1. Translation of research data into programmes and practice: UN Work Plan on Male Circumcision Translation of research data into programmes and practice: UN Work Plan on Male Circumcision Catherine Hankins Associate Director and Chief Scientific Adviser to UNAIDS New perspectives in prevention on HIV sexual transmission International AIDS Conference ANRS Satellite, Toronto, August 15, 2006

2. New perspectives in prevention on HIV sexual transmission ANRS satellite at the International AIDS Conference Toronto August 15, 2006 UN Work Plan on Male Circumcision

3. New perspectives in prevention on HIV sexual transmission ANRS satellite at the International AIDS Conference Toronto August 15, 2006 UN Work Plan on Male Circumcision Focus: Improving safety of current practices Supporting anticipatory activities by countries Funding support: (US$ 1,040,000): Bill and Melinda Gates Foundation UNAIDS Secretariat USA National Institutes of Health (NIH) Agence nationale de recherches sur le sida (ANRS) Programme support: UNAIDS: HQ and regional support teams, country offices WHO: HQ and regional UNICEF: HQ and regional UNFPA: HQ and regional Collaborations: World Bank (regional), USAID, PEPFAR

4. New perspectives in prevention on HIV sexual transmission ANRS satellite at the International AIDS Conference Toronto August 15, 2006 UN Work Plan on Male Circumcision  briefing packs (key publications, fact sheets, maps, Q&A, reference lists and slides) for policy-makers, programme managers and partners  technical guidance on clinical and programmatic approaches to male circumcision, in an appropriate human rights framework  pre-circumcision assessment, including the role of HIV testing and counselling  informed consent/adolescent assent/parental consent  clinical/surgical procedures to ensure safety, minimize and manage complications, and prevent risk compensation  simple programmatic tools for countries where uptake of services is increasing: supervision, standard setting, certification, accreditation, monitoring and evaluation

5. New perspectives in prevention on HIV sexual transmission ANRS satellite at the International AIDS Conference Toronto August 15, 2006 UN Work Plan on Male Circumcision  anticipate potential impact and resource needs:  model impact of male circumcision at population level under different post-circumcision sexual risk and behavioural scenarios  estimate resources needed for male circumcision services under various scenarios, assess cost-effectiveness  develop and field test a rapid assessment tool for use at country level to document male circumcision practices, identify key providers, and assess social-cultural determinants of circumcision  develop an operations research plan, research agenda and tools.  support country stakeholder meetings in 5 sub-Saharan Africa countries  bring countries together to review emerging information and document experiences  provide programming and technical support to countries wanting to increase the supervision and safety of current circumcision practices through training, regulatory and licensing improvements

6. New perspectives in prevention on HIV sexual transmission ANRS satellite at the International AIDS Conference Toronto August 15, 2006 Next steps: watch this space…… NIH Data Safety Monitoring Board (DSMB) of the Kisumu, Kenya and Rakai, Uganda MC trials (female to male transmission) will review results of interim analyses in early 2007 Outcomes:  Both trials continue to intended end: Uganda (July, 2007), Kenya (September, 2007)  One trial is stopped for observed effect size  Both trials are stopped for observed effect size If one or more trials are stopped, the UN will rapidly convene a meeting to examine randomised controlled trial data (including the Gates funded Rakai trial of male to female transmission if data available), results of impact modelling and implications for policy and programming

7. New perspectives in prevention on HIV sexual transmission ANRS satellite at the International AIDS Conference Toronto August 15, 2006 Male circumcision for HIV prevention: If effective, safe male circumcision would increase HIV prevention choices, create synergies with correct and consistent male and female condom use for increased protection…. provide a golden opportunity to invest in male sexual and reproductive health