| Background: |
A CDC lead recent study has found that being circumcised significantly reduced the risk of HIV infection in heterosexual African American men known to have been exposed to the virus. Male circumcision (MC) may be especially important also for Hispanic populations. In these two subgroups routine circumcision is uncommon while they are most at risk for HIV infection.
Currently, the American Academy of Pediatrics does not recommended routine neonatal circumcision and Medicaid does not cover the procedure - two policy impediments for introducing large scale neonatal and adult MC programs aimed at lowering HIV infection among minority populations at high risk for HIV infection. Another challenge is the limited number of medical teams able to perform mass MC under local anesthesia at community-level clinics.
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| Method: |
"Operation Abraham" is a collaborative of Eight Israeli medical and public health institutions working towards effective technology transfer in MC for HIV prevention through a comprehensive model of training, simulation and education. The experience gained in Israel in large scale adult MC is unique. More than 80,000 adults, mostly new immigrants from Former Soviet Union and Ethiopia seeking voluntary circumcision were operated on at an average rate of 30-34 clients a day per surgeon. Adverse events were below 2% and in most cases very minimal. A significant part of the model was already pilot tested in Swaziland, Africa in response to requests of U.N and local governments for technical assistance from Israel in the field.
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| Results: |
Introducing MC for HIV prevention to African American and Hispanic populations in the U.S. requires a strategic approach which is sensitive to culture, religion, economic level and characteristics of medical services utilization of these populations among other factors to be outlined in this presentation.
On a background of MC being routine for the majority of Americans we believe that an increase of 30% in circumcision rates among sub populations at highest risk for HIV infection in the U.S. is achievable through a comprehensive model. The model, presented here for the first time, involves:
1) Tailoring a community mobilization effort in collaboration with leading CBOs and FBOs credible with the target populations including: development, packaging and dissemination of population-specific messages promoting MC; utilizing role models; educational campaigns
2) Opening community-level designated MC clinics with fully trained teams being able to use "Operation Abraham Collaborative" delivery systems effectively
3) Lobbying for AAP and Medicaid policy change
4) Developing a clients' education campaign to minimize risk compensation
5) Implementing a systematic follow-up, M&E program guided by CDC.
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| Conclusion: |
Increasing MC rates in populations at risk for HIV in the U.S. requires innovation, international cooperation and evidence-based approaches. The presentation will detail a comprehensive model and discuss related challenges and opportunities in the context of the U.S. HIV/AIDS epidemic.
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