President Obama reported on the latest U.S. Government’s response to HIV this month. As a result of work funded through the President’s Emergency Plan for AIDS Relief (PEPFAR), an estimated 1 million children have been born free of HIV and 6.7 million people now receive anti-retroviral treatment.
In rural Malawi, Africa, roughly 10 percent of the adult population has HIV. At the peak of the epidemic, in the 1990s and early 2000s, nearly everyone knew someone infected with or affected by the virus, what demographer Hans-Peter Kohler of the University of Pennsylvania describes as a generalized epidemic. The problem snowballed to the extent that life expectancy dropped dramatically. In just a short period, the epidemic undid nearly two decades of life-expectancy improvements. “The probability of surviving from 15 to 50 declined substantially,” Kohler said.
By the end of this year, PEPFAR reports that it will have supported 4.7 million voluntary medical male circumcisions (VMMC), meeting a goal the President announced in 2011. Nearly all of these procedures, almost four million, were performed in just the past two years.
In 2006, clinical trials showed that VMMC can reduce a man’s chances of acquiring HIV from a female partner by nearly two thirds. Especially in sub-Saharan African countries with high rates of HIV and low rates of circumcision, this simple, life-long approach promised to prevent millions of HIV infections
VMMC is not always an easy sell, especially in places without a cultural history of male circumcision. This hesitance, combined with the logistical hurdles of scaling up a sensitive surgical procedure, left many to wonder if the U.S. government would ever achieve its 2013 target. But today, the goal will be reached.
This cannot be entirely chalked up to a numerical target, or even to an influx of funding. In the past year, several African countries have established rollout plans and made substantial investments. Marketing efforts have gotten under way to generate understanding of, and demand for, VMMC among men who can benefit. New, non-surgical devices have recently come onto the scene, providing an additional option that may eliminate the need for surgery and improve recovery times for some men.
The VMMC efforts is for 80 percent of men to be circumcised in 14 priority African countries. That requires some 20 million circumcisions, meaning that it is just a quarter of the way to the goal. Achieving this target would avert as many as 3.4 million new HIV infections and save $16.6 billion in future healthcare costs.
On Monday, the President noted the huge potential of research towards a cure for HIV, and committed $100 million to a new HIV Cure Initiative at the National Institutes of Health.
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