1. Richard G. Wamai, PhD Assistant Professor of Public Health Department of African American studies Northeastern University r.wamai@neu.edu June 27, 2012

2. Efficacy of Current Interventions Sources: Wamai RG. Et al. JIAS. 2011. Grant et al. NEJM 2010; Karim et al, Science 2010; Thigpen et al. 2011 HPTN-START – Strategic Timing of Antiretroviral Therapy TDF2-Botswana

3. MC Scientific Evidence is Unequivocal  4 Ecological studies  35 Cross-sectional studies  14 Prospective studies  3 Randomized control trials  100s Reviews, systematic reviews and meta- analyses MC Protection rate = 60-80% Sources: Dickson K, Farley T. 2010; Wamai RG, et al. JIAS. 2011. Morris BJ, Wamai RG. JAIDS. 2012

4. Sources: Morris BJ, Wamai RG. JAIDS. 2012

5. MC Acceptability, variable results Source: Morris BJ, Waskett JH, Banerjee J, Wamai RG., et al. A Snip in Time. BMC Pediatrics 2012

6. MC trends in the new-borns, US, 1999-2010 SourceS: CDC. MMWR, 2011, Sep 2; 60:1167-8; Source: Smith KD et al. 2010 CDC policy

7. 18 US states have eliminated Medicaid funding for MC See: http://www.miller-mccune.com/health/circumcision-the-surgical-aids-vaccine-27769/http://www.miller-mccune.com/health/circumcision-the-surgical-aids-vaccine-27769/ Source: Morris BJ, Waskett JH, Banerjee J, Wamai RG., et al. A Snip in Time. BMC Pediatrics 2012

9. MC Implementation in 14 SSA Countries, October 2011 Source: Wamai RG, et al. JIAS. 2011 Distance to Goal

10. Source: http://www.avac.org/ht/a/GetImageAction/i/42801http://www.avac.org/ht/a/GetImageAction/i/42801

12. A march through Kisumu helped publicize the launch of the Rapid Results

13. VMMC Way Forward  Health provider training to be tailored to existing health systems and service structures – public & private (PPPs)  Efficiency Models for accelerating MC Model For optimizing The Volume and efficiency of MC Services (MOVE)- approach (S.Africa) Task shifting for nurses and clinical officers as per WHO Guidelines (Kenya and Zambia) RRI – Rapid Results Initiative (Kenya) Instrumentation: Devices that facilitate quicker and safer adult and infant MC Use of traditional circumcisers after proper training and provision of services in a culturally appropriate fashion  WTA – Conditional economic incentives to spur demand Source: Wamai RG, et al. JIAS. 2011

14. Think you are not at risk of HIV? HIV? Think Again, Again

15. 15 Asanteni – Thanks