For the first time since the beginning of the AIDS pandemic, the global scientific community has proposed a means to achieve an AIDS-free generation by implementing a multi-pronged, comprehensive strategy that targets both prevention and treatment of HIV [
1]. One of the key pillars to achieving this goal includes scaling up voluntary medical male circumcision (VMMC) in sub-Saharan Africa. Multiple observational studies [
2],[
3] and randomized trials (RCTs) [
4]-[
6] have conclusively demonstrated that VMMC can reduce the lifetime risk of male acquisition of HIV by about 60% [
7]. The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) have endorsed innovative approaches to VMMC uptake in 13 priority countries in which HIV incidence remains high, but the prevalence of male circumcision is low [
8]. Major implementing agencies and international donors have agreed to an action plan that aims to reach 80% coverage of VMMC in these 13 countries by 2015. Successful implementation of the plan will require performing about 20 million adult VMMC over the next 2 years. Reaching this target is estimated to avert 3.36 million new HIV infections in these priority countries, for a cost savings of up to US$16.5 billion [
9]. However, implementation in most of these target countries has been slow, with prevalence of VMMC lagging far behind the goal of 80% coverage [
10]. As of 2010, only 2.7% of the total number of VMMC procedures needed to reach this coverage level had been performed, and of all priority countries, only Kenya appears to be on track to achieving the 80% coverage [
8].
Rwanda, as one of the identified priority countries, has set an ambitious goal of performing 700,000 additional VMMC procedures by 2015. Sufficiently convinced by the scientific evidence in support of VMMC, and with implementation support from the WHO, UNAIDS and the US President’s Emergency Plan for AIDS Relief (PEPFAR), the Rwandan government is promoting VMMC as a back-bone strategy of a comprehensive national HIV strategic plan [
11]. However, Rwanda does not have a history of traditional circumcision, and until recently, the country has lagged behind other priority countries. By 2014, less than 10% of the target number of procedures had been performed. This is in comparison to neighboring Kenya, for example, which has achieved almost 50% VMMC coverage in some regions and up to 80% in others [
12]. It may be that conflicting feasibility and optimization models for the scale-up of VMMC in Rwanda generated overly optimistic operational targets [
13].