Scaling up voluntary medical male circumcision

1. Scaling up voluntary medical male circumcision Catherine Hankins MD MSc FRCPC Chief Scientific Adviser to UNAIDS Office of the Deputy Executive Director, Programme THE CUTTING EDGE: What's New in Voluntary Medical Male Circumcision Rome, 19th International AIDS Society, July 2011

2. WHO/UNAIDS Technical Consultation Male Circumcision and HIV Prevention: Research Implications for Policy and Programming Montreux, Switzerland 6- 8 March 2007 Courtesy C Hankins

3. Male Circumcision Priority Countries

4. Community buy-in and engagement of traditional leaders Political will and country ownership Strategic communication Strong leadership and coordination from the Ministry of Health with the National and Provincial MC Task Forces Enough resources for service delivery Technical support from partners Capacity to change strategy as new information becomes available Task shifting to clinical officers and nurses Mobility of service delivery: taking services to people Dedication of sites with campaign style Mixed staffing models (public and private/NGO) Practicality: temporary services, continuous services Innovation Facilitating Factors in VMMC scale-up

5. Communicating about partial protection

6. Male circumcision for HIV prevention in high HIV prevalence settings: What can mathematical modelling contribute to informed decision making? PLoS Medicine 2009: e1000109 6 modelling teams addressed 8 questions of key concern to policy makers Population-levelImpacts by Coverage Women will benefit indirectly, although the effect will be smaller than the direct effect for men and will take longer to develop. The benefits are likely to be large, with one HIV infection averted for every 5 to 15 male circumcisions performed, using a 10 year horizon. Medical male circumcision is highly cost-effective with costs to avert one HIV infection from US$150-$900 using a 10 year time horizon. UNAIDS/WHO/SACEMA

7. Number of MC needed per Infection Averted from 2011 to 2025 Courtesy Emmanuel Njeuhmeli, PEPFAR

8. Decision-makers’ programme planning tool • Developed by Futures Institute in collaboration with UNAIDS under the USAID/Health Policy Initiative • Supports decision makers to understand the cost and impact of scaling-up male circumcision services by service delivery approach, priority populations, pace of scale-up • Populations: • All adult males • 15-24 or 15-29 year old males • Adolescents prior to starting sexual activity • Newborns • Men at higher risk of HIV exposure • others

10. Annual male circumcisions for HIV prevention in eight countries* in Eastern and Southern Africa, 2008–2010 Thousands 400 300 200 100 * Kenya, Malawi, Namibia, Rwanda, South Africa, Swaziland, Zambia and Zimbabwe 0 2008 2009 2010

11. Achievement toward target of 80% coverage Courtesy Emmanuel Njeuhmeli, PEPFAR

12. Supply & Demand - Ideal VMMC Supply VMMC Demand Courtesy Jason Reed PEPFAR

13. Supply & Demand Equation Calculus Courtesy Jason Reed PEPFAR

14. Developedby WHO, UNAIDS, AVAC, and FHI Zero new HIV infections Zero discrimination Zero HIV-related deaths