1. Introduction

 

Medical Male Circumcision (MMC) stands as one of the most successful public health interventions in modern South African history.The relevance of MMC extends beyond HIV prevention. It is a gateway to men’s health, offering a rare point of contact between adolescent boys or adult men and the formal health system. Through this contact, we address adolescent health, provide STI screenings, and foster a culture of health-seeking behaviour in a demographic that historically avoids clinical settings. However, because MMC involves surgical intervention on minors and adults and intersects with deeply held cultural and religious beliefs, its implementation must be guarded by a robust framework of legislation and policy.

The purpose of this blog is to explore the intricate process of how MMC legislation and policy are formulated across international, national, and institutional levels. We will examine how South Africa translates global normative guidance into ethical, lawful, and effective implementation, ensuring that the best interests of the individual are always balanced against the broader goals of public health.

 

2. VMMC in the South African Public Health Context

 

South Africa remains the epicenter of the global HIV epidemic, with a generalized epidemic fueled by high levels of heterosexual transmission. Within this landscape, the South African HIV prevention strategy has evolved into a multi-layered “combination prevention” approach. While  Anti Retroviral Therapy (ART) has revolutionised treatment and Pre-Exposure Prophylaxis (PrEP) offers a vital shield for high-risk individuals, Voluntary Medical Male Circumcision (VMMC) remains a  primary prevention measure that is unmatched in its long-term cost-effectiveness.

The clinical evidence underpinning this policy is ironclad. Three landmark randomized controlled trials conducted in South Africa, Kenya, and Uganda demonstrated that MMC reduces the risk of heterosexual HIV transmission from women to men by approximately 60%. Over time, follow-up studies have shown that this protective effect may even increase beyond 70% as the programme matures. This makes the procedure a “lifelong shield” for sero-negative males, providing a permanent physiological barrier against infection that does not rely on daily pill adherence or situational behavior.

The South African National Department of Health (NDoH) officially endorsed MMC in 2010, marking a turning point in the national response. Since its inception, the programme has scaled remarkably, with over five million procedures performed. However, this scale-up does not happen in a vacuum. It requires a delicate, data-driven approach to match performance outcomes subjected to  several competing priorities:

The Epidemiology of Priority: The Burden of Disease

In South Africa, the HIV burden is not uniform; certain districts and provinces face significantly higher incidence rates than others. Consequently, MMC policy prioritises regions where the “prevented infections per circumcision” ratio is highest. Furthermore, the programme focuses heavily on the 15–49 age bracket—the demographic most at risk of new infections. By concentrating resources on these high-impact groups, the policy ensures that every Rand spent on the programme contributes directly to breaking the cycle of transmission.

The Power of Combination Prevention

VMMC is strategically positioned as a core component of a comprehensive prevention package. Every man who enters a clinic for an VMMC procedure is also provided with HIV testing and counseling (HTS), screened for sexually transmitted infections (STIs), provided with condoms, and educated on safer sex practices. This “combination” approach ensures that even if a man is already HIV-positive, his entry into the MMC programme becomes a pathway to immediate ART initiation, thereby contributing to the UNAIDS 95-95-95 targets.

A Gateway to Men’s Health

In South Africa, men—particularly young men—are notoriously difficult to reach through traditional healthcare channels. They are less likely to visit clinics for routine check-ups and more likely to present only when an illness is advanced. The VMMC programme changes this dynamic. It creates a, positive contact point between men and the formal health system. During the VMMC process, practitioners can screen for non-communicable diseases such as hypertension and diabetes, providing a holistic health intervention that extends far beyond the surgical procedure itself.

Respecting the Social Fabric

In many South African communities, circumcision is not merely a medical choice but a sacred rite of passage known as Cultural Male Initiation (CMI). For decades, a tension existed between medical safety and traditional practices. Modern South African policy has resolved this through the “Medical Male Circumcision with Cultural Initiation” (MMC-CMI) framework. This model allows traditional leaders and medical practitioners to collaborate, ensuring that the rite of passage is preserved while the surgical component is conducted under sterile, clinical conditions. This integration is essential for community “buy-in,” ensuring that the policy is viewed not as a clinical imposition, but as a culturally respectful health enhancement.

