AVAC: Global Advocacy for HIV Prevention - Advocates' Network Update
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December 8, 2011

Dear Advocates,

Voluntary medical male circumcision (VMMC) has been one of the biggest missed biomedical HIV prevention opportunities of the last five years. In many countries with high HIV prevalence and low rates of male circumcision, VMMC programs have been slow to scale up, even though the intervention reduces men’s risk of HIV via vaginal sex by at least 60 percent and could have a profound impact on rates of new infections at the population level if taken to scale. In the past few weeks, however, there has been a concerted effort to build momentum and action around implementation at a scale that could truly affect the course of the epidemic. Released last week, AVAC Report 2011 touches on some key issues, and this update includes news on more recent developments.

New Leadership at the International Level
This week, VMMC was a focus of increased advocacy and urgency at the 2011 International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA), held in Addis Ababa, Ethiopia. There was a high-level meeting to galvanize support for the intervention, with a strong emphasis on the need for community and political leadership. On December 5, UNAIDS and PEPFAR launched a five-year action framework to accelerate the scale-up of voluntary medical male circumcision (VMMC) for HIV prevention. The framework was developed by the World Health Organization (WHO), UNAIDS, PEPFAR, the Bill & Melinda Gates Foundation and the World Bank—in consultation with national Ministries for Health. It calls for the immediate rollout and expansion of VMMC services in priority countries in eastern and southern Africa.

New Evidence on Impact and Implementation Lessons Learned
On November 30, PLoS Medicine published a collection of articles on voluntary medical male circumcision, which make a compelling case for the impact this strategy can have in priority countries with high HIV prevalence and low rates of VMMC. In one article by Hankins et al, the authors calculate that, “An investment of US$ 1.5 billion between 2011 and 2015 to achieve 80 percent coverage in 13 priority countries in southern and eastern Africa will result in net savings of US $16.6 billion.”

The same article features a compelling graphic that shows the number of infections averted between 2011 and 2025 if VMMC targets are met in key countries. In Zimbabwe, for example, nearly 42 percent of anticipated infections in women and men would be averted by 2025.

Other articles focus on lessons learned in scale-up in Tanzania, South Africa and elsewhere; human resources and service delivery innovations; and the challenges of putting a price tag on activities to create demand for the new service. All of the articles are open access and available at PLoS Medicine.

New Advocacy Resources
With re-energized international leadership and new literature on the impact of VMMC, now is the time for expanded advocacy from civil society to take the intervention to scale.

  • AVAC and its partners are working in several countries, including Kenya, South Africa, Uganda, Zambia and Zimbabwe, to develop context-specific projects seeking to scale up VMMC and ART as the two cornerstones of highly effective combination prevention. If you are working in those countries or others and would like to learn more about these activities, please email avac@avac.org as we are looking for additional partners.
  • Later this month, the Medical Male Circumcision Clearinghouse, a joint project of WHO, UNAIDS, FHI 360 and AVAC, will launch a newly expanded advocacy resources section, including the first in a series of interviews with “VMMC Champions”. The series starts with Ugandan champion Dr. Speciosa Wandira, the first-ever woman vice president of an African nation, who has made VMMC one of her focal issues as a champion for an HIV-free generation.
  • AVAC is developing a new series of resources for implementation advocacy. Part of this series will be a set of “talking points”. These one-page tools will feature key statistics and graphics designed to help advocates in action. The first of these talking points focuses on VMMC and can be downloaded here.

In 2012, AVAC will be intensifying its work on VMMC at the local, national and international levels. We hope these resources and updates encourage further work from advocates—where ever you are! Not sure where to start, or want to share an exciting update? Please be in touch.


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