Adult Male Circumcision

What is Adult Male Circumcision for HIV Prevention?

Medical male circumcision refers to the surgical removal of some or all the foreskin of the penis by a trained health professional. The research that has been done to date also shows that medical male circumcision reduces men’s risk of HIV infection and genital ulcer disease. It is believed that removing the foreskin with the vulnerable cells and the resulting toughening of the skin covering the penis decreases a man’s risk of acquiring HIV during sexual intercourse.

Medical male circumcision refers to the surgical removal of some or all the foreskin of the penis by a trained health professional. The research that has been done to date also shows that medical male circumcision reduces men’s risk of HIV infection and genital ulcer disease. It is believed that removing the foreskin with the vulnerable cells and the resulting toughening of the skin covering the penis decreases a man’s risk of acquiring HIV during sexual intercourse.

Adult Male Circumcision Investment

Global public-sector and philanthropic investment in R&D and operations research related to voluntary medical adult male circumcision (VMMC) totaled nearly US$32 million in 2012, a decrease of 42 percent from 2012. The BMGF funded the majority of VMMC research, at US$27.2 million, and the US public sector was the second largest funder, with the CDC contributing US$2.5 million and the NIH investing US$1.2 million.

With the World Health Organization (WHO) recommending full implementation, and with a target set to provide circumcisions for 20 million men in 14 African countries by 2015, VMMC is currently in an implementation phase. Data from Kenya, South Africa and Uganda have already shown that male circumcision reduces the individual risk of HIV infection by 60 percent.15 Study results released in 2011 by France’s ANRS Orange Farm study showed that rollout in the southern and eastern regions of Africa was able to significantly decrease the community level of HIV in high-prevalence areas, and additional results from 2013 confirmed the effectiveness of VMMC in reducing the risk of HIV infection.

Ongoing research in 2013 funded by the NIH at a level of US$1.2 million (a decrease of US$3 million from 2012) focused on the socio-behavioral aspects of VMMC, such as public outreach campaigns for effective implementation of circumcision programs and risk compensation studies, and continuing R&D related to the effect of circumcision on HIV risk.

The largest funder of VMMC implementation research remains the BMGF, which increased its investment from 2012 to 2013 by US$7 million—accounting for most of the 2013 investment increase in this area. BMGF grants focused on the monitoring of scale-up, demand creation and delivery.

Investors also focused on PrePex and the Shang Ring, new devices that were shown in 2011 to be safe and effective, both requiring less surgical skill than traditional male circumcision techniques. Studies to confirm the results of evaluations of PrePex and the Shang Ring were ongoing in 2013 in Zambia, Rwanda and Kenya, supported by funds from the BMGF and USAID. In June 2013, PrePex received prequalification from WHO. Three other devices—the Shang Ring, Plastibell and Tara KLamp—are in the WHO prequalification process, but have not yet been approved.



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