GENEVA/HARARE, 4 December 2023— The world can end AIDS as a public health threat if communities on the frontlines of the HIV response are fully engaged and supported to do their work. This was the important message UNAIDS brought today to the opening of the 22nd International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA), which is being held in Harare, Zimbabwe from 4-9 December.

Under the theme AIDS IS NOT OVER – participants will be calling for inequalities to be addressed and innovation to be accelerated to end AIDS. They will be urging for more support to community-led responses to deliver essential HIV services to people on the margins of society who are often hard to reach.

“AIDS is not over, and it continues to disproportionally affect the most marginalized in poor countries in Africa where some of the highest HIV burdens are found,” said Winnie Byanyima, Executive Director of UNAIDS. “We have an amazing opportunity to end the AIDS epidemic by 2030 by supporting community led organizations to lead the way, and by tackling the drivers of HIV, such as inequalities and harmful laws,” added Ms Byanyima.

Around 66% of the 39 million people living with HIV live in Africa and some 51% of new HIV infections occurred on the continent, as did 61% of AIDS-related deaths.

Communities on the frontlines

Communities from South Africa to Thailand to Brazil waged the battles in the 1990’s and in the 2000’s to break pharmaceutical monopolies on access to HIV treatment. Their campaigning brought the price of these life-saving medicines down from US$ 25 000 per person per year in 1995 to as low as US$ 70 per person per year in many of the countries most affected by HIV.

Communities have been fighting to overturn laws that criminalize people most at risk of HIV. Several countries in Africa including Botswana, Angola, Gabon and just this year, Mauritius have overturned these harmful laws.

“Giving LGBTQI people the freedom to come forward and access the services they need to save their lives – this is community action,” said Ms Byanyima. “Communities have taken services right to the last person in the corners of the villages – they know who needs to be reached and they reach them.”

AIDS still claiming lives unnecessarily

While there is a clear path that ends AIDS, including through collaboration between governments and communities, AIDS claimed a life every minute in 2022. Globally 9.2 million people living with HIV do not have access to HIV treatment, just over half are in Africa where AIDS remains the fourth-leading cause of death. 

Women and girls are still disproportionally affected. In sub-Saharan Africa, 3100 young women and girls became infected with HIV every week in 2022. Across Africa 85% of new infections among adolescents (aged 10-19) are among adolescent girls and 15% among adolescent boys. For young people (aged 15-24) some 77% of new infections are among young women and 23% among young men. 

However, there is hope. There has been a decline in the number of people who were infected with HIV in 2022, showing that the end of AIDS is possible. The number of new infections represented the fewest people who acquired HIV in 2022 than at any point since the late 1980s. The biggest declines in annual new HIV infections in that period have been in eastern and southern Africa (57% reduction) and western and central Africa (49% reduction) since 2010 for both regions. 

In sub-Saharan Africa, Botswana, Eswatini, Rwanda and Zimbabwe, are on the path that ends AIDS. In these countries, 95% of the people who are living with HIV know their HIV status, 95% of the people who know that they are living with HIV are on life-saving antiretroviral treatment, and 95% of people who are on treatment are virally suppressed. When a person’s viral load is suppressed, HIV cannot be transmitted. A further 16 other countries are close to meeting these targets. 

Embrace science and innovation 

Communities drive innovation in the response to HIV. The innovation, passion and insight of communities are crucial to end AIDS. In Windhoek, Namibia, a self-funded project by the youth Empowerment Group is using e-bikes to deliver HIV medicines, food and adherence support to young people who often cannot attend clinics due to their schooling hours. 

Botswana’s success in reducing vertical transmission of HIV stems from its high coverage of HIV testing and treatment among women overall. Women living with HIV start antiretroviral therapy well before becoming pregnant, resulting in achieving and sustaining viral load suppression. That’s following the science.  

Ensure political support, sufficient sustainable funding for communities and innovation to end AIDS 

Despite existing and clear evidence that community-led responses have a positive impact, communities are not yet getting the recognition and the political and financial support they need, instead, communities are under-recognized and under-resourced and, in some places, even under attack.  

Underfunding of community-led initiatives is holding them back from operating and expansion. If these obstacles are removed, community-led organizations can add even greater impetus to the global HIV response, advancing progress towards the end of AIDS.  

