South Africa remains the country with the highest number of people living with HIV. The HSRC estimated that 6.8 million people were infected with HIV in 2014. Only 54% of them are aware of their HIV status. The epidemic has varied significantly across the nine different provinces in South Africa. Its diversity and the presence of concentrated epidemics within the generalised epidemic have played an important role in its spread and had an impact on its effective control.

There is sparse evidence to show that HIV prevention programmes have impacted significantly on HIV incidence. However medical male circumcision (MMC) has been shown in recent randomised clinical trials to provide around 60% reduction in the risk of HIV acquisition through heterosexual transmission in men. The results of these trials support the results of observational studies showing a strong correlation between high rates of male circumcision and lower rates of HIV prevalence.

Furthermore, findings from male circumcision (MC) trials conducted in South Africa and Uganda showed that circumcision offers men partial protection against human papillomavirus and herpes simplex virus type 2. Providing MMC in the public sector provides men with the opportunity of protecting themselves and their partners from HIV infection.

HIV prevention is central to the fight against HIV and South Africa has adopted the combination HIV prevention approach, which includes biomedical, socio-behavioural and structural interventions.

The package of HIV prevention services to men include HIV testing services (HTS), sexually transmitted infections (STI) screening and treatment, condom provision, medical male circumcision, HIV risk reduction counselling and referral to other male sexual health and reproductive services.

South Africa has practiced male circumcision within traditional settings for cultural and religious reasons for many years. There are inter-provincial variations in the proportion of men who are circumcised within the traditional settings. It is important to ensure that circumcision as a whole is safe and that human rights are respected when men are circumcised.

These guidelines provide all stakeholders with the necessary guidance for the provision of safe, effective and accessible voluntary MMC services. They promote cost effective and efficient methods for rapid implementation of this potentially life-saving HIV prevention intervention. They are also aligned to existing HIV policies and strategies of the National Department of Health.

It is envisaged that scaling up MMC and equipping the service providers with the necessary competency and skill will contribute towards the reduction of new HIV infections and will improve access to other health services for men.

Minister of Health

Dr A. Motsoaledi

(Extract from “The South African National Guidelines for Medical Male Circumcision 2016“)

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