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Morbidity and Mortality Weekly Report logoLink to Morbidity and Mortality Weekly Report
. 2023 Mar 10;72(10):256–260. doi: 10.15585/mmwr.mm7210a2

Voluntary Medical Male Circumcisions for HIV Prevention — 13 Countries in Eastern and Southern Africa, 2017–2021

Megan E Peck 1,, Katherine S Ong 1, Todd Lucas 1, Pauline Harvey 2, Phenyo Lekone 2, Mpho Letebele 2, Vasavi T Thomas 2, Vusi Maziya 3, Mandzisi Mkhontfo 4, Teruwork Gultie 5, Dejene Mulatu 6, Mesfin Shimelis 7, Tiruneh Zegeye 7, Ambrose W Juma 8, Elijah Odoyo-June 9, Paul K Musingila 9, John Njenga 9, Andrew Auld 10, Martin Kapito 11, Alice Maida 10, Wezi Msungama 10, Marcos Canda 12, Jotamo Come 13, Inacio Malimane 12, Mekondjo Aupokolo 14, Brigitte Zemburuka 15, Ida Kankindi 16, Samuel Malamba 16, Eric Remera 17, Emmanuel Tubane 18, Richard Machava 19, Nandi Maphothi 19, Peter Vranken 19, Mbaraka Amuri 20, Kokuhumbya J Kazaura 20, Daimon Simbeye 20, Stella Alamo 21, Geoffrey Kabuye 21, Omega Chituwo 22, Royd Kamboyi 23, Joseph Masiye 22, John Mandisarisa 24, Sinokuthemba Xaba 25, Carlos Toledo 1
PMCID: PMC10010757  PMID: 36893046

In 2007, voluntary medical male circumcision (VMMC) was endorsed by the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS after it was found to be associated with approximately a 60% reduction in the risk for female-to-male transmission of HIV (1). As a result of this endorsement, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), through partnerships with U.S. government agencies, including CDC, the U.S. Department of Defense, and the U.S. Agency for International Development, started supporting VMMCs performed in prioritized countries in southern and eastern Africa. During 2010–2016, CDC supported 5,880,372 VMMCs in 12 countries (2,3). During 2017–2021, CDC supported 8,497,297 VMMCs performed in 13 countries. In 2020, the number of VMMCs performed declined 31.8% compared with the number in 2019, primarily because of COVID-19–related disruptions to VMMC service delivery. PEPFAR 2017–2021 Monitoring, Evaluation, and Reporting data were used to provide an update and describe CDC’s contribution to the scale-up of the VMMC program, which is important to meeting the 2025 Joint United Nations Programme on HIV/AIDS (UNAIDS) target of 90% of males aged 15–59 years having access to VMMC services in prioritized countries to help end the AIDS epidemic by 2030 (4).

VMMC programs are incorporated into national HIV prevention portfolios. Services include voluntary HIV testing, HIV risk reduction education, screening and treatment of sexually transmitted infections, and linkage to care and treatment for clients who receive a positive HIV test result. During 2017–2021, CDC supported VMMC programs in 13 countries: Botswana, Eswatini, Ethiopia, Kenya, Malawi, Mozambique, Namibia, Rwanda, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. Not all of these countries were supported by CDC during the entire 5-year period.*

VMMC programs report indicators to the PEPFAR Monitoring, Evaluation, and Reporting database every quarter in accordance with the U.S. government fiscal year (5). This analysis includes the annual number of CDC-supported VMMCs performed, as well as the following indicators: client age group, HIV test results among males who underwent testing at VMMC sites, attendance at postoperative follow-up visits within 14 days, and type of circumcision method (use of a WHO pre-qualified circumcision device as method of circumcision or traditional surgical technique). Age was categorized as <15 years, 15–29 years, and ≥30 years. The prevalence of HIV-positivity was calculated by dividing the number of males who received a positive test result for HIV by the number of males who underwent HIV testing at VMMC sites. All statistical analyses were performed using Stata software (version 16; StataCorp). This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.§

