Geographic coverage of male circumcision in western Kenya
Voluntary Medical Male Circumcision (VMMC) reduces the risk of HIV acquisition in men by ∼60%. Many countries in sub-Saharan Africa have begun a rapid scale-up VMMC in high HIV prevalence areas where circumcision coverage is low. Though a majority of the Kenyan population traditionally practices male circumcision, the burden of HIV is highest in regions where circumcision is not traditionally practiced. The Kenyan national VMMC program has set a target of 80% prevalence of VMMC among men ages 15 to 49 in high HIV prevalence areas. Between 2008 and 2013, 793,000 VMMCs were conducted in Kenya, increasing the proportion of men who reported being circumcised nationwide from 85% in 2007 to 92.6% in 2014.
The VMMC program in Kenya has achieved great gains where it is most needed for HIV prevention. Our mapping results indicated a clear boundary in circumcision status between traditionally circumcising regions of western Kenya, primarily in the counties of Kisii and Nyamira and portions of Migori, and regions with counties with the lowest circumcision prevalence and highest HIV prevalence in Kenya—Homa Bay, Siaya, western Migori, and Kisumu. By 2014, the boundary could no longer be discerned from DHS data for 15 to 24-year-old men, although some regions remained where VMMC coverage was significantly lower than surrounding areas. Among men aged 25 to 49 years, circumcision prevalence in traditionally noncircumcising regions rose, but did not approach the levels of traditionally circumcising regions.
Weighted sample sizes (wn) and smoothed proportions of men age 15 to 24 (top) and 25 to 49 (bottom) who reported to be circumcised prior to Voluntary Medical Male Circumcision (VMMC) scale-up in 2008 (left) and in 2014 (right). Significantly lower than expected departures from the mean prevalence circumcised indicated by one-sided 97.5% credible bound (thick dashed lines). VMMC = Voluntary Medical Male Circumcision.