Background and Methods: By December 2013, it was estimated that close to 6 million men had been circumcised in the 14 priority countries for scaling up voluntary medical male circumcision (VMMC), the majority being adolescents (10–19 years). This article discusses why efforts to scale up VMMC should prioritize adolescent men, drawing from new evidence and experiences at the international, country, and service delivery levels. Furthermore, we review the extent to which VMMC programs have reached adolescents, addressed their specific needs, and can be linked to their sexual and reproductive health and other key services.
Results and Discussion: In priority countries, adolescents represent 34%–55% of the target population to be circumcised, whereas program data from these countries show that adolescents represent between 35% and 74% of the circumcised men. VMMC for adolescents has several advantages: uptake of services among adolescents is culturally and socially more acceptable than for adults; there are fewer barriers regarding sexual abstinence during healing or female partner pressures; VMMC performed before the age of sexual debut has maximum long-term impact on reducing HIV risk at the individual level and consequently reduces the risk of transmission in the population. Offered as a comprehensive package, adolescent VMMC can potentially increase public health benefits and offers opportunities for addressing gender norms. Additional research is needed to assess whether current VMMC services address the specific needs of adolescent clients, to test adapted tools, and to assess linkages between VMMC and other adolescent-focused HIV, health, and social services.
*USAID Washington/Global Health Bureau/Office of HIV/AIDS, United States Agency for International Development, Washington, DC;
†Population Services International, Harare, Zimbabwe;
‡Johns Hopkins University Center for Communication Programs, Baltimore, MD;
§Jhpiego-Tanzania, Dar es Salaam, Tanzania;
‖Futures Institute, Washington, DC;
¶Centre for Sexual Health & HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe;
#Ministry of Health and Child Care, Harare, Zimbabwe;
**Ministry of Health and Social Welfare, Iringa Region, Tanzania;
††Integrated Delivery, Global Development Program, Bill & Melinda Gates Foundation, Seattle, WA;
‡‡Department of Global Health, University of Washington, Seattle, WA; and
§§United Nations Children's Fund (UNICEF), New York, NY.
Correspondence to: Emmanuel Njeuhmeli, MD, MPH, MBA, Senior Biomedical Prevention Advisor USAID Wasington/Global Health Bureau/Office of HIV/AIDS (firstname.lastname@example.org).
The authors have no conflicts of interest to disclose.
Zimbabwe: The VMMC program in Zimbabwe described in this article is supported by the United States President's Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID) and implemented by Population Services International (PSI) through the Zimbabwe Strengthening Private Sector Services Program, Prime Award Number 674-A-00-1000081-00. Tanzania: The Tanzania program described in this article is funded by the PEPFAR through USAID and implemented by the Maternal and Child Health Integrated Program (MCHIP) (Award No. GHS-A-00-08-00,002-000), which is led by Jhpiego—an affiliate of Johns Hopkins University. Additional funding for this work was provided by President's Emergency Program for AIDS Relief through the USAID|Health Policy Project. The Health Policy Project is a 5-year cooperative agreement funded by the USAID under Agreement No. AID-OAA-A-10-00,067, beginning September 30, 2010. It is implemented by Futures Group, in collaboration with CEDPA (part of Plan International USA), Futures Institute, Partners in Population and Development, Africa Regional Office, Population Reference Bureau, RTI International, and the White Ribbon Alliance for Safe Motherhood. The funder, USAID, played a significant technical role in study design, analysis, decision to publish, and preparation of the manuscript.