Annual number of males voluntarily circumcised
Progress in scaling up male circumcision services
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. Other benefits of medical male circumcision include the reduced risk of some other STIs, including human papillomavirus, the cause of cervical cancer. The World Health Organization (WHO) and UNAIDS recommendations emphasize that voluntary medical male circumcision should be provided as part of a package of prevention interventions including safer sex education, condom education and provision, HIV testing and linkages to care and treatment, and management of sexually transmitted infections.
Number of males circumcised during the past 12 months according to national standards
Health facility recording and reporting forms, programme data, health information system. It is important to ensure that voluntary male medical circumcision is provided with an ethics and human rights approach. The procedure should be voluntary and include procedures for informed consent and assent.
Age (<1, 1–9, 10–14, 15–19, 20–24, 25–29, 30-34, 15-49 and 50+ years).
Optional to estimate coverage: Estimated number of uncircumcised, HIV-negative males.
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.
- 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).
Preventing HIV through safe voluntary medical male circumcision for adolescent boys and men in generalized HIV epidemics: recommendations and key considerations. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/rest/bitstreams/1296029/retrieve).
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).
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).