During 2017–2021, CDC supported 8,497,297 VMMCs in 13 countries (Table) (Figure). During 2017–2019, the number of CDC-supported VMMCs increased annually, with a mean annual increase of 13.5%. During 2020, at the start of the COVID-19 pandemic, the number of VMMCs declined 31.8%, from 2,120,797 in 2019 to 1,447,147, with further reductions during 2021. During 2017–2019, 43.8% of all VMMCs were performed in clients aged 10–14 years and 45.7% in clients aged 15–29 years; the proportion performed in clients aged 15–29 years increased to 61.0% during 2020 and to 86.6% during 2021. Most (74.2%) VMMC clients participated in HIV testing services at VMMC sites; this proportion declined from 86.4% in 2017 to 48.7% in 2021. Among the 5,595,239 males who underwent testing for HIV at VMMC sites, 44,745 (0.8%) received a positive result. HIV-positivity ranged from 0.4% in 2020 to 1.2% in 2021.

TABLE. CDC-supported voluntary medical male circumcisions — 13 countries in eastern and southern Africa, 2017–2021.

Country Fiscal year* No. of VMMCs performed Annual target achieved, % Client age group, yrs, no. (%)
No. (%)
<15 15–29 ≥30 VMMCs performed using a device Clients who received HIV testing at a VMMC site Clients with a positive HIV test result§ Clients with postoperative follow-up within 14 days of VMMC
Botswana
2017
17,870
117.0
11,205 (62.7)
4,814 (26.9)
1,851 (10.4)
287 (1.6)
9,311 (52.1)
14 (0.2)
10,968 (61.4)
2018
15,874
76.0
9,386 (59.1)
4,701 (29.6)
1,787 (11.3)
0 (—)
7,730 (48.7)
29 (0.4)
14,674 (92.4)
2019
16,461
78.4
7,710 (46.8)
6,127 (37.2)
2,624 (15.9)
0 (—)
9,436 (57.3)
11 (0.1)
16,155 (98.1)
2020
5,845
28.0
2,313 (39.7)
2,252 (38.6)
1,265 (21.7)
0 (—)
3,913 (66.9)
20 (0.5)
5,514 (94.3)
2021
2,748
31.0
0 (—)**
1,539 (35.9)
2,748 (64.1)
0 (—)
1,437 (52.3)
25 (1.7)
2,720 (99.0)
Total
58,798
67.4
30,614 (50.8)
19,433 (32.2)
10,275 (17.0)
287 (0.5)
31,827 (54.1)
99 (0.3)
50,031 (85.1)
Eswatini
2017††
0
0
0 (—)
0 (—)
0 (—)
0 (—)
0 (—)
0 (—)
0 (—)
2018††
0
0
0 (—)
0 (—)
0 (—)
0 (—)
0 (—)
0 (—)
0 (—)
2019
761
20.0
298 (39.2)
410 (53.9)
53 (7.0)
0 (—)
707 (92.9)
7 (1.0)
761 (100.0)
2020
4,626
24.0
1,923 (41.6)
2,197 (47.5)
506 (10.9)
0 (—)
4,245 (91.8)
56 (1.3)
4,322 (93.4)
2021
3,269
79.2
3 (0.1)**
2,561 (78.3)
705 (21.6)
0 (—)
2,984 (91.3)
6 (0.2)
3,259 (99.7)
Total
8,656
31.5
2,224 (25.7)
5,168 (59.7)
1,264 (14.6)
0 (—)
7,936 (91.7)
69 (0.9)
8,342 (96.4)
Ethiopia
2017
10,910
96.2
5,290 (48.5)
4,610 (42.3)
1,010 (9.3)
0 (—)
8,149 (74.7)
3 (0.0)
10,905 (99.9)
2018
20,302
112.0
9,023 (44.4)
9,312 (45.9)
1,967 (9.7)
