Overview

Since 2007 the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) have recommended voluntary medical male circumcision (VMMC) as an important strategy for the prevention of heterosexually acquired HIV in men in settings where the prevalence of heterosexually transmitted HIV is high. Over 25 million men and adolescent boys in East and Southern Africa have been reached with VMMC services.

These new guidelines update earlier WHO recommendations to maximize the HIV prevention impact of safe VMMC services and aim to guide the transition to the sustained provision of interventions with a focus on the health and well-being of both adolescent boys and men.

Contents

• Acknowledgements
• Acronyms and Abbreviations
• Glossary
• Executive Summary
• 1. Introduction
  • 1.1. Background
  • 1.2. Goal and objectives
  • 1.3. Intended audiences
  • 1.4. Guideline development process
• 2. Voluntary Medical Male Circumcision as an Intervention for HIV Prevention
  • 2.1. Evidence to inform updated recommendations: the impact of male circumcision on risk of HIV infection
  • 2.2. Other factors to inform decision-making
• 3. Issues and Considerations Regarding VMMC for Younger Adolescent Boys
  • 3.1. Adolescent development
  • 3.2. Rationale and background for review of VMMC for HIV prevention among younger adolescents
  • 3.3. Evidence to inform policy on the offer of VMMC for HIV prevention to adolescents ages 10–14 years compared with older adolescents: safety, acceptability and maintaining effective coverage
  • 3.4. Other factors to inform decision-making
• 4. Use of Device-Based Method for Male Circumcision in Context of HIV Prevention
  • 4.1. Rationale for review and background on use of device-based methods for male circumcision in the context of HIV prevention
  • 4.2. Evidence to inform updated recommendations
  • 4.3. Evaluation of collar clamp and elastic collar compression (in situ) devices
  • 4.4. Evaluation of surgical assist devices
  • 4.5. Programme considerations on use of device-based methods for male circumcision
• 5. Enhancing Uptake of VMMC among Adult Men and Male Adolescents in High HIV Prevalence Settings
  • 5.1. Rationale and background
  • 5.2. Evidence-based interventions: service delivery changes for enhanced uptake of VMMC for HIV prevention among adolescents and adults
  • 5.3. Evidence-based interventions: economic compensation
  • 5.4. Programme and policy considerations from evidence and Guideline Development Group discussions
  • 5.5. Policy review on men’s health and services
  • 5.6. Case studies
• 6. Sustaining VMMC Services with a Focus on Adolescent Boys: Programme and Implementation Considerations
  • 6.1. Introduction and background
  • 6.2. Framework for transition to sustainable services
• References
• Web Annexes
  • WEB ANNEX 1.1. Guideline Development Process and Groups; Declarations of Interests
  • WEB ANNEX 2.1. Grade and Evidence-to-Decision Tables on Voluntary Medical Male Circumcision for HIV Prevention Among Adolescents and Men
  • WEB ANNEX 2.2. Male Circumcision and the Risk of HIV Infection in Women: Systematic Review and Meta-Analysis
  • WEB ANNEX 2.3 PART 1. WHO Guidance on Voluntary Medical Male Circumcision for HIV Prevention Among Adolescent Boys and Men: Literature Reviews for PICO Questions 1–3
  • WEB ANNEX 2.3 PART 2. Synthesis of Literature on Voluntary Medical Male Circumcision: Facilitators and Barriers, by Country
  • WEB ANNEX 4.1. Grade Tables, Summary of Studies and Evidence-To-Decision Table on Safety and Acceptability of Male Circumcision Devices: Collar Clamp, Elastic Collar Compression and Surgical Assist Devices
  • WEB ANNEX 5.1. Grade and Evidence-to-Decision Tables on Enhancing Uptake of Voluntary Medical Male Circumcision Among Men
  • WEB ANNEX 5.2. Case Studies on Enhancing Uptake of Voluntary Medical Male Circumcision Services
  • WEB ANNEX 6.1. Sustaining Voluntary Medical Male Circumcision Services and Linkages with Adolescent Sexual and Reproductive Health: The Zimbabwe Smart-Lyncages Project. Executive Summary

Suggested citation:

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. Licence: CC BY-NC-SA 3.0 IGO.

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