Enhanced linkage to voluntary medical male circumcision: an essential prevention tool in programs serving men who have sex with men


BACKGROUND: Programs serving men who have sex with men (MSM) present an opportunity to reach men at risk of HIV infection with prevention services such as pre-exposure prophylaxis (PrEP) and voluntary medical male circumcision (VMMC). The goal of the Lesotho VMMC program funded by USAID is to reach 80% coverage among 10- to 29-year-old males by 2021, but there are no data to show representation of MSM in accessing VMMC services. There are likely missed opportunities for circumcision among MSM. However, in Lesotho specifically, MSM who also have sex with women represent a very high proportion of the cohort.
DESCRIPTION: We analyzed routine program data from the risk assessment of MSM as part of service provision from April 2020 to January 2021 to determine the proportion of MSM circumcised. Data were cleaned, and circumcision was analyzed as a factor associated with HIV diagnosis among MSM. The analysis adjusted for age, other sexually transmitted infection (STI) symptoms, number of sexual partners, and identity of partners.
LESSONS LEARNED: Records from 2,780 MSM were analyzed. Of these individuals, 2,480 (89.2%) were circumcised, 119 (4.3%) reported not being circumcised, and 181 (6.5%) did not respond. Of the men tested for HIV, 78% (2,181) reported having sex with women. The HIV case-finding rate was 10% (10/101) among MSM who have sex with women and are not circumcised and 3% (63/1,967) among MSM who have sex with women and were reported to be circumcised (p<0.001). MSM who had sex with men only had lower HIV positivity rates, and the result did not differ by circumcision status.
CONCLUSIONS: The MSM program is strengthening linkages with VMMC providers, referring men identified as not circumcised, and following up on the referral outcome and documentation. Information is needed about why uncircumcised MSM who also have sex with women had not accessed VMMC services, and whether there was perceived stigma in accessing VMMC services.

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