A report prepared jointly by AVAC (Global Advocacy for HIV Prevention) who is based in the US, and a number of African based AIDS advocates, calls for a health drive involving Voluntary Medical Male Circumcision (VMMC).
The publication entitled “A Call to Action on Voluntary Medical Male Circumcision: Implementing a Key Component of Combination Prevention” cites VMMC as one of the leading tools in the preventing the spread of HIV. Research has proven it particularly effective in African countries, prompting the involvement of the National Empowerment Network of People Living with HIV/AIDS in Kenya (NEPHAK); Sonke Gender Justice Network (Sonke), in South Africa; and the Uganda Network of AIDS Service Organizations (UNASO), in preparing the report.
Mitchell Warren, executive director of AVAC said:
“Voluntary medical male circumcision is one of the most effective HIV prevention tools available today. Countries where VMMC can have an impact should be acting to ensure access and advocates should be demanding accountability … At this moment in the epidemic, there are few things that could do more to reduce the human and economic toll of HIV. When the AIDS community gathers this month in Washington, we need to refocus on this inexpensive, one-time intervention that offers men life-long partial protection against HIV.”
Figures suggest that VMMC could make quite an impression, with long term projections based on clinical trials on the African Continent, showing the risk of a man contracting HIV from an HIV positive heterosexual female can be up to 75% lower. Putting that figure into action by reaching an 80% VMMC rate in men aged 15-49 in 13 key African countries by 2015, would prevent more than 3.3 million new HIV infections by 2025. The financial benefits are also considerable with some $16 Billion in medical costs saved. Unfortunately, it may no longer be possible to reach the 80% mark, as the uptake has been rather slow, so to some extent, an opportunity has been missed.
Nelson Otwoma, National Coordinator of NEPHAK said:
“Even if we cannot achieve 80 percent VMMC coverage in all priority countries by 2015, each of these countries should issue a clear timeline for when they will meet their targets … My own country, Kenya, provides a positive example. This essential prevention strategy cannot be allowed to stall as it has for some time in many countries.”
There has been some progress and some notable successes though, with 1.5 million circumcision procedures performed in the key African States, however, the US funded PEPFAR program estimated that some 20 million procedures were needed to hit the 80% mark, leaving the progress painfully slow at only 7.7% of the target. The report looks at key areas where progress has been held back. Funding, of course, is always amongst the main challenges to healthcare programs for developing nations, with $1.5 Billion needed over the next five years to meet the 80% target. While this is a tiny amount in comparison to global anti HIV programs, the money just doesn’t seem to be flowing into the VMMC programs.
Leadership in the countries themselves also remains inadequate. When healthcare challenges present themselves, it’s one area that government and community programs can really make a difference, but many of the African nations lack the vision and drive on a national and local level and few politicians or community leaders have taken up the issue. There has been little effort to address the stigma, misinformation and logistical challenges to circumcising 18.5 Billion males. Kenya seems to present a model for progress with rates reaching 45% by 2008 and passing 70% today.
The report says that by the end of the year, all priority African nations should have a VMMC program in place. PEPFAR the largest funder of the VMMC drive, needs to rapidly allocate resources to meet it’s stated goal of an additional 4.7 million circumcisions, and there is also a call for European and middle income countries to step up to the table with contributions to help close the funding gaps. The WHO is also mentioned, with encouragement to produce and test better medical devices to make the procedure easier, especially considering many of the countries lack well equipped medical facilities and can be relatively remote and rural.
A coalition of some 300 African Scientists, including doctors, nurses, counselors and started the drive for public awareness in their nations, with a campaign known as Africans Telling the Truth about VMMC being started in response to what seemed to be a great amount of misinformation and resistance to the preocedure.
As Richard Hasunira of HEPS Uganda, a member of the coalition says:
“The story of male circumcision and AIDS is an African story: it’s largely thanks to African scientists, nurses, doctors, and men and women at risk that we have this powerful option … We’ll certainly need the support of the global community to succeed in scaling up VMMC. But in the end, Africans must continue to lead.”
Written by Rupert Shepherd