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Intervention Update: Voluntary Medical Male Circumcision

Voluntary medical male circumcision (VMMC) is a highly effective HIV prevention strategy that has benefited from ambitious target setting that ticked all the boxes—investment, political will and evidence. In 2011, US President Barack Obama set a target of 4.7 million PEPFAR-supported procedures by World AIDS Day 2013. Nothing about the pace of scale-up to date suggested that such an ambitious goal could be met, but it was. Since 2007, it is estimated that over nine million VMMCs have been performed, with support not only from PEPFAR but also national governments, the GFATM and the Bill & Melinda Gates Foundation. This reflects decisions made by these boys and men, together with their communities—a tremendous, life-saving collective effort.

That’s the good news.

The bad news is that, in 2015, there is no new global target. PEPFAR has not set a new target since 2013. Right now, UNAIDS doesn’t have prevention targets either. That’s a huge omission given the strength of evidence of impact, remarkable progress to date, and feasibility for continued scale-up. Individual countries including Rwanda, Zimbabwe and many others are setting milestones for reaching 80 percent coverage and showing political will.

But these country commitments have to be matched by funders, normative agencies and implementers. And it is possible that this might not happen.

Beginning in 2012, PEPFAR almost doubled its annual budgets for VMMC for two years, in support of the Presidential target. This was mainly through use of “central” funds that supplemented countries’ conventional funding. As of today, no 2015 central funding has been identified for VMMC, and unofficial information from countries suggests the 2015 VMMC target is roughly one million less than in 2014. Reports also suggest that countries aren’t seeking funds from GFATM grants to fill the gap left by PEPFAR.

In the next 12 months, VMMC in sub-Saharan Africa will likely experience a contraction. New cases of HIV that might have otherwise been prevented will occur and the infrastructure will be lost. This makes little financial or public health sense. Countries should be resourced to perform at current or even expanded capacity. Advocacy is needed to ensure that this is a brief slow—down, and that 2016 sees programs back on track. Now is the time for a new target (see below) with global endorsement.