About eight years ago three randomized controlled studies showed done in Uganda, Kenya and South Africa showed that male circumcision for sexually active men provides up to 60% protection against HIV infection. Increasingly with support from PEPFAR, voluntary medical male circumcision (VMMC) is being added to other HIV prevention interventions in high HIV prevalence and low male circumcision prevalence areas, particularly in sub-Saharan Africa.
In Uganda—a largely traditionally non-circumcising country—it is estimated that over the next three years, up to 4.4 million men aged 15 years and above need to be circumcised in order to achieve population-level impact for reduced HIV infection through this intervention. In East Central Uganda where JSI runs the Strengthening TB and HIV&AIDS Responses in East Central Uganda (STAR-EC) program (funded by USAID) an estimated 500,000 men need to be circumcised in the nine districts covered by STAR-EC.
Since 2010, STAR-EC has supported the circumcision of more than 150,000 men in the region through the use of static health facilities, outreach activities, and ‘circumcision camps.’ The uptake of VMMC has so far been impressive and the program and our district-level partners can now support high-quality circumcision services for up to 10,000 men monthly through the innovative methods such as the use of disposable circumcision kits; weekend ‘tent outreaches’ to bring services nearer to those who need them; and week-long ‘circumcision camps’ in hard-to-reach areas where HIV prevalence is high.
Voluntary medical male circumcision is now integrated into other health service delivery since STAR-EC’s approach is to strengthen the public health system to deliver combination HIV prevention interventions. Through this approach, other health services are provided concurrently including HIV counseling and testing (HTC), immunization for children, family planning, laboratory tests, condom promotion, antiretroviral therapy, etc. STAR-EC has ambitious targets and expects that by the end of 2015, half a million men over the age of 15 years will have received VMMC resulting in averting an estimated 26,000 new HIV infections in the region.