Recommendations for Communication about Halting VMMC for 10–14-Year-Olds Based on Updated PEPFAR VMMC Guidance: VMMC Key Messages for Target Audiences

President's Emergency Plan for AIDS Relief (PEPFAR) has updated its guidance on voluntary medical male circumcision (VMMC) for HIV prevention. The new guidance sets the lower age limit for VMMC at 15 years to minimize the risk of severe adverse events in younger boys. This change affects PEPFAR-supported VMMC programs in Eastern and Southern Africa, where boys aged 10-14 years have made up a significant proportion of clients. The updated guidance is based on new evidence showing a higher risk of injuries, such as glans injuries and fistulas, in younger boys whose male genitalia are not yet fully developed. To ensure the safety of clients, PEPFAR-supported VMMC programs are transitioning to the new age guidance, which means that boys who were previously eligible for VMMC will no longer be eligible if they are under 15 years old. To communicate this new eligibility information clearly and broadly, PEPFAR-supported VMMC programs need to be prepared to inform younger clients, parents, guardians, teachers, mobilizers, and providers about the change. The programs should use the new guidance as an opportunity to provide basic facts and safety information on VMMC and other age-appropriate prevention services. Key messages for different target audiences have been developed to support the implementation of the updated guidance. For boys aged 10-14 years, the message is that they will need to wait until they are 15 years old for circumcision, when their male genitalia will be fully developed. Parents and guardians of boys in this age group are informed that VMMC is no longer offered for boys 10-14 years due to the higher risk of injuries, and they are encouraged to bring their sons back for circumcision once they turn 15. Community mobilizers and volunteer community advocates are advised not to mobilize boys 10-14 years old for circumcision service and to explain to them that they will need to wait until they turn 15 and their male genitalia are fully developed. Health providers are informed that the minimum age for VMMC is being changed to 15 years due to the risk of injuries in younger clients, and they are encouraged to provide information on VMMC to parents and to use this opportunity to provide boys with age-appropriate comprehensive sexual health education and HIV prevention information. Teachers and school principals are informed that PEPFAR-supported VMMC clinics are no longer offering VMMC for boys 10-14 years of age, and they are encouraged to advise their male students to wait until they turn 15 years old and their male genitalia are fully developed to go for circumcision. Eligible clients aged 15 years and above are informed that VMMC is a safe procedure, but they are encouraged to tell their younger friends and children to wait until they turn 15 and their male genitalia are fully developed to go for circumcision.