15 million circumcisions per year, each taking about 20 minutes, means that approximately 500 males are being circumcised right now.
Although its origins are unknown, the earliest reliable evidence of the practice comes from ancient Egypt in the form of pictures dating from 4300 years ago. Cave paintings approximately 15,000 years old appear to show circumcised penises, but not the act of circumcision itself. By the time of the Roman colonisation of Egypt in 30 BC, the practice had acquired a ritual significance; only circumcised priests could perform certain religious rites.
There is increasing pressure on the already overburdened Health Services, to commence HIV-positive patients earlier on ARV'S. ARV initiation, according to 2010 Treatment guidelines, is to commence ARV treatment at CD4 counts of 350 cells or lower. In June 2013, the WHO recommends raising the CD4 counts to 500 cells per microlitre of blood. This means, that treatment should start at a much earlier stage of infection.
Curnently, if every HIV-positive person in Southern Africa (around 22million) would be on ARV's at the cost of $100 per year with the new daily ARV Regime of $9 per month, this would ad about $2 billion per year to the current cost of the 32-year AIDS epidemic in Southern Africa.
Attempting to integrate VMMC into existing State and Public Health Circimcision programs only to achieve targets in Southern African countries is unobtainable. It is absolutely essential to also involve the Private Healthcare sector to reach targets.
According to the Framework for Clinical Evaluation of Devices for Adult Male Circumcision (WHO, 2011):
"WHO and other health authorities wish to identify one or more devices that
- would make the VMMC safer, easier, and quicker
- would have more rapid healing than current methods and/or might entail less risk of HIV transmission in the post-operative period
- could be performed safely by health-care providers with a minimal level of training and
- would be cost-effective compared to standard surgical methods for male circumcision scale up."