Findings from three randomised controlled trials in South Africa, Kenya and Uganda have shown the efficacy of medical male circumcision in reducing HIV transmission risk among men when engaging in vaginal sex. These results led to a recommendation from the World Health Organization calling for immediate scale-up of Voluntary Medical Male Circumcision (VMMC) in high HIV-prevalence settings to 80% coverage among men aged 15-49. South Africa, with an astounding 6.4 million people infected with HIV and medical circumcision coverage of only 18.6%, has been identified as one of 14 priority countries in east and southern Africa targeted for scale-up. This chapter reviews the current situation regarding VMMC in South africa, including progress in achieving scale-up, the complexities of rolling out such an intervention, demand creation, and supply-side issues such as costs and resource availability to achieve coverage. The chapter also examines issues related to integrating safe medical circumcision into traditional practices. Finally, we look at the implementation of the intervention going forward, including new technologies for non-surgical circumcision, possible targeting strategies for maximum cost-effectiveness, and the integration of VMMC in a wider range of HIV prevention and treatment services being rolled out in the country.
Voluntary medical male circumcision in South Africa: Challenges and Opportunities