0 (—)
13,941 (68.7)
43 (0.3)
19,874 (97.9)
2019
23,776
98.3
10,024 (42.2)
11,768 (49.5)
1,984 (8.3)
0 (—)
21,907 (92.1)
7 (0.0)
23,169 (97.4)
2020
33,483
82.1
3,198 (9.6)
25,681 (76.7)
4,604 (13.8)
0 (—)
31,189 (93.1)
30 (0.1)
32,540 (97.2)
2021
45,499
101.1
0 (—)**
39,148 (86.0)
6,351 (14.0)
0 (—)
23,417 (51.5)
14 (0.1)
44,636 (98.1)
Total
133,970
96.1
27,535 (20.6)
90,519 (67.6)
15,916 (11.9)
0 (—)
98,603 (73.6)
97 (0.1)
131,124 (97.9)
Kenya
2017
149,286
90.7
106,754 (71.5)
38,858 (26.0)
3,674 (2.5)
1,446 (1.0)
146,157 (97.9)
285 (0.2)
121,855 (81.6)
2018
191,111
96.5
158,642 (83.0)
29,540 (15.5)
2,929 (1.5)
2,140 (1.1)
82,772 (43.3)
281 (0.3)
159,537 (83.5)
2019
185,145
93.9
161,990 (87.5)
20,405 (11.0)
2,750 (1.5)
2,820 (1.5)
24,346 (13.1)
64 (0.3)
170,353 (92.0)
2020
68,173
48.8
45,030 (66.1)
21,366 (31.4)
1,708 (2.5)
1,750 (2.6)
14,823 (21.7)
25 (0.2)
60,432 (88.6)
2021
25,351
115.6
1 (0)**
22,803 (89.9)
2,547 (10.0)
2,789 (11.0)
7,671 (30.3)
16 (0.2)
24,683 (97.4)
Total
619,066
85.8
472,417 (79.2)
110,169 (18.5)
13,608 (2.3)
10,945 (1.8)
275,769 (44.5)
671 (0.2)
536,860 (86.7)
Malawi
2017
30,136
86.1
5,612 (18.6)
21,455 (71.2)
3,069 (10.2)
0 (—)
30,063 (99.8)
104 (0.3)
24,219 (80.4)
2018
46,004
92.0
4,199 (9.1)
37,562 (81.6)
4,243 (9.2)
109 (0.2)
45,780 (99.5)
520 (1.1)
37,216 (80.9)
2019
52,062
104.1
3,205 (6.2)
45,015 (86.5)
3,842 (7.4)
824 (1.6)
51,791 (99.5)
434 (0.8)
52,041 (99.9)
2020
34,239
38.9
4,423 (12.9)
27,677 (80.8)
2,139 (6.2)
371 (1.1)
28,482 (83.2)
14 (0.0)
34,239 (99.9)
2021
70,178
97.5
0 (—)**
65,226 (92.9)
4,952 (7.1)
5,667 (8.1)
23,429 (33.4)
25 (0.1)
69,961 (99.7)
Total
232,619
78.8
17,439 (8.1)
196,935 (91.9)
18,245 (8.5)
6,971 (3.0)
179,545 (77.2)
1,097 (0.6)
217,676 (93.6)
Mozambique
2017
189,225
62.5
96,218 (50.8)
83,211 (44.0)
9,796 (5.2)
0 (—)
178,615 (94.4)
4,350 (2.4)
144,708 (76.5)
2018
233,069
90.9
131,881 (56.6)
90,365 (38.8)
10,823 (4.6)
0 (—)
219,906 (94.4)
4,530 (2.1)
200,060 (85.8)
2019
222,887
83.1
130,731 (58.7)
82,253 (36.9)
9,903 (4.4)
0 (—)
206,983 (92.9)
4,736 (2.3)
193,267 (86.7)
2020
120,464
42.9
59,232 (49.2)
54,596 (45.3)
6,636 (5.5)
0 (—)
57,490 (47.7)
1,109 (1.9)
98,738 (82.0)
2021
46,292
84.3
0 (—)**
37,873 (81.8)
8,419 (18.2)
0 (—)
31,419 (67.9)
3,183 (10.1)
39,549 (85.4)
Total
811,937
69.8
418,062 (51.5)
348,298 (42.9)
45,577 (5.6)
0 (—)
694,413 (85.5)
17,908 (2.6)
676,322 (83.3)
Namibia
2017
15,579
70.1
5,037 (33.0)
7,937 (51.9)
2,305 (15.0)
0 (—)
9,377 (60.2)
63 (0.7)
15,106 (97.0))
2018
19,384
82.7
8,807 (46.0)
8,393 (43.8)
1,957 (10.2)
0 (—)
