CSU 93/2010: MALE CIRCUMCISION IN SOUTH AFRICA

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CSU 93/2010: MALE CIRCUMCISION IN SOUTH AFRICA

This desk review of literature on male circumcision, also available at

http://www.malecircumcision.org/programs/documents/Review_MC_research_services_SA.pdf

comes from the first country in Africa to publish a randomized clinical trial on the impact of male circumcision on HIV acquisition in sexually active males. Given the progress of MC in neighboring countries, South Africa’s position is proof positive that ‘the first shall be last, and the last first.’

Recommendations are at the foot of this Email.

Country updates from other African countries are available online at

http://www.malecircumcision.org/programs/country_implementation_updates.html#progress_in_scaleup2

Good reading.

BD

RECOMMENDATIONS

The following recommendations from this review should be taken into consideration in

expanding, promoting and integrating MC into existing health services:

• Future expansion of circumcision services must be embedded within comprehensive HIV

prevention programming, including informed consent, confidentiality, a stigma free

environment, HIV counselling and testing and risk‐reduction counselling.

• MC programmes should be designed to increase uptake of HCT and partner disclosure, as

well as counselling to minimise MC in HIV positive men; priority should be placed on pairing

MC roll‐out with successful/innovative approaches (such as home‐based testing, integration

of HCT with family planning clinics, male‐oriented services).

• A plan for introduction of voluntary neonatal MC services within the provisions of the               

Children’s Act of 2005 and integration of neonatal MC into existing maternal, women,

neonatal and child health programmes must be drawn up.

• MC must be delivered as part of a recommended minimum package which includes    

counselling about risks and benefits of MC, counselling around risk reduction, HIV

counselling and testing, couple counselling, condom promotion and provision, and STI

management.

• A plan for reciprocal linking of traditional and medical MC is required. MC in traditional

settings should include standards for infection control, pain management, and counselling

on HIV prevention, sexual and reproductive health and rights of women and mechanisms to

train traditional MC providers are urgently required. In addition, messaging around

reduction of stigma and discrimination for males who opt for circumcision in clinical settings

and before the age of traditional initiation is necessary.

• A forum be set up to ensure structured coordination and communication of activities and

resources of donors and other stakeholders including policymakers, technical teams,

private and public sector health providers.

• A culturally sensitive communications strategy for promoting acceptability and access to

both adult and neonatal MMC and targeting both men and women for dissemination of

consistent and correct packaging of messages around MC is critical.

• In order to address human resource challenges; service integration, task sharing,

standardisation of methods and equipment, large scale training of health workers and

integration of private health providers must be undertaken.

• The absence of existing mechanisms to monitor and evaluate the impact of the proposed

national MC policy such as indicators for monitoring and evaluation, and quality assurance

standards must be urgently addressed.

• Consideration should be given to the expansion of dedicated sexual and reproductive health

services in SA, targeted at young men through schools and health facilities which could

include MC as well as counselling on sexual health, substance abuse etc.