Johannesburg, 17 April 2012—Right to Care will perform 125 000 medical male circumcisions in 18 months and help the Department of Health’s efforts to scale up circumcision countrywide with technical experts, through support from USAID (US Agency for International Development) and funding from the US PEPFAR (President’s Emergency Plan for AIDS Relief).

Voluntary medical male circumcision (MMC) is a key component of the National Department of Health’s strategy to prevent the spread of HIV. Men can protect themselves and their partners to reduce the risk of HIV infection and cervical cancer.

The new Right to Care agreement builds on USAID investments in 15 high-quality, high-volume MMC sites servicing the Free State, Gauteng, KwaZulu Natal, and Mpumalanga. Right to Care will also establish a new site in KwaZulu-Natal and expand satellite sites in informal settlements and urban areas in Gauteng. The contract targets men aged 14 to 49, who are HIV-negative, for the free MMC services. In just 18 months, 125 000 circumcisions will be performed.

To achieve these results, Right to Care, the prime recipient of the US Government’s support, will work with three NGO partners: Anova Health, the Centre for HIV/AIDS Prevention Studies (CHAPS), and Maternal, Adolescent and Child Health (MatCH).

The programme’s second component is to provide technical assistance to the Department of Health to assist districts establish and operate high-volume high-efficiency MMC services and to efficiently utilise their resources for the MMC programme. This will be in all nine provinces.

Right to Care’s Chief Executive Officer, Prof Ian Sanne, welcomed USAID’s support from PEPFAR, saying, “MMC is an important component in the basket of prevention interventions.” Research shows that MMC reduces male HIV sexual acquisition risk from females by up to 60%. It also reduces the risk of other sexually transmitted infections, the most important of which is probably human papillomavirus.

“Human papillomavirus can lead to penile cancer in males and, when transmitted to women, contributes to a high incidence of cervical cancer.

“The continued use of male and female condoms is vitally important, even when the man is circumcised.”

USAID’s Southern Africa Director, Jeff Borns, said, “We support HIV/AIDS cost-efficient prevention strategies that work, and MMC has been tested extensively and is effective.”

The MMC programme will follow South African national and World Health Organisation guidelines. These advocate that voluntary MMC be packaged with a set of services that include:

• HIV testing and counselling
• Screening for sexually transmitted infections
• Provision of male and female condoms and promotion of their correct and consistent use
• Promotion of safer sex practices and risk-reduction counselling
• Full surgical removal of the foreskin
• Linkage of HIV-positive patients to care and treatment

Right to Care and its partners will use a model called MOVE (Maximising Options for Volume and Efficiency). This innovative service-delivery model, developed in South Africa by CHAPS, applies a forceps-guided technique. The model is being adopted internationally as the standard for large-scale MMC programmes.

Communications will be key to the success of the programme. Community advisory boards will be formed and tasked with informing service providers of community perceptions, identifying service improvements, and motivating men to get circumcised. Recent surveys indicate that over 50% of men are willing to be circumcised.

Existing cultural platforms and traditional authority will be leveraged to promote norms that encourage sexual health and risk reduction. Johns Hopkins Health and Education in South Africa is spearheading a national strategy to address men’s healthcare communications needs. The organisation has set up a cellphone-based information service that provides health information via SMS or hash codes.

Men who want to get circumcised can SMS “MMC” to 43740 (standard SMS rates apply). They will be sent a hash code (*120*662#) that can be used to identify the nearest MMC facility, based on the user’s location. MMC is provided at no charge.

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