Table 2

Design and implementation of MC services for HIV prevention in 14 priority countries in east and southern Africa, 2011

Country

HIV prevalence (%)

Men circum-cised (%)

Policy framework

Implementation strategy, plan status

MC delivery structure

Potential infections averted by scaling up MC to 80% by 2015 and maintain rate through 2025*

Total Net Savings, 2009-2025 (US$)

Circum-cisions to date

Estimated number of MCs needed to reach 80% target

Achievement towards 80% target (%)


Botswana

17.6

11.2

MC as part of existing HIV prevention policy

In place

Services integrated in existing HIV prevention strategies

62,773

248 million

11,197

345,244

3.2

Phased scale-up goal, 80% of 0-49 years HIV-negative men by 2014

Ethiopia

1.4 - National

93 - National

MC as an additional HIV prevention strategy. Regional MC Task Force is to be established; draft regional MC strategic direction document under finalization.

Under development

MC to be provided in 100% of medical facilities in Gambella (one hospital and 25 health centres)

1,479

5.8 million

5,786

100,000

5.8

6.0 - Gambella

46 - Gambella

Target to provide services in 100% of healthcare facilities in Gambella Region

Kenya

7 - National

86- National

MC policy in place: 'National Guidance' for MC

In place

Stand alone and integrated, mobile clinics; prison services

73,420

247 million

232,287

860,000

27

15.4 - Nyanza

48 - Nyanza

Target to reach 80% of 15-49 year old men (1.1 million men) and newborns by 2013

Lesotho

24

52

MC policy in place

In place

MC to be integrated in HIV prevention services focused in MNCH settings

106,427

618 million

4,000

376,795

1

Launched in 2010

Malawi

11

21

In place

National operational plan includes voluntary MC

Currently offered by free-standing clinics. Scale-up structure not yet developed

240,685

1.2 billion

3,119

2,101,566

0.1

Mozambique

12

52

Formal policy developed

MC included in operational plan for HIV prevention

MC services available on demand; adolescent and neonatal MC are planned.

215,861

1.5 billion

7,733

1,059,104

0.7

Rollout in pilot sites

Namibia

13

21

MC policy approved

In place

Stand-alone, mobile services are being considered. Plans to integrate into hospital services.

18,373

120 million

1,987

330,218

0.6

Rollout in pilot sites

Rwanda

3

12

Formal policy in development. Detailed operational plan in place

In place

Formal scale up started in the military. Plans to integrate into standard HIV prevention services.

56,840

200 million

1,694

1,746,052

0.1

Detailed operational plan being rolled out

South Africa

18

42

Draft policy in place, under finalization

In place

Facility based, and stand-alone centres and camps, scale up from Orange Farm to 143 sites

1,083,869

6.5 billion

131,117

4,333,134

3.4

Currently being scaled up nationwide

Swaziland

26

8.2

Policy adopted by cabinet

In place

Formal scale-up of integrated services started; dedicated "circumcision Saturdays'

56,810

332 million

18,869

183,450

13.3

Tanzania

5.7

67

Policy under way

Under development. Plans to target 8 regions with high HIV and low MC prevalence

Scale-up demonstration sites, MOVE strategy recommended in the public sector

202,900

966 million

18,026

1,373,271

1.4

Uganda

6.4

25

Policy in place

In place

Piloted in the military and a mobile site, plans to integrate into routine services

339,524

2 billion

9,052

4,145,184

0.2

Zambia

14

12.8

Cabinet approved MC as part of HIV prevention policy

In place

Multi-sectored approach focused on military, police, prisons, and neonatal services

339,632

2.4 billion

81,849

1,949,292

4.2

Target of 250,000 MCs a year; MC sites to increase to 300 by 2014

Zimbabwe

14

10

Policy in place

Under development (2010-2014)

Services offered through mobile and free-standing sites and in public health clinics. Nationwide neonatal MC planned

565,751

3.8 billion

13,977

1,912,595

0.7


Notes and data sources: Ethiopia MC data (personal communication, Hannah Gibson, Country Director Jhpiego, Ethiopia) and estimated target [173]; Lesotho (4000 annual circumcisions before programme intervention) [169]; for Zimbabwe 30,000 circumcisions have previously been reported [170]; all other data [13,132,167,171].

* The 80% target in all three columns is for uncircumcised males 14-49 years.

Wamai et al. Journal of the International AIDS Society 2011 14:49   doi:10.1186/1758-2652-14-49

Open Data