9,752 (50.3)
36 (0.4)
18,857 (97.3)
2019
17,059
73.3
7,480 (45.5)
7,235 (44.0)
1,711 (10.4)
546 (3.2)
8,829 (51.8)
44 (0.5)
15,614 (91.5)
2020¶,††
0
0
0 (—)
0 (—)
0 (—)
0 (—)
0 (—)
0 (—)
0 (—)
2021††
0
0
0 (—)
0 (—)
0 (—)
0 (—)
0 (—)
0 (—)
0 (—)
Total
52,022
75.4
21,324 (41.9)
23,565 (46.3)
5,973 (11.7)
546 (1.0)
27,958 (53.7)
143 (0.5)
49,577 (95.3)
Rwanda
2017
91,689
191.2
25,123 (27.4)
63,301 (69.1)
3,245 (3.5)
53,351 (58.2)
90,564 (98.8)
281 (0.3)
91,662 (99.9)
2018
75,338
222.2
28,866 (38.3)
43,323 (57.5)
3,149 (4.2)
30,178 (40.1)
68,384 (90.8)
22 (0.0)
75,201 (99.8)
2019
79,622
152.6
23,933 (30.1)
52,202 (65.6)
3,487 (4.4)
15,167 (19.0)
44,729 (56.2)
14 (0.0)
79,420 (99.7)
2020
140,984
143.2
35,383 (25.1)
100,287 (71.1)
5,314 (3.8)
7,615 (5.4)
0 (—)§§
0 (—)§§
140,784 (99.9)
2021
181,539
156.4
14 (0)**
163,800 (90.2)
17,725 (9.8)
2,016 (1.1)
0 (—)§§
0 (—)§§
179,435 (98.9)
Total
569,172
163.3
113,319 (19.9)
422,916 (74.3)
32,920 (5.8)
108,327 (19.0)
203,677 (35.8)
317 (0.2)
566,502 (99.5)
South Africa
2017
232,198
94.3
91,312 (39.3)
114,436 (49.3)
26,450 (11.4)
886 (0.4)
140,960 (60.7)
4,390 (3.1)
169,955 (73.2)
2018
284,202
81.7
144,208 (50.8)
107,826 (38.0)
32,037 (11.3)
0 (—)
260,025 (91.5)
4,524 (1.7)
189,787 (66.8)
2019
332,096
109.1
125,598 (38.0)
175,228 (53.0)
30,055 (9.1)
0 (—)
285,267 (85.9)
1,795 (0.6)
247,819 (74.6)
2020
144,622
46.4
34,347 (23.7)
89,195 (61.7)
21,080 (14.6)
0 (—)
134,101 (92.7)
412 (0.3)
131,951 (91.2)
2021
164,995
52.4
0 (—)**
113,625 (68.9)
51,369 (31.1)
0 (—)
142,756 (86.5)
1,068 (0.7)
152,267 (92.3)
Total
1,158,113
75.9
395,465 (34.2)
600,310 (51.9)
160,991 (13.9)
886 (0.1)
1,022,493 (88.3)
14,189 (1.4)
891,779 (77.0)
Tanzania
2017
290,041
91.7
131,039 (45.2)
136,000 (46.9)
23,002 (7.9)
0 (—)
222,693 (76.8)
547 (0.2)
258,342 (89.1)
2018
451,073
92.8
206,288 (45.7)
209,371 (46.4)
35,414 (7.9)
0 (—)
450,318 (99.8)
674 (0.1)
390,295 (86.5)
2019
453,764
110.4
193,883 (42.7)
223,742 (49.3)
36,139 (8.0)
1,517 (0.3)
59,909 (13.2)
105 (0.2)
438,954 (96.7)
2020
299,967
104.4
140,485 (46.8)
140,580 (46.9)
18,902 (6.3)
817 (0.3)
0 (—)§§
0 (—)§§
296,017 (98.7)
2021
337,989
95.9
0 (—)**
304,264 (90.0)
33,725 (10.0)
0 (—)
0 (—)§§
0 (—)§§
334,933 (99.1)
Total
1,832,834
98.9
671,695 (39.3)
891,557 (52.1)
147,182 (8.6)
2,334 (0.1)
732,920 (40.0)
1,326 (0.2)
1,718,541 (93.8)
Uganda
2017
334,515
71.5
68,104 (33.2)
119,705 (58.4)
17,175 (8.4)
1,590 (0.5)
310,211 (92.7)
1,324 (0.4)
296,092 (88.5)
2018
340,168
100.1
144,585 (49.4)
128,088 (43.8)
20,029 (6.8)
134 (0.0)
319,255 (93.9)
5,422 (1.7)