 

3. International Normative Guidance for MMC

 

South African policy is informed by a global consensus on what constitutes safe and effective MMC, developed through decades of epidemiological research and clinical trials. This international framework serves as the direction for the National Department of Health (NDoH), ensuring that local protocols are aligned with global safety standards and efficacy targets. Three primary international bodies shape the landscape, each playing a distinct yet complementary role in the policy-making lifecycle:

3.1 World Health Organisation (WHO)

The WHO serves as the ultimate norm-setting authority. Its primary role is to synthesize global evidence—such as the landmark 2005–2007 Randomized Controlled Trials  (RCTs)—into actionable clinical and implementation guidelines. The 2020 WHO Guidelines for Preventing HIV through Safe VMMC (and subsequent updates) provide the technical blueprint for the South African programme.

3.2 UNAIDS

While the WHO focuses on the clinical “how,” UNAIDS focuses on the strategic “why” and “where.” UNAIDS is the architect of the Global AIDS Strategy, which established the ambitious 95-95-95 targets to end AIDS as a public health threat by 2030. Within this framework, UNAIDS advocates for MMC as a high-impact primary prevention “pillar.”

 

4. How International Guidance Is Adopted in South Africa

The process involves a rigorous review by the South African National AIDS Council (SANAC) and various technical working groups. They contextualise international guidance by asking: Does this align with the South African Constitution? Can our rural health infrastructure support this? Does this conflict with the Children’s Act among others? This alignment ensures that when a policy is finally signed into law, it is not an “imported” idea but a South African solution.

 

5. Constitutional and Legal Foundations for VMMC in South Africa

 

In the South African legal hierarchy, the Constitution is the supreme law of the land, and every health policy—including the Voluntary Medical Male Circumcision (VMMC) framework—must be anchored in its values. For a procedure that involves surgical intervention, personal autonomy, and cultural identity, the legal “scaffolding” is exceptionally rigorous. This section provides a detailed analysis of the legislative acts that govern MMC, moving from the overarching rights of the Constitution to the specific clinical regulations of the health professions.

5.1 The Constitution of the Republic of South Africa (Act 108 of 1996 As amended

The Constitution provides the bedrock for all healthcare services. In the context of VMMC, several Bill of Rights sections are particularly influential:

• Section 10: Human Dignity: Every individual has inherent dignity and the right to have their dignity respected and protected. In a medical setting, this necessitates that the MMC procedure is conducted in a private, respectful environment where the client is treated as an active participant in their health journey rather than a mere subject of a clinical procedure.
• Section 12(2): Right to Bodily Integrity: This section is the cornerstone of medical law in South Africa. It states that everyone has the right to bodily and psychological integrity, which includes the right “to security in and control over their body” and “not to be subjected to medical or scientific experiments without their informed consent.” For MMC, this means that no procedure can be performed without legally valid informed consent, which must be given voluntarily by a person with the capacity to do so.
• Section 14: Right to Privacy: Confidentiality is a legal and ethical requirement. The HIV status of a client, or even the fact that they are seeking MMC, is protected information. Policy must ensure that data collection systems—while necessary for public health monitoring—never compromise the individual’s right to privacy.

Section 28(2): Best Interests of the Child: This section dictates that “a child’s best interests are of paramount importance in every matter concerning the child.” This creates a complex legal landscape for MMC on minors, as the long-term public health benefit of HIV prevention must be weighed against the immediate rights of the child to bodily integrity.

5.2 The Children’s Act 38 of 2005

The Children’s Act provides the specific regulatory framework for circumcision performed on male children. Section 12 of the Act is perhaps the most critical piece of legislation for MMC providers:

• General Prohibition: Circumcision of male children under the age of 16 is prohibited except for medical reasons (prescribed by a medical practitioner) or religious purposes (performed in accordance with the tenets of that religion).
• Consent at age 16: A male child who is 16 years or older may be circumcised if he provides informed consent in the prescribed manner. This is a significant legal threshold; in South Africa, a 16-year-old is deemed to have the maturity to consent to this specific surgical procedure independently, provided they understand the risks and benefits.
• Mandatory Counseling: The Act stipulates that no circumcision (for children 16 and older) may be performed unless the child has been “duly counselled” in the prescribed manner. This counseling must cover the surgical risks, the healing process, and the fact that circumcision only provides partial protection against HIV.
• The Right to Refusal: Even if a parent or guardian desires the procedure, a child who has the capacity to understand the situation has the right to refuse the circumcision. Coercion is a direct violation of the Children’s Act.

