Bibliographic Info
Recommendation
Recommended in favor
Strong
Certainty of evidence
High
Voluntary medical male circumcision (VMMC) should continue to be promoted as an additional efficacious HIV prevention option within combination prevention for adolescents 15 years and older and adult men in settings with generalized epidemics to reduce the risk of heterosexually acquired HIV infection
Notes and Remarks
Decisions on offering VMMC to younger adolescents 10–14 years must consider several factors based on new evidence, human rights and national and local context, including:
- the public health burden of HIV and the impact on HIV incidence of deferring circumcisions among those ages 10–14 years;
- human rights guidance to postpone non-emergency invasive and irreversible interventions until the child is sufficiently mature to provide informed consent;
- capacity of health workers to facilitate informed consent and the existence of supportive policies to ensure that children, parents and health workers have adequate rights-based guidance on consent, assent and confidentiality;
- safety of procedure: increased risk of serious adverse events among adolescents with immature genitalia (usually under 15 years); therefore, encourage deferral until they are more physically developed;
- preferences of adolescent, parents, community on providing VMMC as a safer alternative to traditional male circumcision.
Also Featured In
This recommendation also appears in the following guidelines:
Preventing HIV through safe voluntary medical male circumcision for adolescent boys and men in generalized HIV epidemics: recommendations and key considerations: web annex 2.3 part 2. synthesis of literature on voluntary medical male circumcision: facilitators and barriers, by country
Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach