Prevention of HIV in high HIV settings by voluntary medical circumcision of men

Preventing heterosexually acquired HIV and achieving the global goals of the HIV incident require a combination of interventions. Voluntary medical male circumcision (VMMC) is one of these interventions in high-burden HIV settings. New guidelines from the World Health Organization (WHO) update earlier recommendations on the VMMC for HIV prevention.

These new guidelines provide additional evidence in favor of VMMC’s continued service as part of combined prevention for adult men and adolescents 15 years of age and older, as well as the safety of retrained male device circumcision methods and interventions to improve sigh service among men. The guidelines also provide a framework for health systems that guide the transition to sustainable adolescent-focused services and the maintenance of high VMMC coverage.

“In 2007, three randomized controlled trials of the ‘gold standard’ showed that VMMC reduced men’s risk of heterosexual HIV by 59%. Now, more than 10 years of further evidence shows that VMMC has a significant effect in real-world environments. This includes an independent prevention effect in environments where other HIV prevention measures, such as pre-exposure prophylaxis (PrEP) and anti-retroviral therapy, have been brought to a size. VMMC is cost-saving – it eliminates the cost of lifelong HIV treatment among people protected from infection. We must do all we can to advocate for greater political support and funding to increase and maintain coverage of VMMC services in East and South Africa, where the burden and potential impact on HIV is greatest. “said Meg Doherty, director of the World Health Organization for the global HIV, hepatitis and STI virus.

“Similar to the prevention of COVID by applying several interventions, VMMC is an essential option in the tool of effective HIV prevention interventions in East and South Africa. The new guidelines recommend VMMC services for adolescents 15 years of age and older and for men, especially those at higher risk of HIV infection. Considerations were also presented on whether VMMC should be offered to younger adolescents (aged 10–14 years), taking into account their diversity in physical and cognitive development, including their ability to give consent. When communities, parents, and partners are involved, they can support decisions about that prevention option. said Frank Lule, physician, WHO Regional Office for Africa.

“VMMC has reached over 25 million men in East and South Africa by 2019, avoiding an estimated 650,000 to 1.5 million HIV infections by 2030, depending on the scope of other preventive interventions. As countries achieve higher levels of VMMC coverage, services will move to sustainable approaches that focus on each new generation of adolescents. The integration of service delivery into established health systems is in line with global efforts to strengthen health systems. These new guidelines offer considerations for maintaining VMMC services using WHO health system “building blocks”. Said Lycias Zembe, Technical Prevention Officer, United Nations Joint Program on HIV / AIDS in Switzerland.

In the guidelines, the WHO emphasizes the importance of providing safe and efficient VMMC services. Patient safety measures and monitoring of adverse events are crucial for all VMMC programs.

“Patient safety is a top priority for VMMC programs in Zambia. The National Strategic Plan for Surgery, Obstetrics and Anesthesia (NSOASP) for the period 2017-2020 provides a broad framework for planning, providing and managing quality surgical (including VMMC), obstetric and anesthesia services at all levels of health delivery systems. One of the goals of this strategy is to build safe and high quality surgical systems. For VMMC intervention, the key to this success is effective and timely monitoring of adverse events and improvement of the learning culture through strengthened health management information systems and research capabilities. “explained Albert Kaonga, Head of HIV Prevention Program, Ministry of Health, Zambia.

The WHO guidelines update the recommendations on the use and safety of WHO retrained devices based on male circumcision methods, including new techniques and devices. Such innovative surgical methods can further improve safety, simplify the procedure, and possibly increase acceptability and access. These additional methods may have advantages over conventional surgeries, but their use is limited and needs to be further expanded and safety measured in real-world settings.

“VMMC services come to men and adolescents who often do not seek health care. Services include a package with safer sex education, condom promotion and the recognition and treatment of sexually transmitted infections. VMMC contributes to reducing the risk of other STIs such as human papilloma virus, which causes cervical cancer. HIV, STI, and sexual and reproductive health programs and services need to work more closely together to provide more health services needed by adolescent boys and men. The services provided need to be improved and refocused to be tailored to men, including adolescents. said Sinokuthemba Xaba, VMMC National Program Coordinator, Ministry of Health and Child Welfare, Zimbabwe.