5.3 The National Health Act 61 of 2003 As amended

The National Health Act (NHA) governs the broader healthcare system. Its relevance to MMC lies in its standards for clinical safety and the management of health information:

• User Rights: Sections 6, 7, and 8 of the NHA detail the rights of health service users to be informed of their health status and the range of available treatment options.
• Health Records: The Act mandates the creation and maintenance of health records. In MMC programmes, this involves the meticulous completion of the Clinical Management Information (CMI) forms, which serve as the legal record of the procedure, the consent process, and any follow-up care.
• Quality of Care: The NHA empowers the Office of Health Standards Compliance (OHSC) to set and monitor safety standards. MMC sites must adhere to these national standards, ranging from sterilization protocols to the management of medical waste.

5.4 Professional Regulation: The Health Professions Act and the Nursing Act

The final layer of the legal scaffolding concerns “who” can perform the procedure. In South Africa, task-shifting—allowing lower-level clinicians to perform tasks usually reserved for doctors—is strictly regulated.

• The Nursing Act (Act 33 of 2005): Traditionally, surgery was the domain of medical doctors. However, to meet public health targets, the South African Nursing Council (SANC) issued specific circulars (such as SANC Circular 3/2024) that authorise Professional Nurses to perform MMC under specific conditions. They must be trained in an accredited programme, mentored by an experienced clinician, and formally assessed as competent.
• The Health Professions Act (Act 56 of 1974): This Act governs medical practitioners and ensures that doctors providing oversight or performing complex cases adhere to the highest ethical and clinical standards. It provides the legal basis for clinical governance and accountability in the event of an adverse event.

5.5 Customary Initiation Act 2 of 2021:

To provide for the effective regulation of customary initiation practices; to provide for the establishment of a National Initiation Oversight Committee and Provincial Initiation Coordinating Committees and their functions; to provide for the responsibilities, roles and functions of the various roleplayers involved in initiation practices as such or in the governance aspects thereof; to provide for the effective regulation of initiation schools; to provide for regulatory powers of the Minister and Premiers; to provide for the monitoring of the implementation of this Act; to provide for provincial peculiarities; and to provide for matters connected therewith.

By integrating these constitutional, statutory, and professional laws, South Africa has created a “belt and braces” legal environment. This ensures that the scale-up of VMMC is not just a clinical success, but a victory for human rights and the rule of law.

 

6. Ethical and Human Rights Principles Embedded in VMMC Law and Policy

 

The implementation of Voluntary  Medical Male Circumcision (VvMMC) in South Africa is not merely a clinical exercise; it is an ethical imperative governed by the principles of bio-ethics and human rights. Because the procedure is elective and often involves minors between the ages of 10-14 years, the ethical framework must be robust enough to withstand legal scrutiny and maintain public trust.

• Autonomy and Informed Consent: Central to South African law is the principle of autonomy—the right of an individual to make decisions about their own body. For adult men, this requires a comprehensive consent process where the practitioner ensures the client understands that MMC provides only partial protection against HIV and does not replace the need for condoms. For minors aged 16 and 17, the Children’s Act mandates that the child himself must provide informed consent after receiving prescribed counseling.
• Beneficence: This principle requires healthcare providers to act in the best interest of the patient. In the context of the National Strategic Plan (NSP), the long-term benefit of MMC—reducing the lifetime risk of HIV infection and preventing other STIs—is the primary “good” being provided.
• Non-maleficence (The “Do No Harm” Principle): Given that MMC is performed on healthy individuals, the tolerance for surgical error is zero. This principle is operationalised through rigorous Quality Assurance (QA) and the mandatory reporting of Adverse Events (AEs). Any death or serious complication is a failure of this ethical duty and must be investigated under the National Health Act.
• Justice and Equity: Ethical policy requires that MMC services are distributed fairly. This means ensuring that men in deep rural areas of the Eastern Cape or Limpopo have access to the same high-quality surgical care and sterile environments as those in private urban facilities.
• Best Interests of the Child: Under Section 28(2) of the Constitution, the child’s best interests are paramount. Policy formulation must constantly balance the immediate surgical risk against the lifelong health benefit, ensuring that the procedure is never used as a tool for coercion.
• Cultural Sensitivity and Integration: In South Africa, the right to practice one’s culture is constitutionally protected. Ethical MMC policy does not seek to replace traditional initiation but to “medicalise” the surgical component to ensure safety while respecting the ritualistic and social aspects of the transition to manhood.

