CHAPTER 1. Introduction & Background to Edition 2

This document provides implementing partners supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) with a collection of the best resources available for sites providing voluntary medical male circumcision (VMMC) for HIV prevention. This version is Edition 2; Edition 1, released in 2013, focused on assisting implementing partners and site staff with opening new VMMC service locations. The first version covered all aspects of the planning, launch, and oversight of daily operations at the site level. Given the maturation of VMMC programs since 2012, Edition 2 focuses on optimizing management of existing service locations, though chapters still remain for those establishing new sites. The primary intended audience for Edition 2 remains site-level staff, with different chapters most relevant to different staff positions.

Optimized management includes renewed attention to safety and quality of the services provided; technological innovation and efficiencies in service delivery techniques; and strategies for the age pivot (to males aged 15 to 29 years) and the geographical pivot (to DREAMS districts and non-DREAMS scale-up districts with high HIV burden and low male circumcision prevalence) to contribute to epidemic control, to name a few. [See PEPFAR DREAMS].

DREAMS was launched on World AIDS Day in December 2014 and is an ambitious $385 million public-private partnership to reduce HIV infections among adolescent girls and young women in 10 sub-Saharan African countries. The goal of DREAMS is to help girls develop into Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe women. Girls and young women account for 71 percent of new HIV infections among adolescents in sub-Saharan Africa. The 10 DREAMS countries (Kenya, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe) account for nearly half of all the new HIV infections that occurred among adolescent girls and young women globally in 2014.

Since 2013 standards of care have changed, and new PEPFAR policies have been introduced covering issues like tetanus risk mitigation, age requirements for certain surgical techniques, and enhanced adverse event (AE) reporting requirements. Two medical devices, PrePex and Shang Ring, have also been prequalified by the World Health Organization (WHO) for use by VMMC programs since the release of Edition 1. These updated/new topics are covered in this revised version. In addition to an update of the technical content, this document gives attention to increasing utilization by enabling web-based and mobile access. While the print version appears much the same, the e-platforms have been designed for “point-and-click” functionality, so that resources are more readily available to the broadest possible audience of VMMC sites and staff.

As in the first edition, the second edition has included new best practices of VMMC service provision from across the 14 priority countries. These have been summarized and placed in the respective chapters.

In addition, each chapter is designed as a stand-alone resource covering all aspects of the respective topic, including:

  • Chapter Goals: States the objectives of the chapter
  • What Users Need to Know: Summarizes the most important information and referenced documents with links (online version) or directions (printed version) to the tools/instruments/resources
  • Frequently Referenced Information: Additional relevant content embedded into the body of the text
  • For Additional Information: Provides additional details on the topic for those that want more
  • Tools, Instruments and Guidance Documents: Lists all the resources referenced in the chapter
  • Case Studies: Provides program examples where applicable
  • References: Lists the manuscripts cited in the chapter.

The printed version of this guide will be made available on the AIDSFree website. The tools, instruments, and guidance documents referenced throughout are available on the web through links that take you directly to the information of interest.

The array of materials referenced in this collection have been sourced from Joint United Nations Programme on HIV/AIDS (UNAIDS) and WHO guidance, the PEPFAR Voluntary Medical Male Circumcision Technical Working Group (VMMC TWG), and the experiences and materials from existing VMMC programs in Southern and Eastern Africa.

The scope of this document is limited to establishing and supporting quality VMMC services for HIV prevention at the facility or VMMC site level. The necessary steps involved in scaling up VMMC services at the national, regional, and district levels are beyond the scope of this document. For a more comprehensive view of the key steps in scaling up VMMC services at the above site (national VMMC program), see WHO Operational Guidance for Scaling Up Male Circumcision Services for HIV Prevention.

To read more about the frequently referenced information, additional information, and to read related case studies download the chapter PDF.