Second Edition of PEPFAR’s Best Practices for Voluntary Medical Male Circumcision Site Operations Focuses on Quality

October 25th, 2017 | Viewpoint


Managers of sites providing voluntary medical male circumcision (VMMC) are getting the latest updates and advice on how to set up, provide, and sustain these services for HIV prevention, a key intervention for controlling the epidemic.

The second edition of PEPFAR’s Best Practices for Voluntary Medical Male Circumcision Site Operations focuses on how to establish and maintain quality services at VMMC sites. The first edition, published four years ago, focused on how to set up VMMC sites.

The second edition, published by the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the US Agency for International Development, and developed by JSI’s AIDSFree Project is available here.  

Proven safety and efficacy

VMMC, the surgical removal of the foreskin of the penis, remains a vital intervention because it’s safe and cost-effective, and has been shown to significantly reduce men’s risk of acquiring HIV through heterosexual sex. It also brings men—still an underserved, vulnerable population even as countries move toward epidemic control—into the health arena. VMMC is a kind of gateway service, bringing men into the health care system and giving them access to broader services, including HIV testing and care.

The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) have endorsed VMMC as part of a package of HIV prevention services, recommending 80 percent coverage in countries with high HIV prevalence and low circumcision rates. The 80 percent threshold is the point at which VMMC services (combined with other essential prevention and treatment interventions) contribute to reduced HIV incidence and control of the epidemic.

PEPFAR’s focus is on supporting countries in sub-Saharan Africa to reach that level of coverage, also called “saturation,” especially among men aged 15–29. The second edition’s focus on quality assurance reflects the maturity of the VMMC program and the number of sites already established since 2009.  

The document guides PEPFAR implementing partners with approaches for providing high-quality VMMC services at the facility or site level. It also provides direction on how to ensure successful VMMC scale-up from the site level to the global level. It emphasizes strengthening or enhancing linkages among other men’s health services, increasing community-level support and participation, and using data to develop the most cost-effective interventions possible.

A Goal of 27 Million Men

As of December 2015, PEPFAR had supported a cumulative total of 11.7 million circumcisions in 14 priority countries. PEPFAR continues to support the goal of the WHO/UNAIDS initiative VMMC 2021, aimed at reaching 27 million men with VMMC services as part of integrated sexual and reproductive health services for men. The expectation is that the countries’ progress in establishing robust and sustainable systems and services will help move Africa and the world toward control of the HIV epidemic.

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