 

7. Policy Drivers Shaping VMMC in South Africa

 

The formation of policy is a response to specific environmental, economic, and social pressures. In South Africa, four primary “drivers” have pushed MMC to the forefront of the health agenda:

• Public Health and Epidemiological Drivers
• Economic and Cost-Effectiveness Drivers
• Social and Cultural Drivers
• Legal and Human Rights Drivers

 

8. Policy Formulation Process for MMC in South Africa

 

The process of moving from a clinical recommendation (like those from the WHO) to a signed South African National Guideline involves several distinct stages:

• Agenda Setting
• Evidence Generation and Synthesis
• Consultation and Stakeholder Engagement
• Drafting and Regulatory Approval
• Financing and Implementation Planning
• Monitoring and Evaluation (M&E)

 

9. Stakeholders in MMC Policy Formulation and Implementation

 

A programme of this magnitude requires a multi-sectoral coalition. The stakeholders are categorised by their role in the “Policy-to-Practice” pipeline:

• The South African Government (NDoH & SANAC)
• International Norm-Setting Bodies (WHO & UNAIDS)
• Implementing Partners (e.g., JPS Africa)
• Regulatory Bodies (SANC & HPCSA)
• Traditional and Community Leadership

 

10. Operationalising MMC Legislation and Policy: JPS Africa Perspective

 

JPS Africa serves as a critical link between high-level national policy and the granular reality of clinical practice. Their approach demonstrates how the “legal scaffolding” of the Constitution and the Children’s Act is translated into safe, life-saving procedures through a dedicated focus on clinical governance and leadership development.

Translating Law and Policy into Practice: The Miller’s Pyramid Approach

JPS Africa operationalises the SANC Circular 3/2024 and NDoH clinical standards through a rigorous training and assessment framework. Rather than relying on theoretical knowledge alone, the organisation applies Miller’s Pyramid to ensure every practitioner moves from “Novice” to “Professional Authenticity”:

• Knows (Fact Gathering): Trainees must first master the theoretical clinical and legal foundations of MMC, often assessed through traditional clinical examinations where a minimum score of 80% is required.
• Knows How (Interpretation/Application): This level involves applying theory to clinical scenarios, such as case presentations and standardized MCQ assessments.
• Shows (Demonstration of Learning): Before touching a patient, practitioners must demonstrate their skills in controlled environments, such as simulations or Objective Structured Clinical Examinations (OSCEs).
• Does (Integrated into Practice): The ultimate legal and clinical benchmark is the “Does” level, where the practitioner is directly observed in the workplace performing the procedure. JPS Africa requires at least 10 supervised, successful procedures for a clinician to be certified as competent to work independently.

Internal SOPs and Quality Systems: The GROW and Kirkpatrick Models

To maintain the integrity of the programme across high-volume seasons, JPS Africa utilises advanced management models to ensure that Quality Assurance (QA) is a continuous process rather than a periodic event.

• The GROW Model for Quality Improvement: JPS Africa utilises the GROW framework (Goal, Reality, Options, Way forward) to facilitate continuous feedback between mentors and clinical teams. This ensures that any clinical or operational bottleneck is identified in real-time and resolved through a collaborative, problem-solving approach rather than a purely directive one.
• Digital Recording and Reporting (R&R): During the 2022 CMI season, JPS Africa developed an MS Excel-based electronic tool that revolutionised data management. By capturing demographics, facility links, and mandatory 2-day and 7-day follow-up data, this tool ensured a “robust audit trail” for the National Treasury and the Auditor-General, fulfilling the transparency requirements of the PFMA.
• The New World Kirkpatrick Model: To evaluate the effectiveness of their clinical interventions, JPS Africa tracks performance across four levels: Reaction (trainee satisfaction), Learning (knowledge gain), Behaviour (on-the-job application), and Results (impact on HIV prevention and safety outcomes). This ensures that training investment directly correlates to improved patient safety.