In the 2021 Political Declaration on ending AIDS, United Nations member states recognized the critical role communities play in HIV service delivery, particularly to key populations. However, whereas in 2012, over 31% of all HIV resources were channelled through civil society organizations, in 2021, only 20% of funding for HIV was allocated for civil society—an unprecedented backsliding in commitments which is costing lives.   

“When community-led organizations are supported politically and financially to accelerate their life-saving work, the end result can be an end to AIDS as a public health threat,” said Ms Byanyima. “An AIDS-free world is possible, but only if communities lead.”

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Since the beginning of the war in Ukraine, communities of people living with and affected by HIV have been at the forefront of ensuring the continuity of life-saving HIV services, both for those who remained in Ukraine and for those arriving in Germany as refugees.

At a special World AIDS Day event in Berlin co-hosted by UNAIDS and 100% Life Ukraine, community representatives and civil society activists thanked the German government and UNAIDS for their support and spoke about the continued challenges they face.

“Our journey exemplifies how the strength of perceived minorities and real community leadership can drive life-saving programmes and innovations that can impact the lives of millions of people,” said Valeriia Rachinska, Director of Human Rights, Gender and Communities at 100% LIFE Ukraine. “None of this would be possible without the support of international partners and donors. Global solidarity and support from our partners are the chance for a fair and thriving tomorrow for all, especially those living with HIV.”

100% LIFE is the largest patient-led organization in Ukraine which has as its mission to fight for life. The Network works with patients and for patients, including the representation of the interests of people living with HIV in 25 regions of Ukraine.

Since the beginning of the war in Ukraine, Germany has donated €1,050,000 in emergency funding to UNAIDS, empowering the provision of critical support to people living with and affected by HIV in Ukraine, Poland and Moldova. This includes providing temporary accommodation, humanitarian assistance, social protection, primary health care and testing for HIV, hepatitis C, STIs and tuberculosis. The emergency fund also covered the enrollment of people in HIV prevention and treatment programmes, offering comprehensive care and support.

Among the speakers at the World AIDS Day event was Silke Klumb, CEO of the German AIDS Federation, who underlined the importance of the partnership between government and civil society in ensuring continued access to HIV prevention, treatment and care services for people affected by the war in Ukraine.

"Community-led responses have been and continue to be critical in the HIV response, both in Germany and globally. Thanks to public funding Deutsche Aidshilfe has been able to engage in community-led prevention, counselling, testing, care, and support for 40 years now. Upon this foundation and through the broad network in Ukraine, Eastern Europe and Central Asia, Germany’s community-led organizations under the umbrella of Deutsche Aidshilfe were able to act immediately to Russia’s full-scale invasion of Ukraine,” said Ms Klumb. ”Over the last 18 months, we provided support, information, translations to people fleeing the war and linked them to care. Platforms such as self-help conferences and other meetings helped to strengthen the communities of people living with and affected by HIV. Deutsche Aidshilfe is committed to continue putting the communities at the centre of our work.” 

During the event, UNAIDS Deputy Executive Director of Policy, Advocacy and Knowledge, Christine Stegling, presented the new UNAIDS World AIDS Day report Let Communities Lead. The report shows how communities have been the driving force for progress in the global fight against HIV.  It shows that investing in community-led HIV programmes can have transformational benefits.

“Since the earliest days of the AIDS pandemic, community leadership has driven life-saving access to HIV treatment and prevention. Continued progress against HIV/AIDS in Ukraine - despite the war and its resulting refugee crisis - is the direct result of Ukrainian and German community leadership. A community-led response is well-positioned to maintain continuity of HIV prevention and treatment services, especially in times of crisis,” said Ms Stegling. “Continuity of HIV care is essential for achieving our ultimate goal of ending AIDS as a public health threat by 2030. UNAIDS thanks all community leaders who stepped up in these challenging times and we thank nations like Germany who understand the value of investing in a community-led response to HIV/AIDS - especially in times of war and other crises.”

The event was moderated by Peter Wiessner of Action against AIDS Germany.

HIV opt-out testing will consolidate the gains towards HIV epidemic control in the UK

LONDON/GENEVA, 29 November 2023—Ahead of World AIDS Day (1 December) UNAIDS welcomes a new research project to potentially expand ‘opt-out’ HIV testing programmes across England. According to NHS figures, a pilot ‘opt-out’ HIV testing scheme, pioneered by the Elton John Foundation in England has identified more than 3,500 cases of three bloodborne infections since April 2022—HIV, Hepatitis B and Hepatitis C—including identifying more than 580 HIV cases of HIV.