321,776 (94.6)
2019
336,947
98.1
140,769 (41.8)
168,459 (50.0)
27,603 (8.2)
399 (0.1)
283,062 (84.0)
612 (0.2)
321,085 (95.3)
2020
291,955
73.2
65,981 (22.6)
193,944 (66.4)
32,030 (11.0)
925 (0.3)
227,315 (77.9)
497 (0.2)
284,636 (97.5)
2021
153,534
103.0
544 (0.4)
132,983 (86.6)
20,007 (13.0)
7,627 (5.0)
89,554 (58.3)
284 (0.3)
143,644 (93.6)
Total
1,457,119
85.8
419,983 (31.0)
743,179 (54.9)
116,844 (8.6)
10,675 (0.7)
1,229,397 (84.4)
8,139 (0.7)
1,367,233 (93.8)
Zambia
2017
181,767
171.4
68,397 (37.6)
97,113 (53.4)
16,237 (8.9)
477 (0.3)
173,555 (95.5)
824 (0.5)
175,361 (96.5)
2018
173,425
128.2
48,704 (28.1)
109,385 (63.1)
15,328 (8.8)
391 (0.2)
170,722 (98.4)
482 (0.3)
162,355 (94.0)
2019
271,099
167.7
67,514 (24.9)
176,690 (65.2)
26,852 (9.9)
2,371 (0.9)
226,737 (83.6)
570 (0.3)
259,892 (95.9)
2020
240,857
126.9
31,032 (12.9)
188,853 (78.4)
20,972 (8.7)
4,738 (2.0)
66,969 (27.8)
91 (0.1)
233,739 (97.0)
2021
282,259
139.0
0 (—)**
258,048 (91.4)
24,211 (8.6)
12,217 (4.3)
39,859 (14.1)
71 (0.2)
276,061 (97.8)
Total
1,149,407
144.4
215,647 (18.8)
830,089 (72.2)
103,600 (9.0)
20,194 (1.8)
677,842 (59.0)
2,038 (0.3)
1,107,408 (96.3)
Zimbabwe
2017
103,677
103.7
43,383 (41.9)
51,357 (49.5)
8,914 (8.6)
5,037 (4.9)
103,546 (99.9)
270 (0.3)
99,821 (96.3)
2018
70,494
66.7
24,026 (34.1)
39,383 (55.9)
7,083 (10.0)
0 (—)
70,454 (99.9)
111 (0.2)
64,721 (91.8)
2019
129,118
102.7
42,994 (33.3)
72,084 (55.9)
13,966 (10.8)
52 (0.0)
129,044 (99.9)
119 (0.1)
124,692 (96.6)
2020
61,932
48.0
20,059 (32.4)
35,674 (57.6)
6,199 (10.0)
0 (—)
61,880 (99.9)
86 (0.1)
59,796 (96.6)
2021
48,363
37.1
0 (—)**
39,042 (80.7)
9,321 (19.3)
221 (0.5)
47,935 (99.1)
73 (0.2)
45,513 (94.1)
Total
413,584
70.0
130,462 (31.6)
237,540 (57.4)
45,483 (11.0)
5,310 (1.3)
412,859 (99.8)
659 (0.2)
394,543 (95.4)
All countries 2017
1,646,893
89.7
657,474 (43.3)
742,797 (49.0)
116,728 (7.7)
63,074 (3.8)
1,423,201 (86.4)
12,455 (0.9)
1,418,994 (86.2)
2018
1,920,444
95.3
918,615 (49.1)
817,249 (43.6)
136,746 (7.3)
32,952 (1.7)
1,719,039 (89.5)
16,674 (1.0)
1,654,353 (86.1)
2019
2,120,797
106.8
916,129 (43.2)
1,041,618 (49.2)
160,969 (7.6)
23,696 (1.1)
1,352,040 (63.8)
8,511 (0.6)
1,942,461 (91.6)
2020
1,447,147
72.2
443,406 (30.6)
882,302 (61.0)
121,355 (8.4)
16,216 (1.1)
630,407 (62.7)§§
2,340 (0.4)
1,382,708 (95.5)
2021
1,362,016
92.5
562 (0)
1,180,912 (86.6)
182,080 (13.4)
30,537 (2.2)
410,461 (48.7)§§
4,765 (1.2)
1,316,661 (96.7)
Total 8,497,297 91.2 2,936,186 (35.3) 4,664,878 (56.1) 717,082 (8.6) 166,475 (2.0) 5,595,239 (74.2) §§ 44,745 (0.8) 7,715,177 (90.8)

