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Voluntary Medical Male Circumcision for HIV Prevention – Introducing New Mathematical Models

This week PLOS launched a new collection, Voluntary Medical Male Circumcision for HIV Prevention: New Mathematical Models for Prioritizing Sub-Populations by Age & Geography, featuring new modeling research that aims to help country decision-makers examine the potential effects of targeting sub-populations for voluntary medical male circumcision services.

 

With 2.3 million new HIV infections occurring in sub-Saharan Africa each year, scaling up impactful programs such as voluntary medical male circumcision (VMMC) for HIV prevention has become increasingly important.

 

VMMC can make a unique contribution to HIV prevention: it is a single event with lifetime benefits for men, along with indirect benefits for women and even uncircumcised men. Because it is a one-time intervention, it is not subject to user adherence challenges that plague other HIV prevention approaches.

 

Image Credit: Pixabay
Image Credit: Pixabay

By the end of 2015, 11.7 million males had been circumcised, out of the projected 20.9 million needed to reach 80% adult male circumcision prevalence in priority countries by 2015. Decision makers are now considering the impact of the achievements thus far and the next prioritization strategies, as they plan the next steps for the programs in light of implementation experience and changes in the HIV landscape. Now the question is how to efficiently reach the levels of male circumcision coverage needed to create and sustain further reductions in HIV incidence toward the 2030 goal of a world in which AIDS is no longer a public health threat.

 

This new collection developed in collaboration with USAID, the World Bank, and the Bill & Melinda Gates Foundation, focuses on the next steps of the program and features new modelling articles published in PLOS ONE and PLOS Medicine aiming to help countries examine the potential effects of focusing on specific sub-populations for male circumcision services.

 

Using these new mathematical models, it is hoped that all decision makers will be in a better position to make more-informed choices about which strategies to prioritize and where best to invest efforts to achieve goals if they are equipped with the evidence, analysis, and impact estimates for HIV prevention.

 

This PLOS Collection, and a related collection to be published in Global Health: Science and Practice developed in collaboration with UNICEF and PEPFAR, focusing on introducing early infant male circumcision (EIMC) to sustain VMMC programs, will be featured at a satellite session, Voluntary Medical Male Circumcision (VMMC) as Primary HIV Prevention: Maximizing Our Investment and Considerations for Sustainability at the International AIDS Conference in Durban, South Africa on Monday, 18 July 2016 from 10:15am to 12:15pm in Session Room 11. The satellite, organized by the AIDSFree Project on behalf of PEPFAR and USAID, the Bill & Melinda Gates Foundation, World Bank and UNICEF, will provide a summary of VMMC and early infant male circumcision (EIMC)-related research findings.

 

Please visit the collection here: www.collections.plos.org/vmmc2016

 

Discussion
  1. The International AIDS Conference will not include any critics of the policy to promote circumcision. Without open debate, there is no scientific process.

    Claiming that circumcision prevents a health problem is a compulsion of circumcised men to have done to others what was done to them. Historically, this compulsion has led to over 200 potential health claims for circumcision. All have been refuted. Thirteen national and international organizations recommend against circumcision.

    Many professionals have criticized the studies claiming that circumcision reduces HIV transmission. The investigators did not seek to determine the source of the HIV infections during their studies. They assumed all infections were heterosexually transmitted.

    Many HIV infections in Africa are transmitted by contaminated injections and surgical procedures. The absolute rate of HIV transmission reduction is only 1.3%, not the claimed 60%. Even if the claim were true, based on the studies, about 60 men had to be circumcised to prevent one HIV infection.

    Authorities that cite the studies have other agendas including political and financial. All other national and international organizations that have positions on circumcision oppose it. Research shows that circumcision causes physical, sexual, and psychological harm, reducing the sexual pleasure of both partners. This harm is ignored by circumcision advocates. Other methods to prevent HIV transmission (e.g., condoms and sterilizing medical instruments) are much more effective, much cheaper, and much less invasive. Even HIV/circumcision studies advise using condoms. With condoms circumcision adds no benefit to HIV prevention.

    Circumcision will not be “voluntary” when it is forced on children.

  2. There is NO evidence that INFANT male genital cutting has ANY effect on HIV transmission. The studies of adult volunteers for genital cutting by that very fact created selection bias.

    It is striking that the entire “circumcision prevents HIV” initiative has been carried by a handful of interconnected activists. Few studies claiming benefits or discussing implementation lack at least one of these names: Robert Bailey, Stefan Bailis, Ronald Gray, Daniel Halperin, Godfrey Kigozi, Jeffrey Klausner, Brian Morris, Stephen Moses, Malcolm Potts, Thomas Quinn, David Serwadda, Dirk Taljaard, Aaron Tobian, David Tomlinson, Richard Wamai, Maria Wawer, Helen Weiss or Thomas Wiswell – and usually more than one.

    Australia has declared the HIV epidemic over while the infant male genital cutting rate has declined betow 12% – much lower in some states.

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