A man right after being circumcised by Society for Family Health service providers following a SHARe II-sponsored VMMC demand-creation event in Cooma Chiefdom; he led by example by being the first from his village to be circumcised. Project: Support to the HIV/AIDS Response in Zambia II (SHARe II)
Photo credit: JSI/SHARe II
Overview
Voluntary medical male circumcision (VMMC) is the complete surgical removal of the foreskin. It’s a one-time primary prevention intervention that reduces the risk of HIV transmission from women to men by 60 percent. It offers men substantial lifelong partial protection against HIV and a number of other sexually transmitted diseases, and reduces risk of penile cancer and cervical cancer in female partners of circumcised men. By preventing new HIV infections in men, male circumcision indirectly protects women. VMMC offers an excellent opportunity to bring men into health care, link HIV-positive men and their families to treatment, and expand men’s access to the full range of other clinical services. VMMC services are provided as a package of prevention interventions, including safer sex education, condom promotion and provision, HIV testing, and linkage to care and treatment for men living with HIV (MLWH), and management of sexually transmitted infections. As of March 2022, PEPFAR had supported nearly 30 million circumcisions in 15 priority countries in Southern and Eastern Africa; this is estimated to avert at least 340,000 HIV infections and would continue to avert an additional 1.8M HIV infections among men and their female partners by 2030 (WHO and UNAIDS VMMC Progress Brief 2022).
VMMC FOCUS FOR THE NEXT 5 YEARS
Most VMMC priority countries are using recent PHIA data and modeling to learn about their VMMC coverage, estimate the remaining gap (by age and geography) to reach more than 90% saturation and determine where to focus their resources. The VMMC program now needs to accelerate program scale up and maximize impact in underserved communities and age groups to reach high levels of saturation, while establishing robust plans to transition, integrate and sustain the program from vertical, donor funded to routine country-led services.
USAID Impact
Since 2007, the World Health Organization (WHO) and Joint United Nations Programme on HIV/AIDS (UNAIDS) have recommended the implementation of VMMC in countries with high HIV prevalence and low male circumcision prevalence. USAID, through PEPFAR, has been at the forefront of this effort; introducing, launching, and rolling out this effective HIV prevention intervention in 10 VMMC priority countries in Eastern and Southern Africa, including Uganda, Tanzania, Kenya, Namibia, Zambia, Zimbabwe, Malawi, Mozambique, Lesotho, and Eswatini.
USAID works in close collaboration with host country governments, other U.S. Government agencies, multilateral and bilateral donors, the private sector, and implementing partners to effectively implement the the VMMC program through several key approaches including:
- Technical assistance for program design, implementation, monitoring and evaluation.
- Technical assistance for policy, strategic, and operational plan development.
- Generation of coverage estimates to inform target setting and impact projections for VMMC programs through the VMMC Decision-Makers' Program Planning Toolkit 2 monitoring and planning tool.
- Service delivery, including demand creation and communication, human resources for health, monitoring and evaluation, and quality assurance and improvement.
- Identification and sharing of best practices and support for regional learning exchange.
- Monitoring and management of adverse events and ensuring client safety.
- Continuous quality improvement supported by External Quality Assessments (EQAs) that ensure that VMMC programs are conducted according to WHO/UNAIDS, PEPFAR and national guidelines and that VMMC service delivery remains optimal.
- Advocacy for the transition to sustainable VMMC programming.
- Commodity procurement and logistics management including quality assurance on commodities and distribution.
2022 Achievements
From FY15 to FY22, USAID through PEPFAR, has supported up to 8 million men to receive VMMC services across 11 priority countries. Despite COVID-19 related service interruptions, USAID programs were still able to provide 795,270 medical circumcisions in FY20 and over 650,000 circumcisions in FY21. As of FY22, the program has adapted well from the COVID-19 pandemic and bounced back with 670,593 total circumcisions.
Figure 1: USAID total and cumulative number of male circumcisions, per year from fiscal years (FY) 2015 - 2022
Figure 2: USAID - Number of male circumcisions performed by country during FY22
Seven out of 10 USAID supported countries Kenya, Uganda, Zambia, Zimbabwe, Malawi, Eswatini and Namibia achieved at least 90% of their annual targets, (Figure 3) targets in FY22.
Figure 3: USAID Number and proportion of male circumcisions performed against FY22 annual targets by country.
With PEPFAR’s age guidance to reach sexually active, older adolescent boys and men, all USAID supported VMMC countries strengthened their ability to reach priority age groups of men 15 years or older who are at risk of acquiring HIV. During FY20, USAID programs successfully transitioned VMMC services from minor clients aged 10-14 years of age to older age groups ages 15 and older. USAID’s VMMC performance by age group during each quarter can be seen in the graph below. USAID will continue to work with all VMMC supported countries to improve uptake of VMMC services among priority age groups (15 and older), by adapting successful VMMC demand generation approaches.
Figure 4: USAID - Annual male circumcisions results by age over time FY2015 to FY2022
