Male Circumcision for HIV Prevention: Challenges to Policy Development and Implementation

Mokete Joseph Titus, Jack Moodley

Abstract


Male Circumcision [MC] is being promoted by health services as an additional HIV prevention measure following results of three randomised controlled trials [RCTs] which demonstrated a 50% reduction in HIV transmission in males who engage in unprotected heterosexual activity. Added impetus for promotion of MC has come from traditional leaders and politicians. Amid conflicting reports on estimates of the cost of the programme, the campaign has already started and it would seem that this is taking place at circumcision camps using the Tara KLampô [TK]. By the end of June 2010, the procedure had been carried out on more than 1000 men. In addition, the standard forceps-guided [FG] method would be used at various public hospitals in the province. The procedures are being carried out by health care personnel and patients are discharged within 24 hours of completion of the procedure. As far as we know, there are no objective reports as yet of the clinical outcomes of MMC performed at the circumcision camps. This is of particular import as reports on complications with the use of the TK for MC are limited and contentious. Health care professionals are currently being trained on the use of the Tara KLamp for mass MMC in KZN. A recent report in mass print media stated that of the 5571 circumcisions performed as at end of July 2010, more than 800 have been done with the TK. This gives us the opportunity to compare the two methods in terms of acceptability, complications, costs and sustainability. It is also of particular interest to know how the communities in the targeted areas will respond to the MMC campaign as KZN is a high prevalence area for HIV infection and a low prevalence area for MC which fulfils the criteria for the recommendations from the WHO and UNAIDS for the promotion of or scaling up of MC for HIV prevention.