Under pilot scheme in England, anyone having a blood test in selected hospital accident and emergency units has also been offered a test for HIV, Hepatitis B and Hepatitis C, and has been given the option to opt out should they not wish to have the test. The trials have been taking place in 33 hospitals in London, Greater Manchester, Sussex and Blackpool.

"HIV opt-out testing will consolidate the gains towards HIV epidemic control in the UK," said Winnie Byanyima, Executive Director of UNAIDS. "Normalization of HIV testing will not only enable timely access to HIV treatment, allowing people with HIV to live healthy lives—it will also stop new HIV infections and reduce the stigma around getting an HIV test. It will save and change lives and help ensure that no one is left behind."

People living with HIV who are on effective HIV treatment cannot transmit the virus. In the UNAIDS Global AIDS Strategy, UNAIDS has set “95-95-95” targets. Aiming for 95% of people who are living with HIV to know their HIV status, 95% of people who know that they are living with HIV to be on lifesaving antiretroviral treatment, and 95% of people who are on treatment to be virally suppressed.

At least five countries, Botswana, Eswatini, Rwanda, the United Republic of Tanzania, and Zimbabwe have already achieved the “95-95-95” targets. A further 16 other countries, eight of them in sub-Saharan Africa, the region which accounts for 65% of all people living with HIV, are also close to doing so.

On 28 November, UNAIDS released its World AIDS Day report in London, UK urging governments to Let Communities Lead across the world to in ending AIDS. The report shows that AIDS can be ended as a public health threat by 2030, but only if communities on the frontlines get the full support they need from governments and donors. The Elton John Foundation is one of the many organizations supporting community action.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

A new report by UNAIDS demonstrates the critical role communities play, and how underfunding and harmful barriers are holding back their lifesaving work and obstructing the end of AIDS.

LONDON/GENEVA, 28 November 2023—As World AIDS Day (1 December) approaches, UNAIDS is urging governments across the world to unleash the power of grassroots communities across the world to lead the fight to end AIDS. A new report launched today by UNAIDS, Let Communities Lead, shows that AIDS can be ended as a public health threat by 2030, but only if communities on the frontlines get the full support they need from governments and donors.

“Communities across the world have shown that they are ready, willing and able to lead the way. But they need the barriers obstructing their work to be pulled down, and they need to be properly resourced,” said Winnie Byanyima, Executive Director of UNAIDS. “Too often, communities are treated by decision-makers as problems to be managed, instead of being recognised and supported as leaders. Communities are not in the way, they light the way to the end of AIDS.”

The report, launched in London during a World AIDS Day event organized by the civil society organization STOPAIDS, shows how communities have been the driving force for progress.

Community advocacy from the streets to the courtrooms to parliaments has secured groundbreaking changes in policy. Communities’ campaigning helped open up access to generic HIV medicines, leading to sharp, sustained reductions in the cost of treatment from US$ 25 000 per person per year in 1995 to less than US$ 70 in many countries most affected by HIV today.

Let Communities Lead shows that investing in community-led HIV programmes delivers transformational benefits. It sets out how programmes delivered by community-based organizations in Nigeria were associated with a 64% increase in access to HIV treatment, a doubling of the likelihood of HIV prevention service utilization, and a four-fold increase in consistent condom use among people at risk of HIV. It also notes how, among sex workers reached by a package of peer-based services in the United Republic of Tanzania, the HIV incidence rate was reduced to below half (5% vs 10.4%).

“We are the vehicle for change that can end systematic injustices that continue to fuel HIV transmission. We have seen groundbreaking developments with U=U, improved access to medicines, and have made great strides in decriminalisation," said Robbie Lawlor, Co-Founder of Access to Medicines Ireland. “Yet, we are expected to move mountains without being financially supported. We are supposed to fight for a more equitable world and are tasked with dismantling stigma yet are side-lined in crucial discussions. We are at a tipping point. Communities can no longer be relegated to the periphery. The time for leadership is now.”

The report highlights how communities are at the forefront of innovation. In Windhoek, Namibia, a self-funded project by the youth Empowerment Group is using e-bikes to deliver HIV medicines, food and adherence support to young people who often cannot attend clinics due to their schooling hours. In China, community organizations developed smartphone apps that link people to self-testing which contributed to a more than four-fold increase in HIV tests across the country from 2009 to 2020.

