Funding cuts push Zimbabwe to consider reusable circumcision kits
By Michael Gwarisa
HARARE (HealthTimes) — Zimbabwe is exploring the use of reusable circumcision kits to sustain voluntary medical male circumcision (VMMC) services amid declining international funding and the gradual withdrawal of donor support.
VMMC has been a key HIV prevention tool in Zimbabwe, credited with significantly reducing new infections since its launch in 2009. At its peak in 2012, the program recorded more than 1.1 million circumcisions, contributing to the national goal of achieving 80% coverage among adult males and newborns. The country aimed to maintain about 150,000 circumcisions annually to sustain coverage levels.
However, the program’s future faces uncertainty following funding cuts by major donors. Earlier this year, the U.S. government, through the President’s Emergency Plan for AIDS Relief (PEPFAR), announced a halt in support for VMMC and condom programming outside new administration priorities.
This follows years of support from PEPFAR, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Bill & Melinda Gates Foundation, which previously financed most VMMC activities through partners such as the ZAZIC Consortium and Population Services for Health (PSH).
Although PEPFAR has introduced a $65 million Bridge Plan to sustain Zimbabwe’s HIV programs for six months, VMMC and condom programming are no longer part of its funding portfolio.
Government Takes Over Amid Funding Gaps
Since donor support ended, the Ministry of Health and Child Care (MoHCC) has assumed full responsibility for the program, marking a shift toward domestic ownership and sustainability. Yet, with annual costs still high, the ministry is exploring reusable circumcision kits as a potential cost-saving measure.
“VMMC is one of the programs most affected by the cuts in funding. At 0% funding, we are looking at using reusable kits and focusing mainly on efficiency-based delivery of VMMC,” said Dr. Tsitsi Apollo, deputy director in the AIDS and TB Unit at the MoHCC.
She added that other cost-cutting measures include reducing outreach and community activities.
“At 25% funding, we can combine reusable and limited disposable kits with targeted campaigns. With 50% funding, we would have more flexibility to expand operations. Condom programming has also been affected,” she said.
Dr. Apollo emphasized that both VMMC and condom distribution remain critical interventions that require continued government support.
Addressing Safety Concerns
The suggestion to use reusable circumcision kits has raised safety concerns among stakeholders. Experts note that reusable kits require strict sterilization protocols to prevent infection transmission. Potential risks include inadequate cleaning, contamination, or damage to instruments that could compromise sterility.
Key safety measures include thorough cleaning with soapy water and brushes, avoiding corrosive disinfectants such as chlorine, and routinely inspecting instruments to remove defective tools.
Addressing these concerns, Dr. Apollo said safety remains a top priority and that reusable kits are widely used in several countries under stringent standards.
“The Ministry of Health has infection control policies and standards to ensure minimal or no risk of transmission. Safety is guaranteed. This is not a practice unique to Zimbabwe; it is in line with World Health Organization (WHO) guidelines,” she said.
WHO Guidance on Circumcision Kits
The WHO provides guidelines for male circumcision devices in HIV prevention programs, recognizing two main types of kits: single-use disposable kits and reusable surgical instruments that can be safely sterilized and reused multiple times.
Countries such as Kenya, South Africa, Tanzania, Zimbabwe, and Eswatini have long used a mix of these approaches depending on cost and logistical considerations. Non-surgical circumcision devices are also being rolled out or piloted in several Southern African nations as part of ongoing innovation in HIV prevention.
Is VMMC Still a Viable HIV Prevention Strategy?
Scientific evidence shows that circumcision reduces the risk of female-to-male HIV transmission by about 60%. Despite this, recent data indicate a decline in VMMC uptake across Zimbabwe.
According to MoHCC’s VMMC cascade data, between January and March 2024, the program targeted 235,366 circumcisions but achieved only 41,160. As of December 2023, no province had reached the 80% coverage target. The highest coverage levels were in Lupane and Tsholotsho (61%), while Kariba and Binga recorded 17% and 19%, respectively.
COMPASS Zimbabwe Country Director Munyaradzi Chimwara said the current uptake suggests that resources could be redirected toward other HIV prevention methods with broader reach.
“In my personal opinion, VMMC uptake has been very low when measured in U.S. dollar terms compared to condoms and PrEP. It does not make a strong investment case. Also, VMMC, like condoms, is a male-controlled prevention measure, which limits women’s protection. PrEP provides an opportunity for both genders to take control of their sexual health,” said Chimwara.
Balancing Efficiency, Safety, and Sustainability
As Zimbabwe navigates reduced donor funding, decisions about the future of circumcision services will require a careful balance between efficiency, safety, and sustainability.
Health experts agree that with proper infection control and adherence to WHO standards, reusable kits can offer a safe and practical way to sustain VMMC services in resource-limited settings. However, maintaining public confidence and high standards of care will be critical as the country transitions toward more locally financed health programs.
