# A comparative analysis of voluntary medical male circumcision before and during the COVID-19 pandemic in Gauteng province, South Africa

## TL;DR

This study compares the number of voluntary male circumcisions in South Africa's Gauteng province before and during the COVID-19 pandemic to understand how the pandemic affected this HIV prevention method.

## Contribution

The study provides insights into how the COVID-19 pandemic disrupted VMMC services in Gauteng and highlights district-level variations in service delivery.

## Key findings

- VMMC declined by 33.8% in 2020 compared to 2019 in Gauteng province.
- Tshwane Metropolitan district saw an increase in VMMC for younger age groups despite a decline in older age groups.
- The West Rand district experienced the highest disruption in VMMC across all age groups.

## Abstract

Voluntary medical male circumcision (VMMC) is a significant biomedical and cost-effective intervention in preventing human immunodeficiency virus (HIV) transmission. This study aimed to compare VMMC before and during coronavirus disease 2019 (COVID-19) in Gauteng, one of the most affected provinces in South Africa by HIV and/or acquired immunity deficiency syndrome (AIDS) and COVID-19, to inform VMMC delivery and uptake during future pandemics.

A comparative analysis. Routine VMMC data were obtained from all public and private hospitals in Gauteng province from the District Health Information System and medical schemes. The datasets were merged with the years 2019 and 2020 as before and during COVID-19 periods, respectively. Percentage change in VMMC was calculated to determine changes in VMMC before and during the COVID-19 pandemic.

Provincially, VMMC declined in 2020 by an overall 33.8% for ≥ 10 years, 32.4% for 10–14 years and 35.8% for ≥ 15 years. All five districts in Gauteng province were affected differently. Exceptionally, the Tshwane Metropolitan district recorded an increase of 21.8% in ≥ 10 years and 36.0% in 10–14 years, despite a decline of –18.2% in ≥ 15 years in VMMC. While the other four districts saw a significant percentage decline in the three age groups of VMMC, the highest disruption was experienced in the West Rand district, in all three age groups.

In 2020 during the COVID-19 pandemic, VMMC substantially declined in Gauteng province. However, Tshwane, one of the five districts in Gauteng experienced an increase in VMMC, highlighting a health system resilient lesson to be learned. The fight against HIV is crucial and warrants the continuum of VMMC during future crises.

The evidence may inform policies on VMMC delivery post-COVID-19 and particularly during future outbreaks as a strive to curb HIV transmission in South Africa.