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
- 1)Effective combination prevention strategies, including high VMMC coverage combined with the HIV prevention benefits of ART, will be necessary to reach the 2030 United Nations HIV incidence goals in East and Southern Africa.
- 2)A minimum package of services, including education on safer sex, condom promotion, offer of HIV testing services and management of STIs, must be delivered along with the surgical procedure.
- 3)The 23 million VMMCs performed through 2018 are estimated to have averted 250 000 HIV infections in the 15 priority countries of East and Southern Africa, with even larger future benefits, given VMMC’s lifelong partial protection. The number of infections averted by these circumcisions is projected to grow to 1.1 million by 2030 even if no more VMMCs were performed.
- 4)VMMC should be offered through the formal health sector and performed by competent trained health professionals.
- 5)Circumcised men and their female partners experience lower rates of several sexually transmitted infections (STIs), including human papillomavirus, herpes simplex virus-2, bacterial vaginosis and Trichomonas vaginalis.
- 6)Women benefit indirectly, from the lower risk of HIV infection in circumcised men as VMMC programmes expand and fewer men acquire HIV.
- 7)Women may be less likely to acquire HIV infection from an HIV-positive man who is circumcised than from one who is not, except when the man is recently circumcised and healing.
- 8)For adolescents ages 15 through 19 years, consent procedures must reflect the legal age for minor surgery in the country.
- 9)VMMC is a cost-effective and cost-saving HIV prevention intervention in countries of East and Southern Africa when compared with lifetime costs of ART.
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