Abbreviations: PEPFAR = U.S. President’s Emergency Plan for AIDS Relief; VMMC = voluntary medical male circumcision.

* October 1–September 30.

VMMCs performed using a device refers to use of World Health Organization–prequalified circumcision device as method of circumcision instead of traditional surgical technique.

§ HIV prevalence was calculated by dividing the number of males who received positive HIV test results by the number undergoing HIV testing services at VMMC sites.

COVID-19 was declared a pandemic in 2020.

** In 2021 most countries reported zero or a small number of VMMCs conducted in clients aged <15 years because of a change in VMMC age eligibility to 15 years with the exception of the ShangRing device (Wuhu Snnda Medical Treatment Appliance Technology).

†† Eswatini in 2017 and 2018 and Namibia in 2020 and 2021 did not have a CDC-supported VMMC program.

§§ Rwanda and Tanzania stopped conducting PEPFAR-supported HIV testing at VMMC sites in 2020 and 2021. These countries were excluded from the combined country estimates.

FIGURE.

The figure is a stacked bar chart showing CDC-supported voluntary medical male circumcisions, by year, in 13 eastern and southern African countries during 2017–2021.

CDC-supported voluntary medical male circumcisions, by year — 13 eastern and southern African countries, 2017–2021*

* COVID-19 was declared a pandemic in 2020.

Among all VMMC clients during 2017–2021, 90.8% returned for a follow-up visit within 14 days. Postoperative follow-up visits increased among all countries from, 86.2% in 2017 to 96.7% in 2021. Two percent (166,475) of all circumcisions were performed using a device; this proportion was highest (3.8%) in 2017, declined annually until 2020, then increased from 1.1% in 2020 to 2.2% in 2021.

Discussion

Overall, substantial progress has been made in scaling up CDC-supported VMMC programs, with 8,497,297 VMMCs performed during 2017–2021. Increased programmatic experience in VMMC scale-up and the continued prioritization of VMMC by ministries of health and global stakeholders have contributed to this progress. The decreased number of VMMCs performed during 2020 was largely related to mitigation measures implemented to prevent the spread of COVID-19. In addition, in 2020, based on 2015–2018 data showing that certain severe adverse events associated with VMMC, while very rare, were higher among clients aged 10–14 years (2.9 per 100,000 procedures) than among clients aged ≥15 years (1.6 per 100,000 procedures), PEPFAR increased the age eligibility for VMMC to ≥15 years (6). This change in age eligibility likely contributed to the increase in the proportion of VMMCs performed in persons aged 15–29 years during 2020 and 2021.

