIV prevention in the 14 priority countries of east and southern Africa (Fig. 1). Among these, 2.2 million were carried out in 2015 alone, attaining 56% of the global VMMC target of 20.8 million, set in 2011. • The majority (61%) of VMMCs performed were among the prime target population of males aged 15 years and older, based on 2015 age-disaggregated reporting from 10 countries. • Countries are attaining and surpassing targets. In 2015, Ethiopia (Gambella province), Kenya and the United Republic of Tanzania surpassed their targets set in 2011. The cumulative number of VMMCs performed in four other countries—Mozambique, South Africa, Uganda and Zambia—attained more than 50% of VMMCs targeted. • Overall numbers of VMMCs performed declined from 2014 to 2015. While five countries in the region—Kenya, Malawi, Namibia, South Africa and Swaziland— showed an increase in the number of VMMCs performed in 2015 compared with 2014, all other countries in the region reported decreases over the same period. The declines in the number of VMMCs carried out in 2015 may be attributed to supply-side factors such as reductions in external and domestic funding for VMMC, limited numbers of health-care workers available to perform VMMC and to demand-side factors.
Figure. Annual number of voluntary medical male circumcisions performed for HIV prevention in 14 countries in East and Southern Africa, 2008–2015 3 500 000 3 000 000 2 500 000 2 000 000 1 500 000 1 000 000 500 000 0
Botswana
Cumulative total: 11 685 591 VMMC through 2015
Ethiopia Kenya Lesotho Malawi Mozambique Namibia Rwanda South Africa Swaziland Uganda United Republic of Tanzania Zambia Zimbabwe
2008
2009
2010
2011 2012 Year
2013
2014
2015
WHO / HIV / 2016.14
Source: Global AIDS Response Progress Reporting from national programmes, UNAIDS/UNICEF/WHO
• The 11.7 million VMMCs are projected to avert 335 000 HIV infections by 2025 and nearly half a million infections by 2030. Importantly, under the UNAIDS Fast Track approach, VMMC is projected to avert 16% of HIV infections, with condom use for those with multiple partners projected to avert 37% and effective ART use an additional 37%.1,2 • VMMC services provide a much needed entry point for reaching adolescents and men with other HIV prevention and health services, including HIV testing; and for linking those who test positive to treatment and care, safer sex education, condom education and provision,
sexually transmitted infections management and other local and age-relevant health services such as tetanus-toxoid-containing vaccination. • VMMC continues to be accepted and demanded. Despite an overall 19% decrease in the number of VMMCs performed in 2015 compared with 2014, uptake by over 2.5 million men during the past three years demonstrates the continued acceptability of VMMC in east and southern Africa. The nearly 400% increase in the annual number of VMMCs performed since 2010, when scale-up began to take off, reaffirms the feasibility and the potential
for further expansion of this highly effective intervention for reducing men’s heterosexual acquisition of HIV. As countries shift from reaching early acceptors of VMMC to reaching later acceptors who act in response to different motivational approaches, innovative approaches are needed to sustain increases in VMMC. ENDNOTES 1 United States Agency for International Development (USAID) Project Strengthening Opportunities and Access to Resilience (SOAR), using Decision Makers Program Planning Toolkit (DMPPT) 2.1 for modelling and Global AIDS Response Progress Reporting for numbers of VMMCs 2 Stover J, Bollinger L, Izazola JA, Loures L, DeLay P, Ghys PD et al (2016). What is required to end the AIDS epidemic as a public health threat by 2030? The cost and impact of the fast-track approach. PLoS ONE 11(5): e0154893, diu:10.1371/journal.pone.0154893
Table. Annual numbers of voluntary medical male circumcisions in east and southern Africa by country, 2008–2015 Country Botswana Ethiopia Kenya Lesotho Malawi Mozambique Namibia Rwanda South Africa Swaziland Uganda United Republic of Tanzania Zambia Zimbabwe Total 2008 0 0 11 663 0 589 0 0 0 5 190 1 110 0 0 2 758 0 21 310 2009 5 424 769 80 719 0 1 234 100 224 0 9 168 4 336 0 1 033 17 180 2 801 122 988 2010 5 773 2 689 139 905 0 1 296 7 633 1 763 1 694 131 117 18 869 21 072 18 026 61 911 11 176 422 924 2011 14 661 7 542 159 196 0 11 881 29 592 6 123 25 000 296 726 13 791 77 756 120 261 85 151 36 603 884 283 2012 38 005 11 961 151 517 10 835 21 250 135 000 4 863 138 711 422 009 9 977 368 490 183 480 173 992 40 755 1 710 845 2013 46 793 16 393 190 580 37 655 40 835 146 046 1 182 116 029 514 991 10 105 801 678 329 729 294 466 112 084 2 658 566 2014 30 033 11 831 193 576 36 245 80 419 240 507 4 165 173 191 482 474 12 289 878 109 573 845 315 168 209 125 3 240 977 2015 15 722 9 744 207 014 25 966 108 672 198 340 18 459 138 216 485 552 12 952 556 546 435 302 Total 156 411 60 929 1 134 170 110 701 266 176 757 218 36 779 592 841 2 347 227 83 429 2 703 651 1 661 676 % progress towards 2011 targets
45 152 132 29 13 71 11 34 54 45 64 121 60 31 56
222 481 1 173 107 188 732 601 276 2 623 698 11 685 591
Source: Global AIDS Response Progress Reporting from national programmes, UNAIDS/UNICEF/WHO
It is important to continue to grow the coverage of VMMC to attain the new 2020 Fast Track target of 90%, which goes beyond the 80% coverage target set in 2011. In 2015, funding gaps for VMMC had already been reported in most countries of the subregion and these are projected to increase in the coming years. In the context of reduced available resources, there is a need to achieve greater programmatic efficiencies, innovate and increase commitment.
For more information, contact: World Health Organization Department of HIV/AIDS 20, avenue Appia 1211 Geneva 27 Switzerland E-mail: hiv-aids@who.int www.who.int/hiv © World Health Organization 2016
PROGRESS BRIEF
MALE CIRCUMCISION FOR HIV PREVENTION