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Male circumcision: the message is catching on, but scale-up poses monitoring and follow-up problems
Gus Cairns, 2013-07-15 09:50:00
Programmes offering voluntary medical male circumcision (VMMC) as part of HIV prevention are now starting to expand in a number of countries in sub-Saharan Africa, delegates at the recent 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013) heard.
Two presentations from Zambia found that one in five previously uncircumcised men aged 15-49 have undergone the operation in the last two years, and community norms about being circumcised are changing significantly.
Other studies explored some of the difficulties encountered in the push to scale up circumcision. A study from South Africa found that in the race to scale-up, while VMMC is still being performed safely, the reporting of adverse events has deteriorated markedly.
A study from Nyanza province in Kenya found a very high rate of loss to follow-up; when men were proactively followed up, they had a somewhat greater proportion of adverse events than men who attended a follow-up appointment.
Achieving economies of scale without sacrificing safety will be key to the expansion of programmes, and the conference also heard about the Shang Ring, one of several different devices (another being PREPEX) which are being promoted:. The Shang ring is popular among men coming for circumcision, cuts the time taken to do the operation by two-thirds and avoids the need for sutures, but the time taken to heal seems slightly longer, the conference heard.
Source:1