During 2017–2021, a total of 44,745 males who underwent testing at a VMMC site received a positive HIV test result. VMMC sites serve as an important entry point for HIV testing; without this opportunity, many cases of HIV infection among males might go undiagnosed. The decrease in HIV testing at VMMC sites in 2020 and 2021 was likely due to changes in testing approaches after the 2019 PEPFAR recommendations to provide targeted testing including screening for clients at higher risk for HIV (7). VMMC postoperative follow-up visits increased in all countries during 2017–2021. The percentage of males who returned for a postoperative follow-up visit within 14 days exceeded the recommended 80%, which helped to facilitate timely detection of an adverse event. To reduce the transmission of COVID-19, many countries conducted virtual follow-up visits during 2020. In 2021, PEPFAR supported this approach based on evidence from the scientific literature and programmatic success (8).

VMMC programs can use WHO-prequalified male circumcision devices which typically includes application of a device for removal of the foreskin, as an alternative to traditional surgical circumcision techniques. The overwhelming majority of VMMCs are still performed through conventional surgical methods; the decision to introduce a circumcision device is country-specific, with many programs still piloting use of the devices. Device-based circumcisions declined from 3.8% during 2017 to 1.1% during 2019 and 2020; one factor contributing to the decline might be the lack of programmatic experience to scale up use of the ShangRing device (Wuhu Snnda Medical Treatment Appliance Technology) when practitioners started to phase out the PrePex device (Circ MedTech, Ltd.) during 2016–2018 after reports of tetanus in patients who received VMMC with this device (9). During 2021, more programs scaled up device-based circumcisions, and their use increased to 2.2% from 1.1% during 2020.

The findings in this report are subject to at least three limitations. First, only CDC-supported VMMC results are reported, so the actual number of VMMCs performed might be higher than that reported here. Second, Monitoring, Evaluation, and Reporting data are subject to reporting and data entry errors. Finally, the data used for this analysis cannot be used to directly assess progress towards reaching the goal of 90% of eligible males having access to VMMC services.

Modeling analyses have estimated that the 26.8 million PEPFAR-supported VMMCs performed during 2008–2019 in prioritized countries have helped prevent 340,000 new HIV infections; this estimate is projected to increase to 1.8 million by 2030, given that VMMC provides a lifelong reduction in HIV risk (10). CDC’s continued support of the VMMC program is a critical component of ending the AIDS epidemic and reaching the UNAIDS 2025 target of 90% of eligible males having access to VMMC in prioritized countries (4). Prioritization of uncircumcised males living in areas of high HIV incidence and those at highest risk for HIV can maximize VMMC’s contribution to HIV epidemic control.

Summary.

What is already known about this topic?

Voluntary medical male circumcision (VMMC) is associated with an approximately 60% reduction in the risk for female-to-male transmission of HIV. The U.S. President’s Emergency Plan for AIDS Relief, through CDC and other organizations, has supported VMMC for HIV prevention in eastern and southern Africa. During 2010–2016, CDC supported 5,880,372 VMMCs performed in 12 countries.

What is added by this report?

During 2017–2021, CDC supported an additional 8,497,297 VMMCs performed in 13 countries in eastern and southern Africa. Compliance with postoperative follow-up visits within 14 days of VMMC was high, and use of device-based circumcisions remains low.

What are the implications for public health practice?

CDC’s continued support of the VMMC program is a critical component to ending the AIDS epidemic and reaching the Joint United Nations Programme on HIV/AIDS 2025 target of 90% of eligible males having access to VMMC in prioritized countries.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Footnotes

*

Eswatini started receiving CDC support in 2019, and in 2020 Namibia shifted PEFPAR support from CDC to another U.S. government agency.

Years in VMMC program data refer to U.S. government fiscal years (October 1–September 30).

§

45 C.F.R. part 46, 21 C.F.R. part 56; 42 U.S.C. Sect. 241(d); 5 U.S.C. Sect. 552a; 44 U.S.C. Sect. 3501 et seq.

Rwanda and Tanzania stopped reporting HIV testing rates in fiscal year 2020 because of a change in funding and testing practices at VMMC sites.

References


Articles from Morbidity and Mortality Weekly Report are provided here courtesy of Centers for Disease Control and Prevention

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