The report reveals how communities are also holding service providers to account. In South Africa five community networks of people living with HIV inspected 400 sites across 29 districts and conducted more than 33 000 interviews with people living with HIV. In the Free State province, these findings led provincial health officials to implement new appointment protocols to reduce clinic wait times and three- and six-month dispensing of antiretroviral medicines.

“I am extremely concerned about the exclusion from health services of key populations like the LGBT+ community,” said Andrew Mitchell, Minister of State for Development and Africa. “The UK champions the rights of such communities, and we will continue to protect them, working closely with our partners in civil society. I thank UNAIDS for keeping us focused on the inequities driving the pandemic and I look forward to working with our partners to champion the voice of people living with HIV and end AIDS as a public health threat by 2030.”

Despite the clear evidence of community-led impact, community-led responses are unrecognized, under-resourced and in some places even under attack. Crackdowns on civil society and on the human rights of marginalized communities are obstructing communities from providing HIV prevention and treatment services. Underfunding of community-led initiatives is leaving them struggling to continue operating and holding them back from expansion. If these obstacles are removed, community-led organizations can add even greater impetus to end AIDS.

In the 2021 Political Declaration on ending AIDS, United Nations member states recognized the critical role communities play in HIV service delivery, particularly to people most at risk of HIV. However, whereas in 2012, when over 31% of HIV funding was channelled through civil society organizations, ten years later, in 2021, only 20% of funding for HIV was available—an unprecedented backsliding in commitments which has cost and is continuing to cost lives.

“At this time, community-led action is the most important countermeasure in the AIDS response,” said Solange Baptiste, Executive Director of the International Treatment Preparedness Coalition. “Yet, shockingly, it isn’t a cornerstone of global plans, agendas, strategies, or financing mechanisms for improving pandemic preparedness and health for all. It is time to change that.”

Every minute, a life is lost to AIDS. Every week, 4000 girls and young women become infected with HIV, and out of the 39 million people living with HIV, 9.2 million do not have access to lifesaving treatment. There is a Path that Ends AIDS and AIDS can be ended by 2030, but only if communities lead.

UNAIDS is calling for: Communities’ leadership roles to be made core in all HIV plans and programmes; Communities’ leadership roles to be fully and reliably funded; And for barriers to communities’ leadership roles to be removed.

The report features nine guest essays from community leaders, in which they share their experience on the achievements they have secured, the barriers they face, and what the world needs to end AIDS as a public health threat.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

With just two years left to attain the 2025 HIV prevention target of fewer than 370 000 new HIV infections annually, the world is not on track. In 2022, 1.3 million people became infected with HIV – the urgency to accelerate progress cannot be overemphasized. The Global HIV Prevention Coalition co-convened by UNAIDS and UNFPA ensures a strengthened and sustained political commitment for primary prevention across key policy makers and programme implementers. It includes countries such as Botswana, Cameroon, Eswatini, Lesotho, Malawi, Rwanda South Africa, and Zimbabwe – which have reduced new HIV infections by more than 70% since 2010.  

However, there were disparities across populations and regions. No significant declines were seen among key populations (sex workers, men who have sex with men and people who inject drugs).

Globally, 4,000 new HIV infections occurred among adolescent girls and young women aged 15-24 years, every week – 3,000 of these occurred in Sub-Saharan Africa. Approaches and investments for HIV prevention are currently insufficient to meet global targets.

The directors of National AIDS Coordinating Agencies, Ministry of Health HIV leads from the Global HIV Prevention Coalition focus countries and development partners were convened by the HIV Prevention Leadership Forum, with support from UNAIDS and UNFPA, to reinforce their commitment to stopping new HIV infections. This is part of efforts to ensure effective implementation of expanded HIV programmes with a focus on key and priority populations .

During the meeting, each country identified commitments  that they will drive and will be held accountable for in 2024 as well as technical level actions necessary for programme optimization.  Donors and global technical partners identified opportunities for technical and financial resources available at country level to supplement national resources to drive the action plans. 

The first lady of Namibia and UNAIDS Special Advocate for Adolescent Girls, and Young Women, Her Excellency Monica Geingos urged the country leaders in the HIV response to adapt solutions tailored to their national needs culturally, socio-economically, and politically. Whilst strengthening global collaboration, leaders should strengthen partnerships across sectors within the countries. Success in HIV prevention is possible, however, not only does it require leadership at government level, but also communities must lead.

