UNAIDS and the US President's Emergency Plan for AIDS Relief (PEPFAR) have launched a five-year plan to have more than 20 million men in 14 eastern and southern African countries undergo medical male circumcision by 2015 as part of HIV prevention efforts.
According to mathematical modelling by the two organizations, achieving 80 percent coverage among males aged between 15 and 49 by 2015 - an estimated 20.3 million circumcisions - would avert some 3.4 million new HIV infections by 2025. The plan also aims to have established a sustainable national programme for infant circumcision of all boys up to two months old, and at least 80 percent of male adolescents.
"Voluntary medical male circumcision is a high-impact, cost-effective prevention tool that will bring us one step closer to our goal of an HIV-free generation," said Michel Sidibe, executive director of UNAIDS. "Each HIV infection averted is money in the bank and fiscal space for the future."
The plan was launched at the 16th International Conference on AIDS and Sexually Transmitted Infections in Africa, in Addis Ababa, Ethiopia. Achieving the targets set will cost an estimated US$1.5 billion, and save some $16.5 billion in HIV treatment and care costs by 2025.
The UN World Health Organization (WHO) and UNAIDS have provided operational guidance for the scale-up of medical male circumcision, but to date few countries have rolled out large-scale programmes. At the end of 2010, just 550,000 men had been circumcised in the 14 priority countries.
"Science has shown us the way, and it is time we closed the gap between scientific evidence and implementation... we have a real implementation deficit," said Sidibe. "This one-time surgical procedure provides partial life-long protection against HIV... it has benefits not just for men but for women too, who will be less likely to be exposed to HIV in future."
Medical male circumcision has also been shown to reduce urinary tract infections in infants and children; human papillomavirus, which causes cervical cancer in women; bacterial vaginosis in partners of circumcised men; and ulcerative sexually transmitted infections.
Speaking at the launch, US Global AIDS Coordinator Eric Goosby reiterated US President Barack Obama's pledge of 4.7 million PEPFAR-supported male circumcisions in eastern and southern Africa over the next two years.
Goosby noted that while the initial "catch-up" phase of the plan would be largely donor-funded, it was hoped that the second component of the plan, which involves sustaining the benefits of male circumcision through infant male circumcision, will largely be part of national medical funds.
Kenya has so far had the greatest success in scaling-up male circumcision - some 350,000 circumcisions over the past three years. Government officials said the key to the programme's achievements was advocacy and quality of care.
Dr Nicholas Muraguri, head of Kenya's National AIDS and Sexually transmitted infections Control Programme, said, "People must believe in the benefits of the service you are providing, and getting leaders on board is critical; secondly, if you are offering a quality service, the queues will be endless."