Scaling up voluntary male medical circumcision
A few weekends ago, I promised that I would share with you findings from the collection of studies that were published in the Public Library of Science (PLoS) collections. The set of articles highlight “how scaling up voluntary medical male circumcision (VMMC) for HIV prevention in eastern and southern Africa can help prevent HIV not only at individual but also at community and population level as well as leading to substantial cost savings for countries as a result of averted treatment and care costs.” (PloS website).
VMMC involves a single surgical intervention that offers partial life-long protection against acquiring HIV for men and protects women against cervical cancer. The collected reports on findings from programmes aimed at circumcising 20.3 million boys in 14 priority African countries by 2016. This could lead to the prevention of 3.5 million new HIV infections and a saving of $16 billion in medical treatment over 15 years! So far US PEPFAR has supported 4.7 million VMMC services. The scale up has been remarkable!
A report from Malawi is noticeably absent from the collection although I am led to believe, based on online reports, that Malawi has been involved in a number of US PEPFAR and JHPIEGO VMMC campaigns in Thyolo.
A USAID report which, unfortunately is now out of date, modelled and proposed 1.1 million VMMCs in 2012 in Malawi would lead to preventing 265 000 HIV infections between 2009-2025 and result in saving of $1,2 million. In the past, Malawi has been slow to take up VMMC which I suspect was due to government’s concern that people may misunderstand and not realise that circumcision only provides partial protection. Hence the release of 2012-2016 Malawi Voluntary Medical Male Circumcision Communication strategy.
In the communication strategy, it is reported that national circumcision is only around 1 in 5 people with majority of circumcision in the Southern Region, 12 percent in Central Region and five percent in the North. The communication strategy is a well developed document, with research informing its discussion and theoretical frameworks that guides its strategy. Its only downfall is it lists six key messages; too many keys messages confuse audiences. A look at demandcreationforvmmc website – some great posters – under the banner Ndife Otsogola – Tasankha mdulidwe wa abambo wakuchipatala.
Malawi is one of the countries (10 out of 18 for which USAID has figures) where more of the CIRCUMSIED men (13.2%) have HIV than the non-circumcised (9.5&), so how can more circumcisions result in less HIV? That modelling was based on other countries and there is no reason to assume it will apply to Malawi.
There is plenty of evidence that claiming circumcision reduces HIV rates overall will confuse people into thinking that getting circumcised protects them individually. They will act on that, throw caution (and condoms) to the wind, and HIV rates will rise. It’s a recipe for disaster.