Voluntary Medical Male Circumcision

Our Approach and Results

The World Health Organization (WHO) and Joint United Nations Programme on HIV/AIDS (UNAIDS) have recommended the implementation of VMMC in Eastern and Southern African 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, including Eswatini, Kenya, Lesotho, Malawi, Mozambique, Namibia, Tanzania, Uganda, Zambia, and Zimbabwe.

Most VMMC priority countries are using recent Population-Based HIV Impact Assessment (PHIA) data and modeling to estimate their VMMC coverage and the remaining gap (by age and geography) to reach UNAIDS coverage targets of 90% or more among 15-49 year old men, and determine where to focus their resources. The VMMC program is working to accelerate program scale up and maximize impact in underserved geographies and age groups to reach and maintain 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 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 Implementation Planning Toolkit.

• Service delivery, including social and behavior change (SBC), human resources for health capacity strengthening, 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 safely according to global and national guidelines and maintain high quality of VMMC service delivery.

• Advocacy for the transition to sustainable VMMC programming, including uninterrupted funding.

• Supply chain and logistics management, including quality assurance of commodities and distribution to sites.

USAID's efforts in VMMC have led to achievements in the following areas:

• In 2023, USAID’s work resulted in reaching more than 628,000 men with VMMC services in 10 countries (Eswatini, Kenya, Lesotho, Malawi, Mozambique, Namibia, Tanzania, Uganda, Zambia and Zimbabwe).

• Five out of 10 USAID supported countries (Kenya, Tanzania, Uganda, Zambia, and Zimbabwe) achieved at least 90% of their annual targets in FY23.

• In FY20, USAID programs successfully transitioned VMMC services from clients below 15 years of age to older adolescents and men who are more likely to be sexually active and at risk of acquiring HIV, in accordance with updated WHO and PEPFAR guidance.

  •  USAID will continue to work with all VMMC supported countries to improve uptake of VMMC services among priority age groups by adapting successful social and behavior change approaches.