1. FBO Engagement in Male Circumcision May 25, 2009 CCIH Annual Conference

2. Common questions about MC Is it culturally acceptable? Is it culturally acceptable? Does it help women? Does it help women?

3. Male Circumcision & HIV Prevalence in Population- Based Surveys (DHS) in Africa *Very few men in Rwanda report multiple partners (5%), compared to other African countries. **HIV prevalence in Kisumu area, where most men are uncircumcised, is much higher than in rest of Kenya. Source: ORC/MACRO, DHS survey data High (>80%) male circumcision Low (<20%) male circumcision

4. HIV Prevalence by Male Circumcision (Kenya) HIV prevalence is significantly higher among men who have not been circumcised (13%) than among circumcised (3%) Source: DHS Kenya 2003

5. WHO/UNAIDS Statement on Male Circumcision & HIV; March 28, 2007: “The efficacy of male circumcision in reducing female to male transmission of HIV has been proven beyond reasonable doubt. This is an important landmark in the history of HIV prevention… Male circumcision should now be recognized as an efficacious intervention for HIV prevention…” “The efficacy of male circumcision in reducing female to male transmission of HIV has been proven beyond reasonable doubt. This is an important landmark in the history of HIV prevention… Male circumcision should now be recognized as an efficacious intervention for HIV prevention…”

6. Other Benefits of Circumcision Reduction of other STI, including chancroid & syphilis (& to lesser extent herpes) Reduction of other STI, including chancroid & syphilis (& to lesser extent herpes) Elimination of balanitis (foreskin infection) Elimination of balanitis (foreskin infection) Huge reduction in invasive penile cancer Huge reduction in invasive penile cancer Significant reduction of cervical cancer among female partners Significant reduction of cervical cancer among female partners Significant reduction of urinary tract infections (in infants) Significant reduction of urinary tract infections (in infants)

7. Impact on Reported Behaviour in the Circumcision Trials South Africa South Africa –Mean number of sexual acts (frequency) significantly higher in intervention arm (but not number of partners or one-time partnerships or condom use) Kenya Kenya –General decline in risky behaviour in both arms over time –Men in intervention arm more likely to have unprotected sex and inconsistent condom use – due to increase in safer sex practices among men in control arm Uganda Uganda –Behaviour very similar in two arms – control arm reported significantly more alcohol use with sexual intercourse