Sunday, 12th of June 2011 |
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
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.
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