title: Lessons learned from scale-up of voluntary medical male circumcision focusing on adolescents: benefits, challenges, and potential opportunities for linkages with adolescent HIV, sexual, and reproductive health services.
abstract: METHODS
  By December 2013, it was estimated that close to 6 million men had been circumcised in the 14 priority countries for scaling up voluntary medical male circumcision (VMMC), the majority being adolescents (10-19 years). This article discusses why efforts to scale up VMMC should prioritize adolescent men, drawing from new evidence and experiences at the international, country, and service delivery levels. Furthermore, we review the extent to which VMMC programs have reached adolescents, addressed their specific needs, and can be linked to their sexual and reproductive health and other key services.
  
  
  CONCLUSIONS
  In priority countries, adolescents represent 34%-55% of the target population to be circumcised, whereas program data from these countries show that adolescents represent between 35% and 74% of the circumcised men. VMMC for adolescents has several advantages: uptake of services among adolescents is culturally and socially more acceptable than for adults; there are fewer barriers regarding sexual abstinence during healing or female partner pressures; VMMC performed before the age of sexual debut has maximum long-term impact on reducing HIV risk at the individual level and consequently reduces the risk of transmission in the population. Offered as a comprehensive package, adolescent VMMC can potentially increase public health benefits and offers opportunities for addressing gender norms. Additional research is needed to assess whether current VMMC services address the specific needs of adolescent clients, to test adapted tools, and to assess linkages between VMMC and other adolescent-focused HIV, health, and social services.
authors.affiliation: *USAID Washington/Global Health Bureau/Office of HIV/AIDS, United States Agency for International Development, Washington, DC; †Population Services International, Harare, Zimbabwe; ‡Johns Hopkins University Center for Communication Programs, Baltimore, MD; §Jhpiego-Tanzania, Dar es Salaam, Tanzania; ‖Futures Institute, Washington, DC; ¶Centre for Sexual Health & HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe; #Ministry of Health and Child Care, Harare, Zimbabwe; **Ministry of Health and Social Welfare, Iringa Region, Tanzania; ††Integrated Delivery, Global Development Program, Bill & Melinda Gates Foundation, Seattle, WA; ‡‡Department of Global Health, University of Washington, Seattle, WA; and §§United Nations Children's Fund (UNICEF), New York, NY.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Njeuhmeli
authors.forename: Karin
authors.initials: K
authors.lastname: Hatzold
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Gold
authors.forename: Hally
authors.initials: H
authors.lastname: Mahler
authors.forename: Katharine
authors.initials: K
authors.lastname: Kripke
authors.forename: Kim
authors.initials: K
authors.lastname: Seifert-Ahanda
authors.forename: Delivette
authors.initials: D
authors.lastname: Castor
authors.forename: Webster
authors.initials: W
authors.lastname: Mavhu
authors.forename: Owen
authors.initials: O
authors.lastname: Mugurungi
authors.forename: Gertrude
authors.initials: G
authors.lastname: Ncube
authors.forename: Sifuni
authors.initials: S
authors.lastname: Koshuma
authors.forename: Sema
authors.initials: S
authors.lastname: Sgaier
authors.forename: Shanti R
authors.initials: SR
authors.lastname: Conly
authors.forename: Susan
authors.initials: S
authors.lastname: Kasedde
mesh_terms: D000293:Adolescent; D002944:Circumcision, Male / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D008297:Male; D060728:Reproductive Health; D012725:Sexual Behavior