10-Year Review Insights: The Zero-Death Milestone and the Empowerment Dynamic

The landmark achievement of the 2022 VMMC-CMI season—performing 56,026 procedures with zero notified deaths—is the ultimate proof of the effectiveness of these operational policies. This success is rooted in what JPS Africa calls the Empowerment Dynamic:

• Shifting from Rescuer to Coach: In high-stakes medical environments, there is a risk of falling into the “Drama Triangle,” where supervisors act as “Rescuers” who fix problems for their teams, fostering dependency. JPS Africa’s policy forces a shift to the “Coach” role, where clinical leads empower their teams to take personal responsibility for safety and adherence to SOPs .
• Coordinated Monitoring & Evaluation (M&E): The zero-death milestone was sustained through standardized filing methods and internal data verifications that identified “red flag” cases before they could escalate into serious adverse events.
• Strategic Collaboration: The success was further solidified by strong institutional alignment with the Mpumalanga Department of Health (MPDOH), ensuring that medical safety protocols were respected even within the traditionally private space of cultural initiation rites.

 

11. Challenges in Policy Formulation and Translation into Practice

 

While the South African Medical Male Circumcision (MMC) programme is heralded as a global success, the journey from high-level policy formulation to “on-the-table” clinical execution is fraught with systemic and social challenges. These “policy-practice gaps” require constant navigation by implementing partners and Department of Health (DoH) officials to ensure that the legal and clinical integrity of the programme remains intact.

The Consent Dilemma: The 16-Year-Old Threshold

One of the most significant legal and operational challenges is the strict age of consent dictated by the Children’s Act 38 of 2005. South Africa’s requirement that a minor be at least 16 years old to independently consent to VMMC is higher than many neighboring countries. This creates a policy-practice tension: epidemiological data suggests that circumcising younger adolescents (aged 10–14) provides the highest long-term public health impact before they become sexually active. However, the legal requirement for parental or guardian consent for those under 16 adds a layer of administrative complexity. In rural or migrant-labor settings, finding a legal guardian to sign consent forms can be a barrier to service, sometimes leading to “demand-side” drop-offs where young men are willing, but the legal paperwork is incomplete.

The Children’s ACT 38 of 2005 is clear that:

1. A child above 12 can consent for elective procedures like TOP
2. Any child above the age of 12 can consent for HTS

However, as per National MMC guidelines, parental/legal guardian consent is mandatory for all clients below the age of 18. All clients MUST also assent.

Navigating the “Social Fabric”: Medical vs. Traditional Tensions

MMC policy must coexist with Cultural Male Initiation (CMI), a sacred rite of passage in many South African cultures as detailed in the Customary Initiation Act. The challenge lies in the “medicalisation” of a ritual that is traditionally private and non-clinical. Policy formulation is therefore incredibly sensitive; if a policy is perceived as an attempt to “replace” culture with medicine, it faces immediate community resistance. Implementing partners like JPS Africa have overcome this by adopting a collaborative working relationship with traditional leaders to ensure that while the surgical component is performed safely by a professional nurse, the cultural essence of the transition to manhood is preserved.

Geographic Inequity and Resource Constraints

Translating policy into practice is significantly harder in deep rural districts compared to urban centers. Resource constraints include:

• Human Resources: The shortage of SANC-registered Professional Nurses who have completed the mandatory “10 observed cases” competency assessment.
• Infrastructure: Maintaining a “sterile field” and cold-chain management for supplies in clinics with intermittent electricity or water supply.
• Logistics: Reaching men in remote areas requires e.g. mobile units, which increases the cost-per-circumcision and complicates the mandatory 48-hour and 7-day follow-up visits required by NDoH policy.

 

12. Future Policy Directions for MMC in South Africa

 

As South Africa moves toward the 2030 goal of ending AIDS as a public health threat, the policy landscape for Medical Male Circumcision (MMC) is undergoing a fundamental shift. The era of “emergency scale-up”—characterized by high-volume, siloed campaigns—is transitioning into a phase of “sustainable integration.” Future policy directions will be defined by three primary pillars: integration into men’s health, technological innovation, and sustainable domestic financing.

From Siloed programmes to Integrated Men’s Health

The current policy trajectory, outlined in the National Strategic Plan (NSP) 2030, moves away from treating VMMC as a standalone HIV intervention. Instead, the future lies in “Men’s Health Centers of Excellence.” In this model, MMC serves as the entry point for a comprehensive suite of services, including screenings for non-communicable diseases (hypertension, diabetes), prostate cancer awareness, and mental health support. Policy adaptation will focus on making clinics “male-friendly” to ensure that the contact made during an MMC procedure leads to long-term health-seeking behavior.

