NAIROBI, Kenya--Male circumcision is gaining recognition as a fundamental practice for limiting the spread of HIV across sub-Saharan Africa. Three conclusive studies conducted in African countries, including Kenya, have shown that becoming circumcised dramatically reduces a man's chances of acquiring HIV from an infected woman. The challenge now is to transform this clinical knowledge into a public-health strategy that can save millions of lives.
Family Health International (FHI), the Bill & Melinda Gates Foundation, and the Government of Kenya have come together to address this challenge. FHI has received a five-year, US$18.5 million grant from the Gates Foundation to establish the Male Circumcision Consortium (MCC), a partnership with the University of Illinois at Chicago (UIC) and EngenderHealth.
The Consortium will work within the framework of the National Guidance for Voluntary Male Circumcision in Kenya and with a range of health care providers to improve and expand voluntary male circumcision services in Kenya. These efforts will be coordinated through the National Task Force on Male Circumcision at the Ministry of Public Health and Sanitation and, in Nyanza Province, through the offices of the provincial directors of public health and sanitation and of medical services.
The government initiative is also supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) and other partners.
The Consortium, in consultation with the Government of Kenya, will conduct a range of research and training activities to determine the safest and most effective ways to provide voluntary male circumcision services. It will also help Kenya provide comprehensive and accessible HIV prevention in areas with the lowest levels of male circumcision and the highest prevalence of HIV.
The Consortium will focus primarily on Nyanza Province, but the impact will be national, says Dr. Mores Loolpapit of Family Health International, who is senior manager of the Male Circumcision Consortium in Kenya. "This initiative advances the Government of Kenya's national strategic plan to reduce transmission of HIV in Kenya," he adds. "It will generate knowledge that the government can use to implement its national guidance for voluntary male circumcision in Kenya and will likely influence voluntary adult male circumcision programs worldwide."
Clinical trials of adult male circumcision conducted in Kenya and Uganda showed that medically performed circumcision reduces the risk of acquiring HIV by approximately half. A similar trial in South Africa showed a 61 percent reduction in HIV infection among circumcised men.
"This pivotal research has led authorities in eastern and southern Africa to initiate support for widespread provision of circumcision services," says Robert Bailey, professor of epidemiology at the UIC School of Public Health. Bailey was the lead researcher of the Kenyan study and is a lead researcher for the Male Circumcision Consortium.
After reviewing the results of the three circumcision trials, experts convened by the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) concluded that the evidence that male circumcision provides partial protection against HIV infection was compelling. They recommended that safe and voluntary male circumcision be considered part of a comprehensive HIV prevention strategy. The Consortium's partners have worked closely with WHO to ensure that the Consortium's objectives support the WHO/UNAIDS recommendations, and that its activities complement the global health community's efforts to reduce the number of new HIV infections by increasing the number of circumcised men.
The Male Circumcision Consortium's objectives are to:
- Support the Government of Kenya and other local partners in developing and implementing a national male circumcision strategy.
- Expand a male circumcision research and training center in Kisumu to train providers, build the capacity of health facilities, and monitor clinical outcomes.
- Identify and address any misunderstandings about male circumcision for HIV prevention.
- Conduct research to identify the safest, most effective ways to provide voluntary male circumcision as part of a comprehensive package of HIV prevention services.
"Expanding male circumcision services is a great opportunity to engage men to take greater responsibility for HIV prevention," says Feddis Mumba, country director, EngenderHealth-Kenya. "By reaching a population that does not usually access health services, we can maximize opportunities to educate men about behaviour change and the importance of shared sexual decision-making, which would improve health outcomes for both men and women."
About Family Health International
Since 1971, Family Health International (FHI) has been at the forefront of public health research, prevention, care, and treatment in the developing world. FHI delivers services and conducts research in HIV/AIDS, other infectious diseases, and reproductive health to improve the lives and well-being of some of the world's most vulnerable people. For more information, visit www.fhi.org/en/male_circumcision/mcc.
About EngenderHealth
EngenderHealth works to improve the health and well-being of people in the world's poorest communities by transforming the quality of sexual and reproductive health services. EngenderHealth will contribute to a national training plan and system to build a skilled health work force to provide male circumcision, and will conduct research to assess the feasibility of non-physicians (e.g.,. nurses) providing circumcisions and the efficacy of outreach efforts to increase access to these services. For more information, visit www.engenderhealth.org.
About the University of Illinois at Chicago
Since 1995, UIC's Robert Bailey and colleagues have conducted research on male circumcision and HIV infection in Africa. UIC's portion of the grant will be used to expand a medical circumcision training center to build capacity in Kenyan public health facilities and among private practitioners to provide safe circumcisions in the context of full HIV prevention services. UIC investigators and collaborators will also conduct research to evaluate the safety and quality of circumcision and other HIV prevention services. For more information, visit www.uic.edu.