The Global Prevention Coalition co-chair and former Minister of Health of Botswana, Prof. Sheila Tlou encouraged government leaders to follow the science, make data-driven decisions and ensure community leadership and participation in HIV prevention programming. This will secure gains made, bridge disparities and expedite progress needed for success in HIV prevention.

Dr Ruth Laibon Masha, Co-Chair of the HIV Multi-Sector Leadership Forum and Director, National Syndemic Disease Control Council, underscored the need to secure gains made by extraordinary leaders from multiple sectors who have played a crucial role in advancing the HIV movement and achieving significant progress. “By continuing to lead from the front we can work together towards the goal of delivering a future free of new HIV infections and AIDS-related deaths. It’s time to recommit and finish the race against time “, she added.

Vice Minister, National Disease Control and Prevention Administration (NDCPA) affirmed China’s commitment towards strengthened multisectoral leadership and promotion of a nationally led HIV prevention and health agenda.

Quotes

Gathered in Amsterdam for the annual Fast-Track Cities conference between 25 ─ 27 September 2023, cities shared their various initiatives toward achieving key HIV targets.

In Nairobi, Kenya a situation analysis conducted at a granular level helped the county to better understand the gaps in the HIV response and to identify priority actions. The data showed that there was a lack of health service points, especially for key populations and young people living in informal settlements. In addition, stigma and discrimination also keeps people away. Zipporah Achieng, a young person living with HIV navigating the dusty streets of Kibera, one of several informal settlements, can attest to this. “Before, life was not easy, the healthcare workers were not well trained, and when they saw youth coming to the hospital, they would start judging them, discriminating them.”

The Nairobi City County, with the support of the USAID-funded joint UNAIDS-IAPAC Fast-Track Cities project, developed activities to create awareness, address vulnerabilities, and reduce discrimination with a focus on young people. Informal settlements house up to 60% of Nairobi’s population despite covering less than 10% of the city. Over a period of five years, community members worked hand in hand with healthcare providers in the establishment of 30 friendly health centres for young people and men who have sex with men and sex workers. As a result, stigma against people living with HIV has been reduced while the uptake of HIV and other health services increased significantly during this time.  

Ms Achieng is now a peer educator. She goes out in the community sharing her experience and getting people to come to the clinic. “Now I know what is right and what is wrong, I’m happy because life has changed, life is sweet, there is medicine, there is support, and I’m just happy,” said Ms Achieng.

Nairobi's commitment to fast-tracking HIV services for young people and key populations not only contributed to the city's own public health goals but also set an inspiring example for other urban centres in the country.

Discussions about sex and HIV in Indonesia remain taboo and information limited. As a result, HIV-related knowledge is low, especially among young people. In 2018, UNAIDS created an online chatbot named Tanya Marlo and integrated it in the popular messaging application LINE. “Before Marlo, finding reliable information about HIV and sexual health was really hard. It was difficult to get the right information”, says Arisdo Gonzalez, a user of the online application.

Support provided by the Fast-Track Cities project allowed this pilot to grow into a key tool to reach young people and increase HIV prevention and testing.

Last year alone, 200 000 engagements were recorded on social media and on average 100 users are directed to counselling every month. “Tanya Marlo has been an absolute hit among young people in Indonesia,” said Tina Boonto, UNAIDS Country Director in Indonesia. “Young people feel that they can chat with Marlo anytime, anywhere, and in secret, nobody has to know about it.” To ensure its sustainability and further development, a community group, YKS, has taken over the management of the application.

Kyiv joined the Fast-Track Cities initiative in 2016 and had made remarkable progress towards key HIV targets until Russia declared war in Ukraine. Many feared that treatment, HIV services and outreach would disintegrate.  Thanks to emergency funds and the support of the Fast-Track Cities project, a number of interventions were put in place to help those in need, in particular members of key and vulnerable populations like people who inject drugs and LGBTIQ+ members. “Since the invasion, we have managed to maintain our test numbers, didn’t lose a single patient, and ensured continued access to antiretroviral therapy” said Dr. Vitali Kazeka, Director of the Kyiv AIDS center.

