Bleeding and Blood Disorders in Clients of Voluntary Medical Male Circumcision for HIV Prevention - Eastern and Southern Africa, 2015-2016

Voluntary medical male circumcision (VMMC) is a key component of human immunodeficiency virus (HIV) infection prevention programs in 14 Eastern and Southern African countries. The President's Emergency Plan for AIDS Relief (PEPFAR) tracks notifiable adverse events in PEPFAR-supported programs to identify risks and improve practice. A review of adverse event data reported to PEPFAR from VMMC programs in eight countries during 2015-2016 identified 19 cases of bleeding resulting in hospitalization of ≥3 days among 109 notifiable adverse events (17.4%); this was the most commonly reported adverse event. Among the 19 bleeding adverse events reported, seven occurred in clients who were later confirmed to have a bleeding disorder or nonspecific/other hematologic abnormality. Efforts to improve precircumcision screening are intended to reduce the occurrence of bleeding adverse events by identifying clients who might have signs of a bleeding disorder. Clients considered or suspected to have minor bleeding disorders can be circumcised safely in settings where blood products are available.