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
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
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DOI：
10.1097/qai.0000000000000179
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发表时间：
2014-07-01
影响因子：
3.6
通讯作者：
Kasedde, Susan
中科院分区：
文献类型：
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作者：
Njeuhmeli, Emmanuel;Hatzold, Karin;Kasedde, Susan
背景和方法：截至2013年12月，在扩大自愿医疗男性包皮环切（VMMC）的14个重点国家中，估计有近600万男性接受了包皮环切，其中大多数是青少年（10-19岁）。本文从国际、国家和服务提供层面的新证据和经验出发，讨论了为什么扩大男性自愿医疗服务的努力应该优先考虑青少年男性。此外，我们审查了青少年自愿医疗保健项目覆盖青少年的程度，解决了他们的具体需求，并与他们的性健康和生殖健康以及其他关键服务联系起来。结果和讨论：在重点国家，青少年占接受包皮环切手术的目标人群的34%-55%，而来自这些国家的规划数据显示，青少年占接受包皮环切手术的男性的35% - 74%。青少年自愿医疗保健服务有几个优点：在文化和社会上，青少年接受服务比成年人更容易接受；在治疗或女性伴侣压力期间，关于性节制的障碍较少；在初次性行为年龄之前进行的阴道阴道阴道切割对降低个人层面的艾滋病毒风险具有最大的长期影响，从而降低人群中的传播风险。作为一个全面的一揽子方案，青少年自愿医疗保健可能会增加公共卫生效益，并为解决性别规范问题提供机会。需要进一步的研究来评估目前的志愿医疗服务是否满足青少年客户的具体需求，测试适应的工具，并评估志愿医疗服务与其他以青少年为重点的艾滋病毒、健康和社会服务之间的联系。
Background and 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.Results and Discussion: 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.