One of Kyiv's notable achievements is the establishment of shelters designed to cater to the unique needs of key populations affected by HIV. These shelters provide a safe and supportive environment while also ensuring access to essential healthcare services, counseling, harm reduction programmes, and education about HIV prevention. “The Fast-Track Cities project makes people living with HIV, and those from key population groups, feel like equal citizens of the city… They see that there are special initiatives that care about them and their future,” said Nataliia Salabai, UNAIDS Fast-Track Cities focal person in Kyiv.

Launched in December 2014, the Fast-Track Cities partnership has grown to more than 500 cities and municipalities that have committed to accelerate their local HIV, tuberculosis (TB), and viral hepatitis responses to achieve Sustainable Development Goal (SDG) 3.3 by 2030.

More than half of the world’s population currently live in cities and cities account for a large and growing proportion of people living with HIV, tuberculosis (TB) and other diseases. The risk of contracting, and vulnerability to, HIV and TB infection is often higher in urban areas compared to rural areas, because of urban dynamics such as social networking, migration, unemployment and social and economic inequalities.

UNAIDS’ Global AIDS Update The Path that Ends AIDS underscores 2 main challenges faced by voluntary medical male circumcision (VMMC) programmes: diminished funding and low coverage among men in their twenties and older. Since VMMC was recommended by WHO and UNAIDS in 2007 as key to HIV prevention in high-prevalence settings, about 35 million men have accessed services across the 15 VMMC priority countries. While this shows good progress, the Global AIDS update highlights that VMMC coverage remains far from reaching the 90% global coverage target for impact in many subnational areas of priority countries. Additionally, funding has declined by almost half since 2020 from approximately US dollars 285 million to US dollars 147 million for the 15 countries funded by the United States President’s Emergency Plan for AIDS Relief (PEPFAR). But questions have arisen about VMMC’s cost-effectiveness under growing coverage of other biomedical interventions, such as antiretroviral treatment.

“We need strong political leadership to scale up implementation of VMMC programmes; tackle the inequalities holding back progress; and ensure sufficient and sustainable funding” said Angeli Achrekar, UNAIDS Deputy Executive Director of Programmes. “Countries that are putting people and communities first in their policies and programmes are already leading the world on the journey to ending AIDS by 2030.”

Voluntary medical male circumcision is a simple, safe procedure that has proven to reduce the risk of HIV transmission by up to 60% in heterosexual men. But is it cost effective? For how long must policy makers continue to promote VMMC among adolescent boys and adult men across VMMC priority countries? This is what a group of researchers investigated.

Now published in The Lancet Global Health and using 5 existing mathematical HIV models, the researchers aimed to assess whether providing VMMC for the next 5 years would continue to be a cost-effective use of HIV programme resources in sub-Saharan Africa. The models applied assumptions based on HIV epidemiology in VMMC priority countries focusing on Malawi, South Africa, and Zimbabwe. The impact and cost-effectiveness were projected over 50 years to capture clients’ lifetime HIV exposure and infection.

Findings reveal that a continuation of VMMC was cost-effective even in regions with low HIV incidence; VMMC was cost-effective in 62% of settings with HIV incidence of less than 1 per 100 person-years in men aged 15–49 years, increasing to 95% with HIV incidence greater than 10 per 100 person-years They underscored VMMC’s importance in continuing to avert HIV infections and related healthcare costs over time.

While details of the results varied by country and model (see Box1), overall VMMC was shown to be highly cost-effective and even cost saving in nearly all countries and scenarios.

The authors concluded that despite the scale-up of antiretroviral therapy and low HIV incidence in some settings, the continuation of VMMC for at least the next 5 years is cost-effective in almost all settings considered in this study.

“Clearly, intensified efforts and commitments are needed to scale up VMMC while at the same time sustaining these services to reach men and boys,'' said Dr Meg Doherty, Director of WHO’s Global HIV, Hepatitis and STI Programmes. “The new Global AIDS report shows a widening gap for men that is important to recognize and address efficiently and effectively for their own health and to reduce new infections.’’

These analyses support a call to action on intensified efforts to reach men and boys in general and for continued funding for VMMC programmes. The discussion on VMMC sustainability is crucial. UNAIDS and WHO are urging countries to intensify their efforts in scaling up VMMC to global coverage targets (90%), at the same time address programme sustainability.

In the 2025 HIV Prevention Roadmap, VMMC remains a core component of combination HIV prevention under the pillar of men and boys. It is not only cost-effective, but also, cost-saving in many settings. Accordingly, continued progress towards male circumcision coverage targets in all the VMMC priority countries must be accelerated