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Roselyne Sachiti Features, Health & Society Editor
About 4,1 million voluntary medical male circumcisions (VMMCs) were performed in 15 priority countries in Eastern and Southern Africa in 2018 alone with 11 million having been carried out since the beginning of 2016, UNAIDS said on Monday.

The 15 priority countries include Botswana, Eswatini, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, South Sudan, Uganda, Tanzania, Zambia and Zimbabwe.

The voluntary circumcisions which were performed among males of all ages in 2018, are a slight increase from the 4 million carried out in 2017.

In its latest update UNAIDS said there has been progress towards the target of 25 million additional circumcisions for HIV prevention from 2016 to 2020.

However, added UNAIDS, at the end of 2018, when 15 million circumcisions should have been performed, the world was off-target by 4 million circumcisions.

Voluntary medical male circumcision (VMMC) — the removal of all or part of the foreskin of the male sexual organ by a trained health-care professional — reduces heterosexual male vulnerability to HIV infection by approximately 60 percent.

Its effects last a lifetime.

Most interesting is VMMC is also an entry point for providing men and boys, who traditionally do not have health seeking behaviour, with broader health packages to improve their health, and indirectly benefits women and girls.

It can have a major impact on HIV epidemics in high-prevalence settings.

The VMMC services are comprehensive and incorporate a package of prevention interventions, including safer sex education, education on and provision of condoms, HIV testing and the management of sexually transmitted infections.

Zimbabwe launched a VMMC campaign in 2009, aiming for 1,3 million men by 2015, after studies showed that circumcision reduced the risk of contracting HIV by 60 percent.

The country has made remarkable headway in the HIV response and strengthening focus on HIV prevention cannot be over emphasised and VMMC is one of the key interventions.

In June 2018, Zimbabwe celebrated reaching One million men for VMMC and the launch of the Pre-Exposure Prophylaxis (PrEP) Strategy.

VMMC is cost-effective

Estimates by the World Health Organisation say US$16,5 billion could be saved in HIV treatment and care costs by 2025, if even 80 percent coverage is achieved in priority countries.

The evidence of money saved is compelling. According to avert, a UK-based charity that has been providing information about HIV and sexual health worldwide for over 30 years, male circumcision is a one-off procedure and therefore, unlike ART, has no ongoing costs. Once a man has undergone the procedure, he will benefit from the preventive effect for the rest of his life.

VMMC is also cost-effective as it prevents new HIV infections, thereby reducing the number of people needing HIV treatment and care.

Moreover, according to AVERT, a study in South Africa reported the cost of VMMC per person to be US$132.

“Unlike previous studies, which calculated the cost of VMMC in South Africa to be around US$49 per person, this analysis took indirect costs such as demand creation into account, as well as direct costs such as staff time. As the largest proportion of money spent on VMMC went on direct labour, accounting for 43 percent of costs, the study estimated that shifting the task from doctors to nurses could save at least US$15 million a year.”

In their analysis, AVERT also said a study on VMMC services for young homeless men in Eldoret, Kenya found VMMC to be highly cost effective.

“The cost per person of VMMC was estimated at US$108 per person (around US$10 of this was the direct cost of the procedure itself, the rest was spent on indirect costs such as staffing and education programmes).

“The intervention was estimated to save US$267 per person, based on the cost per disability adjusted life year, which describes one lost year of ‘healthy’ life, for each person. The intervention was also estimated to have averted around 8 500 new HIV infections among young men in the area over five years.”

Effectiveness

While male circumcision has been found to reduce the female-to-male sexual transmission of HIV, circumcised men can still become infected with HIV, and if HIV-positive, can infect others.

The WHO makes it clear that:

Male circumcision should never replace other known effective prevention methods and should always be considered as part of a comprehensive prevention package, which includes correct and consistent use of male or female condoms, reduction in the number of sexual partners, delaying the onset of sexual relations, and HIV testing and counselling.