At the end of 2013, HIV prevention efforts in sub-Saharan Africa very likely passed a critical milestone -- more than 5 million adult voluntary medical male circumcision (VMMC) procedures conducted since 2007. This is a quarter of the 20 million procedures that epidemiologists and modelers say are needed to maximize the impact of the strategy on HIV incidence in sub-Saharan Africa. A substantial percentage of these procedures were conducted in the past 12 months as the pace of scale-up has soared in virtually every country that's been identified as a priority for this intervention. While there is still much ground to cover, this progress is welcome. Unfortunately, there may not be a full public announcement of this milestone for some months, or perhaps not until the end of 2014.
Such an announcement would come from the World Health Organization (WHO), which tracks the numbers of procedures performed worldwide. It typically releases a global tally about 12 months after the year in question. For example, on World AIDS Day 2013, WHO released figures through the end of 2012. PEPFAR, which currently funds the majority of VMMC procedures worldwide, also collects and releases data, but its sources and schedule differ from WHO (see table). The PEPFAR data are more current but less comprehensive, which is why it's possible to estimate that the global total has passed five million. PEPFAR-funded implementers alone conducted a cumulative total of 4.7 million procedures by the end of 2013 -- meeting the target that Obama set in his 2011 World AIDS Day address. The Bill & Melinda Gates Foundation also funds VMMC programs in some key countries (and collects data from its grantees as well). Factoring in BMGF-supported programs as well as those funded by national governments -- particularly South Africa -- the progress has been tremendous and, according to modelers, is already preventing thousands of new HIV infections.
Tracking and celebrating this progress can help raise the profile of a powerful prevention strategy that still needs high visibility support from heads of state, influential policy makers and advocates. It's time to improve the tracking systems and ensure more regular reporting of global and country-level totals. All countries implementing VMMC are tracking numbers at a national level. National VMMC Task Forces or Ministries of Health should submit numbers to the WHO biannually or perhaps even quarterly, and the WHO should strive to provide biannual updates on national and global totals based on this information. Such improved reporting will ensure that momentum is both recognized and accelerated.
|Organization||What Gets Counted||Information Source||Reporting Calendar||Most Recent Available Data||Current Estimated Total|
|PEPFAR||PEPFAR-supported procedures||PEPFAR-funded implementers||U.S. Government fiscal year, which runs from October to September. (In 2013, PEPFAR made an exception and released a calendar-year total based on an estimate of Q4 procedures.)||Procedures conducted through Q3 2013, with estimate for Q4||4.7 million procedures cumulative through 2013|
|WHO||All VMMC conducted in the country||National programs, including support from all donors||Calendar year||2012||3.1 cumulative through 2012|