Number of male circumcisions performed

Export Indicator

Number of male circumcisions performed according to national standards during the last 12 months
What it measures

It measures progress in scaling up male circumcision services.

Rationale

There is compelling evidence that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%. Three randomized controlled trials have shown that male circumcision provided by well-trained health professionals in properly equipped settings is safe and can reduce the risk of HIV acquisition. WHO/UNAIDS recommendations emphasize that male circumcision should be considered an efficacious intervention for HIV prevention in countries and regions with heterosexual epidemics, high HIV and low male circumcision prevalence.

Numerator

Number of males circumcised during the past 12 months according to national
standards

Denominator

Not applicable

Calculation
Method of measurement

Health facility recording and reporting forms

Measurement frequency

Annual

Disaggregation

Age group: (greater than) 49 years

Explanation of the numerator
Explanation of the denominator
Strengths and weaknesses

The total number of male circumcisions carried out indicates either change in the supply of services or change in demand. Comparing the results against previous values shows where male circumcision services have been newly instituted or where male circumcision volume has changed.
Further disaggregations are recommended at country level:
i) HIV positive by test(s) on site; HIV negative by test(s) on site; HIV indeterminate result by test(s) on site; Unknown/refused HIV test;
ii) Type and location of health facility
iii) Cadre of provider

When the number of male circumcisions is disaggregated by HIV status and age it will be possible to determine the impact of male circumcision programmes on HIV incidence using models. If a country has prioritized particular age groups this disaggregation will help determine whether age-specific communication strategies are creating demand. Further if the data are available by type and location of health-care facility where the circumcision was performed resource allocation needs can be assessed. Finally by disaggregating these data by the cadre of health-care provider will determine if task-shifting efforts are succeeding and determine resource allocation.

Some programmes will work closely with voluntary HIV counselling and testing services to provide HIV testing. A patient desiring male circumcision may have been recently tested, in which event an on-site HIV test may be unnecessary. In these cases, a written ‘verified result’ may be requested at the facility to verify HIV status. There is no specific length of time before male circumcision that the test should have been done, but within three months is suggested (the purpose of testing is not to identify every man who might be infected but to provide HIV testing to men seeking health care and to identify HIV-positive men who, if they choose to be circumcised, are likely to be at higher risk of surgical complications, i.e. men who are chronically infected and with low CD4 counts).

Further information

For further information on Male Circumcision indicators, see A guide to indicators for male circumcision programmes in the formal health care system, WHO, UNAIDS, 2009
http://whqlibdoc.who.int/publications/2009/9789241598262_eng.pdf