AFRICA: Tracking the male circumcision rollout
Zambia aims to circumcise about 250,000 men every year
NAIROBI, 2 March 2010 (IRIN) - Medical male circumcision is now widely recognized as an important HIV prevention tool, and several African countries have included it in their national HIV strategies.
IRIN/PlusNews lists the progress of 13 nations in eastern and southern Africa identified as priority countries for male circumcision scale-up by the UN World Health Organization.
An estimated 85 percent of men are circumcised, but just 40 percent of those in Nyanza province, which has the country's highest prevalence, have had the procedure. In 2008 the government launched a national campaign and by the end of 2009 more than 90,000 men had been circumcised, 40,000 of them during a two-month "rapid results" initiative in Nyanza.
The government aims
to have all uncircumcised men - an estimated 1.1 million - undergo the procedure by 2013. Kenya is the only African country to have successfully rolled out male circumcision on such a large scale.
Male circumcision prevalence is 13 percent, and Zambia aims to circumcise about 250,000 men every year. More than 16,000 men were circumcised at 11 sites in 2009, and the goal is to have 300 sites offering the services by 2014.
The Ministry of Health and Human Services plans to provide circumcision
to 80 percent of men aged 15 to 24 by the end of 2014. Just eight percent of Swazi men are circumcised. The country - which has the world's highest HIV prevalence - developed a male circumcision strategy in 2008; by the end of 2009 more than 5,000 men had undergone the surgery.
Five centres of excellence have been identified to scale-up circumcision services, and Botswana's Ministry of Health aims to reach at least 460,000 HIV negative men and boys below the age of 49 by 2012. More than 4,300 men have been circumcised since April 2009.
In April 2009 the pilot phase of service delivery began, during which 1,818 men were circumcised at four sites. A national male circumcision policy was launched in November 2009.
Since 2008 the government has been rolling out male circumcision in the army, where prevalence is 4.5 percent compared to a national rate of three percent. A recent study
suggested that Rwanda should also be scaling up circumcision across a broad range of age groups, especially the very young, where the procedure was found to be highly cost-effective.
The government has been criticized for moving too slowly
in developing a national circumcision strategy. By December 2009 the country had a draft policy but no mechanisms for training, quality assurance, or monitoring and evaluation.
South Africa has the world's largest HIV-positive population.
About 35 percent of men are circumcised. Data from the only site currently providing free circumcision - Orange Farm, near Johannesburg - reveals that 14,253 men were circumcised in 2009.
A draft policy was submitted to parliament and training of surgical health professionals is underway. Five circumcision pilot sites have been identified, two of which are in operation. A 2009 field analysis
showed that the unit cost per procedure was very high: US$88 for adults and $72 for newborns.
About 4,000 men are circumcised annually at government and private clinics. A policy has been approved but is yet to be launched, and formal scale-up has not yet started. The Puisano Outreach Organization, a local NGO, is engaged in male circumcision campaigns throughout the country.
A 2009 situation analysis
found male circumcision was accepted, even among traditionally non-circumcising communities, and 70 percent of Tanzanian men were circumcised. A national policy is being developed and three demonstration sites have been set up.
No formal policy for male circumcision has been developed, but an existing operational plan for HIV prevention includes circumcision. Five pilot sites have been selected for scale-up in 2010.
The country is conducting data analysis to inform its male circumcision strategy. A local NGO, Banja la Mtsogolo, is providing male circumcision services in its clinics, where it has 19 trained clinicians performing the procedure.
This is one of the three countries where studies showed the link between male circumcision and HIV, but only 25 percent of men are circumcised and HIV prevalence is rising. There has been some criticism for failing to start male circumcision quickly enough - the country still has no policy, nor has it started service delivery.