To the Editor: Millard et al.[1] state in their editorial in the SAMJ January issue that medical male circumcision (MC) in South Africa (SA) peaked in 2013, only to decline in subsequent years despite improved surgical infrastructure and ‘high-level marketing’. They attach great hope to ‘demand creation’, which they state is supported by the Bill and Melinda Gates Foundation and the Clearinghouse on Male Circumcision. ‘Demand creation is trying to sell something that many men don’t want’, they state.

Elucidating MC statistics, the authors report that ‘45% of all 2014 circumcisions were among boys <15 years of age.’ According to them, ‘it is time for SA to change gears and orient marketing and programmes to males of all ages’, but particularly to boys of this age range. In addition, they compare MC of boys to successful ‘immunisation’ and suggest that ‘mothers are an influential but neglected target of circumcision promotion’, since they will presumably motivate their boys to be circumcised and spread the word about MC to their friends. Their conclusion is that ‘the time to change course is now’.