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Annual number of males voluntarily circumcised

Export Indicator

Number of male circumcisions performed according to national standards during the past 12 months
What it measures

Progress in scaling up male circumcision services

Rationale

Compelling evidence indicates that male circumcision reduces the risk of men heterosexually acquiring HIV infection by about 60%. Three randomized controlled trials - plus post-trial studies - have shown that male circumcision provided by well-trained health professionals in properly equipped settings is safe and can reduce the risk of acquiring HIV. The World Health Organization (WHO) and UNAIDS recommendations emphasize that male circumcision should be considered an efficacious intervention for HIV prevention in countries and regions with heterosexual epidemics and high HIV prevalence.

Numerator

Number of males circumcised during the past 12 months according to national standards

Denominator

Not applicable

Calculation

Not applicable

Method of measurement

Health facility recording and reporting forms, programme data, health information system

Measurement frequency

Annual

Disaggregation
  • Age (<1, 1–9, 10–14, 15–19, 20–24, 25–49 and 50+ years)
  • Cities and other administrative areas of importance
Additional information requested

Please provide city-specific data for this indicator. Space has been created in the data entry sheet to provide information for the capital city and one or two other key cities of high epidemiological relevance: for example, those that have the highest HIV burden or those that have committed to ending AIDS by 2030.

Optional to estimate coverage: Estimated number of uncircumcised, HIV-negative males.

Strengths and weaknesses

The total number of men and boys circumcised indicates either change in the supply of services or change in demand. Comparing the results against previous values shows where male circumcision services have been newly instituted or where male circumcision volume has changed.

As countries successfully scale up voluntary medical male circumcision (VMMC), the number of uncircumcised adolescent boys and men eligible for the procedure will decrease and the number of procedures performed becomes more difficult to interpret. It can be helpful to estimate the coverage of circumcisions performed relative to need; in this instance, need can be understood as the number of uncircumcised, HIV-negative adolescent boys and men who would be eligible for the procedure. These estimates can be derived from models such as those used for the purposes of monitoring progress against HIV Fast-Track Targets and the VMMC Decision Makers' Program Planning Toolkit (DMPPT) 2.

Further disaggregation is recommended at the country level:
  • HIV-positive by test(s) on site, HIV-negative by test(s) on site, HIV-indeterminate results by test(s) on site or unknown/refused HIV test(s).
  • Groups identified as being at increased risk of HIV infection (for example, men seeking services for STI management, male clients of sex workers or occupational groups).
  • Type and location of health facility.
  • Cadre of the provider.
  • Surgical versus device-based procedure.

Disaggregating the number of male circumcisions by HIV status and age will enable the impact of male circumcision programmes on HIV incidence to be determined using models. If a country has given priority to specific age groups, this disaggregation will help to determine whether age-specific communication strategies are creating demand. If the data are available by the type and location of health-care facility where the circumcision was performed, resource allocation needs can be assessed. Disaggregating these data by the cadre of health-care provider will determine whether task-shifting efforts are succeeding and help to determine resource allocation.

Some programmes will work closely with voluntary HIV testing services to provide HIV testing. A man desiring circumcision may have been recently tested, and an on-site HIV test may be unnecessary. In these cases, the facility may request a written verified result to verify HIV status. There is no specific length of time before male circumcision that the test should have been done, but within three months is suggested. The purpose of testing is not to identify every man who might be HIV-positive but to provide HIV testing to men seeking health-care and to identify men living with HIV who, if they choose to be circumcised, are likely to be at higher risk of surgical complications (men with chronic infections and low CD4 counts).

 

Further information

A guide to indicators for male circumcision programmes in the formal health care system. Geneva: World Health Organization and UNAIDS; 2009 (http://whqlibdoc.who.int/publications/2009/9789241598262_eng.pdf).

Related Indicators

DfC.1 VMMC scale-up, 2020, WHO Consolidated HIV strategic information guidelines: driving impact through programme monitoring and management (https://www.who.int/publications/i/item/consolidated-hiv-strategic-information-guidelines).

VMMC_CIRC, PEPFAR, MER 2.0 (Version 2.4), September 2019, Monitoring, Evaluation, and Reporting (https://www.state.gov/wp-content/uploads/2019/10/PEPFAR-MER-Indicator-Reference-Guide-Version-2.4-FY20.pdf).