Male circumcision (MC) has proven to be a highly efficacious method for reducing the spread of HIV infection. Three randomized clinical trials took place in Uganda, Kenya, and South Africa showed a 60% risk reduction in HIV transmission in circumcised men. Currently, there are plans to scale-up and roll-out comprehensive circumcision activities, though researchers face many challenges developing appropriate models for measuring the impact of MC activities at the population level. Much has yet to be assessed in terms risk compensation and sexual onset post-circumcision, safety and delivery (including how health systems will handle the influx of MC procedures at each site, shifting responsibilities to lower cadre healthcare workers versus training few and highly specialized medical providers to perform most MC), and the effect on transmission rates in female partners. Clinically, researchers still need to gain greater understanding of the healing time post MC as well as how MC affects the transmission of other STIs including syphilis and gonorrhea. Overall, from the previous randomized controlled trials, MC has shown to be relatively accepted and desired by African men, though cultural barriers still exist, particularly concerning ritual and social discrimination around male circumcision in some communities. Thus, the role traditional circumcisers will play in the campaign to provide safe and sufficient MC in each region will also need to be further assessed.
These pertinent issues will be addressed in a roundtable discussion with all the major stakeholders from the three RCT sites in Uganda, Kenya, and South Africa, as well as funders and interested parties.
The second discussion will address challenges in evaluating the impact of male circumcision programs amongst the different cohorts and seek to identify sound models for evaluating community and population level effects of male circumcision in these countries. The primary objectives for this meeting are:
1. Review existing and planned research that will provide information on the impact of adult MC programs
2. Identify additional potential sources of information on the impact of MC
3. Discuss the potential approaches to measuring the impact of MC programs at the population level
4. Develop a standardized information collection framework to facilitate comparison across regions and countries
5. Discuss whether existing information sources are adequate to inform policy and investment decisions for MC programs in other countries
6. If gaps do exist, discuss how they can be filled, what the relevant time lines are, and the approximate costs
The Forum will host a roundtable around these objectives and post a comprehensive report discussing the solutions and recommendations for these objectives.
The roundtable was held on October 7-8, 2008 at the offices of the Bill and Melinda Gates Foundation in Washington, DC.