The International AIDS conference kicked off in South Africa in July 2016, and was an opportunity for partners to strategise on addressing the remaining barriers to ending the spread of HIV. A bullet in the arsenal against the spread of HIV is Voluntary Male Medical Circumcision (VMMC).

Medical male circumcision has been shown to reduce the risk of female to male HIV infection and STIs by as much as 60%. Furthermore, MMC also affords a reduction in risk of prostate cancer and cervical cancer for female sex partners.

To address the spread of HIV/AIDS, the WHO upscaled efforts to promote VMMC in 2011 in target countries in the sub-Saharan Africa region. The results have been positive. In 2013, 2.7 million men volunteered to be circumcised in 14 priority countries, bringing the total number of VMMCs in the region to 5.82 million males circumcised since 2008. The target for VMMC by the end of 2016 is 20.8 million males circumcised, and so, much effort needs to be placed on further support and upscaling. The WHO outlined the steps that must be taken to achieve impact and cost efficiencies of the VMMC programme. These were:

• Maintaining investments in and diversifying the funding base for VMMC programmes to address resource gaps;
• Identifying innovative solutions to address supply and demand challenges
• Targeting resources based on demography and geography to improve the impact of programmes (disaggregated data will be key in this endeavour).

JPS Africa is committed to supporting these goals. As part of their overall HIV/AIDS prevention strategies and programmes, JPS Africa has partnered with the Department of Health and key stakeholders to increase awareness around VMMC and the availability of the service in South Africa. This ambitious and important programme will hopefully contribute to the achievement of the target of 80% coverage of VMMC in South Africa. As of 2013, South Africa’s coverage was 32%

The four key strategies of this work are to ensure that high-quality, high-volume integrated VMMC services are provided; to collaborate with traditional circumcision communities and their leaders to encourage VMMC as a part of traditional initiation rights; to partner with companies to bring VMMC services to the workplace and to collaborate with other partners in the districts they work in to encourage referrals and provide a continuum of care.

Currently working in four provinces, JPS Africa has a total of 34 sites that support VMMC and one mobile VMMC clinic. The good results are already being seen. Over 50 000 VMMC procedures have been performed under the JPS Africa programme between October 2011 and April 2015 in 3 districts in 3 provinces. The majority of these circumcisions were performed in rural settings and hard-to-reach communities where overall clinical services are lacking. The organisation works to train Health Promotion Officers on the benefits of the procedure, and how to promote the procedure amongst South African men. Furthermore, JPS Africa provides high quality, high impact training on MMC surgical skills and device-based MMC for healthcare providers across South Africa. This training is thus supported by using the ModCal® Training skills programme utilising group-based training and technology. The training includes simulated practice on anatomical circumcision models and supervised practice on clients in a surgical setting.

In addition, JPS Africa is leading the development of the transition model for PEPFAR supported partners to transition services to local Departments of Health across SA.

JPS Africa is working collaboratively with CDC-SA and the NDoH in assessing the uptake and subsequent roll-out of the WHO pre-qualified male circumcision device, Prepex. This device is a novel alternative to surgical circumcision and requires no injections, no suturing and is considered a bloodless procedure. It has shown favourable uptake and demand in areas where the device is widely available.

JPS Africa is set to contribute significantly to the South African VMMC programme through technical assistance, policy development, high-quality service provision and high impact training.

The good results are already being seen. An incredible 47047 VMMC procedures have been performed under the JPS Africa programme between October 2011 and April 2015. The future is looking bright.