Best buys for Africa: Voluntary medical male circumcision for HIV Prevention
Male circumcision for HIV prevention has been a cornerstone in global efforts towards “ending AIDS.” It has been recognized as one of the most effective and cost-effective HIV prevention interventions, and as of end-2017, nearly 19 million men had been medically circumcised in 14 “priority countries.” Looking ahead, the contribution and cost-effectiveness of male circumcision depends on two factors:
• The continuing expansion of treatment affects the effectiveness of male circumcision for HIV prevention. The higher treatment coverage, and the more effective treatment is in suppressing the virus and preventing HIV transmission, the smaller is the contribution of male circumcision in preventing new HIV infections.
• Following the scaling-up of male circumcision across the male population so far, and reflecting considerations on cost-effectiveness, the focus of programs offering male circumcision has shifted to adolescents and young adults.
The appraisal takes into consideration this changing context, and the variation in the burden of the disease and the state of the response across countries. We distinguish different levels of HIV prevalence (5% to 20%) and treatment coverage (50% to 80%), and offer estimates on male circumcision for adolescents (age 15) and adults at age 30. Estimated benefit-cost ratios range from 1.1 (age 30, HIV prevalence 5%, treatment coverage 80 percent) to 56 (age 15, HIV prevalence 20%, treatment coverage 50 percent).