Male Circumcision: Policy & Programming

The evidence is compelling - male circumcision (MC) reduces female-to-male transmission of HIV by approximately 60%. MC provides additional "back-up" protection to methods such as abstinence, being faithful/partner reduction, and using condoms.

The purpose of this course is to provide health policy makers and program managers with an overview of scientific evidence of MC's protective effect against HIV transmission, to examine the acceptability and safety of MC, to consider challenges to MC program implementation, and to provide policy and program guidance.

This course focuses on public health issues with a brief overview of surgical techniques. It concentrates on the delivery of medical MC services to adult/adolescent populations in settings with high HIV prevalence and low MC prevalence.

Neonatal MC will be discussed in a separate course.

Objective

After completing this course, the learner will be able to:

  • Define MC, describe its practice and prevalence, and recognize the association between MC and HIV prevalence
  • Cite evidence from three randomized controlled trials that shows that MC is effective in preventing female-to-male HIV transmission; cite epidemiological, ecological, and biological evidence that substantiates MC's protective effect against HIV
  • Name other important MC benefits for men and for women
  • Explain why MC is a cost-effective and cost-saving intervention, especially in countries where MC prevalence is low and HIV prevalence is high.
  • Discuss MC acceptability, attributes of three adult/adolescent MC surgical techniques, and desired functions and features of MC devices under investigation
  • Discuss quality assurance, safety, training, surgical efficiencies, and commodities and supply chain management
  • Discuss communication strategies and challenges including demand creation, balancing supply with demand, community mobilization, and counseling
  • Recognize gender issues associated with MC for HIV prevention and discuss their implications
  • Discuss service delivery challenges and opportunities when implementing MC at scale in low-resource settings
  • Access key MC for HIV prevention resources

Credits

We would like to acknowledge the contributions of:

Tigistu Adamu, Jhpiego; Robert Bailey, University of Illinois at Chicago; Mark Barone, EngenderHealth; Lori Bollinger, Futures Institute; Margaret Butao, ZNFPC; Kristin Chrouser, Jhpiego; Roy Dhlamini, PSI/Zimbabwe; Timothy Farley, WHO; Ron Gray, JHSPH; Karin Hatzold, PSI/Zimbabwe; Nathan Heard, US Department of State; Renata Kepner, Jhpiego; Hally Mahler, MCHIP/Jhpiego; Zebedee Mwandi, CDC/Kenya; Jason Reed, CDC; David Tomlinson, Brown University Medical School

We would also like to thank the following course reviewers for their helpful comments and suggestions:

Centers for Disease Control and Prevention (CDC) - Sekai Chideya-Chihota, Jonathan Grund, Jason Reed

Jhpiego - Tigistu Adamu

Population Services International (PSI) - Steve Gesuale, Krishna Jafa, Brian Pedersen, Elizabeth Skorochod

United States Agency for International Development - Peggy d'Adamo, Jim Shelton, Madeleine Short

University of California at San Francisco (UCSF), Urology - Edward Collins, Ira Sharlip

World Health Organization (WHO), HIV/AIDS - Kim Dickson