![]() ![]() Between 20, nearly 18.6 million VMMCs were reported in priority countries with the support of national and global programs including the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria. The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) designated 14 priority countries in southern and eastern Africa with high national HIV prevalence and low coverage of male circumcision (MC), as of 2017 consisting of Botswana, Eswatini, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe (in 2018 South Sudan was included, bringing the total priority countries to 15). Īs a result of this compelling evidence, the regional scale-up of VMMC has been immense. Further, there is growing evidence that VMMC reduces risk of HIV transmission among men who have sex with men (MSM). Protective effects also extend to partners of circumcised men female partners have decreased risks of genital ulcer disease, cervical cancer, trichomonas infection, and bacterial vaginosis, among other outcomes. VMMC provides a unique opportunity to increase awareness of HIV status among millions of men and boys who might otherwise forgo HIV testing. Moreover, VMMC is one-time, efficient, safe, cost-effective, and the only HIV prevention method specifically aimed at heterosexual men-a group with historically low HIV testing rates. Recent evidence justifies the VMMC implementation now in progress, bolstered by additional meta-analyses. Outside of a clinical trial setting, several long-term assessments have confirmed VMMC’s protective role in reducing HIV burden, and even demonstrated a rise in effectiveness as high as 73%. Typically limited to boys and men ages 10 years and older, VMMC reduces the risk of female-to-male transmission of HIV by 50–60%. Voluntary medical male circumcision (VMMC), defined as the complete surgical removal of the foreskin, has emerged in recent years as an effective intervention to reduce HIV transmission risk. ![]() ![]() In 2017, an estimated 25.9 million people were living with HIV in sub-Saharan Africa, with over one million newly infected in that year. These mapped results provide an actionable tool for understanding local needs and informing VMMC interventions for maximum impact in the continued effort towards ending the HIV epidemic in sub-Saharan Africa.ĭespite considerable progress made in combating the HIV epidemic in the past three decades, HIV/AIDS remains the single largest cause of health loss among men and women of reproductive age in sub-Saharan Africa. Conclusionsĭespite MC prevalence increases in all priority countries since the onset of VMMC campaigns in 2008, MC prevalence remains below the 80% coverage target in most subnational areas and is highly variable. In 2017, only three priority countries (Ethiopia, Kenya, and Tanzania) were likely to have reached the MC coverage target of 80% at the national level, and no priority country was likely to have reached this goal in all subnational areas. Although estimated national MC prevalence increased in all priority countries with the onset of VMMC campaigns, seven priority countries contained both subnational areas where estimated MC prevalence increased and areas where estimated MC prevalence decreased after the initiation of VMMC campaigns. We found striking within-country and between-country variation in MC prevalence most (12 of 14) priority countries had more than a twofold difference between their first administrative level units with the highest and lowest estimated prevalence in 2017. We analyzed geo-located MC prevalence data from 109 household surveys using a Bayesian geostatistical modeling framework to estimate adult MC prevalence and the number of circumcised and uncircumcised men aged 15–49 in 38 countries in sub-Saharan Africa at a 5 × 5-km resolution and among first administrative level (typically provinces or states) and second administrative level (typically districts or counties) units. Nonetheless, relatively little is known about local variation in male circumcision (MC) prevalence. From 2008 to 2017, over 18 million VMMCs were reported in priority countries. The World Health Organization (WHO) and Joint United Nations Programme on HIV/AIDS (UNAIDS) identified 14 priority countries for VMMC campaigns and set a coverage goal of 80% for men ages 15–49. Voluntary medical male circumcision (VMMC) reduces the risk of female-to-male transmission of HIV by 50–60%. HIV remains the largest cause of disease burden among men and women of reproductive age in sub-Saharan Africa.
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