Technological Innovation: The Role of Non-Surgical Devices

A significant future policy signal is the adoption of non-surgical or “minimally invasive” circumcision technologies. These devices offer a “bloodless” and potentially “painless” alternative to traditional forceps-guided or dorsal slit methods.

• Policy Adaptation: The 2025 National Guidelines NDoH are expected to provide clear regulatory pathways for the use of such devices by Clinicians.
• Training and Competency: As new technologies emerge, the Miller’s Pyramid framework used by JPS Africa will be essential to ensure that practitioners move from “Knowing” the device to “Doing” the procedure with the same zero-death safety record established in traditional surgery.

Sustainable Financing and the PFMA

The National Treasury is the primary funding source of the VMMC programme, which shows how changes in the international donor landscape can be accommodated.

Community-Led Policy and Traditional Integration

The success of the VMMC-CMI (Cultural Male Initiation) model has shown that policy is most effective when it is co-created with the community which is governed by the Customary Initiation Act. 

 

13. Conclusion

 

The formulation of legislation and policy for Medical Male Circumcision in South Africa represents a masterclass in balancing public health urgency with constitutional integrity. What began as a clinical response to a devastating epidemic has matured into a sophisticated legal and operational framework that protects the rights of the individual while advancing the health of the nation.

Throughout this exploration, several key themes have emerged:

• The Primacy of the Law: MMC in South Africa is not merely a medical “best practice”; it is a constitutionally grounded right. From the Section 12 right to bodily integrity to the Children’s Act protections for minors, the law ensures that every procedure is voluntary, informed, and safe.
• The Importance of Evidence: Policy is only as strong as the data that supports it. By grounding national guidelines in international randomized controlled trials and local successes—such as the JPS Africa 10-Year Review—South Africa has built a programme that is both scientifically sound and practically viable. JPSA is therefore the “Go to Partner” for VMMC in South Africa based on its track record.
• Operational Excellence: The transition from “Policy to Practice” is where lives are saved. The zero-death milestone of the 2022 VMMC-CMI season stands as a testament to what is possible when rigorous SOPs, clinical mentoring, and data-driven oversight are applied at scale.
• The Need for Inclusivity: The future of MMC depends on its ability to remain adaptive. As new technologies like CircumQ emerge and as the programme integrates further into the “Social Fabric” of traditional culture, the policy must remain inclusive, transparent, and rights-based.

In conclusion, MMC remains a critical pillar of South Africa’s journey toward an AIDS-free generation. However, its success is not guaranteed by clinical efficacy alone. It is guaranteed by the clinicians, mentors, and policymakers who work daily to ensure that the “scaffolding” of the law supports the “work” of the hands. By continuing to foster an “Empowerment Dynamic” across all levels of the health system, South Africa will continue to set the global standard for ethical, effective, and life-saving public health intervention.

 

14. Consolidated Reference List

 

• The Constitution of the Republic of South Africa, 1996. [Official Government Gazette].
• The Children’s Act 38 of 2005. [Section 12: Provisions on Circumcision].
• National Health Act 61 of 2003. [Regulations on Health Standards].
• Customary Initiation Act 2 of 2021
• SANC Circular 3/2024. Performance of Medical Male Circumcision by Professional Nurses. South African Nursing Council.
• JPS Africa NPC. Management and Leadership Mentoring/Coaching Guideline 2025.
• JPS Africa NPC. 10-Year Review: Success Stories from the 2022 MMC-CMI Season.
• WHO (2020). Guideline on the use of devices for medical male circumcision for HIV prevention. World Health organisation.
• NDoH (2025). South African National Guidelines for the Medical Male Circumcision programme. National Department of Health.
• UNAIDS (2023). Global AIDS Strategy 2021-2026: End Inequalities, End AIDS.
• Auvert, B., et al. (2005). Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial. PLoS Medicine.
• Bailey, R. C., et al. (2007). Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. The Lancet.
• Gray, R. H., et al. (2007). Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. The Lancet.
• Traditional leaders and MMC in South Africa This video discusses the vetting process for traditional surgeons and the collaboration between government and traditional leaders to ensure safety during initiation seasons.