Voluntary medical male circumcision: an introduction to the cost, impact, and challenges of accelerated scaling up

Abstract

Scaling up voluntary medical male circumcision (VMMC) for HIV prevention is cost saving and creates fiscal space in the future that otherwise would have been encumbered by antiretroviral treatment costs. An investment of US$1,500,000,000 between 2011 and 2015 to achieve 80% coverage in 13 priority countries in southern and eastern Africa will result in net savings of US$16,500,000,000. Strong political leadership, country ownership, and stakeholder engagement, along with effective demand creation, community mobilisation, and human resource deployment, are essential. This collection of articles on determining the cost and impact of VMMC for HIV prevention signposts the way forward to scaling up VMMC service delivery safely and efficiently to reap individual- and population-level benefits.

Figure 1. Achievement towards target of 80% coverage.

This figure illustrates that most countries have had only limited success in bridging the gap between historical male circumcision levels and the 80% target. The one exception is Kenya, which has achieved more than 66% of its objective, primarily in Nyanza Province.

Figure 2. Cumulative number and percentage of HIV infections averted between 2011 and 2025 by scaling up adult VMMC to reach 80% coverage in five years.

This figure illustrates the significant impact that achieving 80% VMMC coverage of 15- to 49-year-old men would have on the epidemics in 13 countries in eastern and southern Africa. South Africa can avert the largest number of HIV infections (over 1 million between 2011 and 2025); Zimbabwe can avert the highest percentage of new HIV infections (almost 42%). More than 20% of new HIV infections would be averted between 2011 and 2025 in nine countries: Botswana, Lesotho, Malawi, Namibia, Rwanda, Swaziland, Uganda, Zambia, and Zimbabwe. Nyanza refers to Nyanza Province in Kenya: the data presented are only for Nyanza Province in Kenya, as this is the only province in Kenya with prevalence of male circumcision lower than 80% and is the province with the highest HIV prevalence compared to the national average.