HIV and AIDS

Overview

UNICEF in action: Strategy and priorities

Preventing mother-to-child transmission (PMTCT) of HIV

Providing paediatric treatment

Preventing HIV infection among adolescents and young people

Protection and care for children affected by AIDS

Infant and young child feeding in the HIV context

Medical male circumcision

Results for children

Children and AIDS Regional Initiative (CARI)

 

Medical male circumcision

© UNICEF 2010/kli
A counsellor explains how male circumcision can reduce the chances of HIV transmission to a man, who has come to undertake the procedure at Kisumu East District Hospital, Kenya.

There is now compelling evidence that male circumcision can reduce the risk of a man contracting HIV from unprotected sex with an infected woman by 60 percent. In March 2007, WHO and UNAIDS called for medical male circumcision to be made widely available to all men living in countries or parts of countries that have a high prevalence of HIV infection. In Eastern and Southern Africa (ESA), 13 countries with high HIV prevalence, a generalised heterosexual epidemic and low levels of male circumcision were identified as priority countries for scale up.

However, medical male circumcision is only partially protective and needs to be part of a more comprehensive HIV prevention. Such prevention efforts also need to include the reduction of multiple and concurrent sexual partners, getting tested to know one’s HIV status and the consistent use of condoms.

Circumcising the young

Adolescent boys and young men: Providing medical male circumcision to older boys and to young men will reduce their HIV-risk when they become sexually active. Providing services to this age group will have an immediate impact on reducing HIV infection. In many societies in ESA, there is a long tradition of circumcising adolescent boys as part of a ‘coming of age’ ceremony. However, surgery carried out by traditional providers often results in dangerous complications and sometimes even death.Therefore, male circumcision needs to be performed by properly trained health workers. It also needs to be accompanied by behaviour change communication in order to ensure reduction of partners and use of condoms.

Babies: Circumcising infant boys is a relatively straightforward procedure and if properly carried out, complications are very rare. However, infant circumcision on reducing the HIV risk will only pay off when the boy has grown up and starts to become sexually active. However, given the enormous challenges of HIV prevention and the uncertainty that better prevention measures, such as a vaccine, will be available some time in foreseeable future, public health experts consider that the introduction of widespread medical male circumcision for infants would be a good investment in African countries with high HIV-prevalence.

UNICEF in action

UNICEF supports advocacy, policy development and information, education and communications work around medical male circumcision in the 13 priority countries. As a co-sponsor of UNAIDS and a close partner of WHO, UNICEF is committed to ensuring that primary prevention of HIV infection is effective.

As part of a ‘life skills’ learning approach, UNICEF works closely with young people to make sure that they are fully aware of the potential benefits of medical male circumcision, if accompanied by condom use and the reduction of sexual relationships. In partnership with the media and young people’s organisations, UNICEF also helps provide the essential facts on medical male circumcision to the general public. In countries such as Rwanda, Swaziland and Botswana, the Government and UNICEF are working together to introduce infant male circumcision.

Results for children

  • The Ministries of Health and National AIDS Control Organisations in most of the 13 priority countries have reviewed the evidence for the benefits of medical male circumcision and convened meetings of stakeholders to determine ways of introducing the service on a wide scale. Preparations include training of health workers to perform the surgery, sensitizing communities and ensuring that the necessary equipment and facilities are in place.
  • Kenya is most advanced in this area. It is the only African country to have successfully rolled out male circumcision on a large scale. A formal Ministry of Health Policy on Medical Male Circumcision was published. Circumcision services are available in many sites in Nyanza Province and Western Kenya, with more than 100,000 men circumcised in 2009/10.  Services are now being introduced in parts of Nairobi, the capital. The government aims to have all uncircumcised men – an estimated 1.1 million – undergo the procedure by 2013.
  • Medical male circumcision is available in several centres in Swaziland and the service is very popular.
  • Services are now widely available throughout the township of Orange Farm in South Africa, where the original scientific trial took place. In April 2010, the South African government announced a vast expansion of HIV testing and other HIV/AIDS services, including medical male circumcision for HIV prevention.
  • In Zambia, more than 16,000 men were circumcised at 11 sites in 2009 and the goal is to have 300 sites offering the services by 2014.
  • In Zimbabwe, more than 5,000 men underwent medical male circumcision in a pilot programme that began in 2007. Plans are in place to scale up the programme. A national medical male circumcision policy was launched in November 2009.

 

 
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