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Reducing HIV Risk with Painless Male Circumcision

  • Joe DeCapua

PrePex device is described as a safe, painless, nonsurgical method to perform circumcision on adult men.

PrePex device is described as a safe, painless, nonsurgical method to perform circumcision on adult men.

Studies have shown that male circumcision greatly reduces the risk of HIV transmission. The World Health Organization is weighing approval of a new device that could make the procedure simple and painless.

The WHO and UNAIDS call male circumcision an important and effective strategy to help slow HIV infections. In a recent report, they said the potential exists to avoid 22 percent of HIV infections by 2025 in 14 countries in eastern and southern Africa.

However, to do that, 80 percent of the men between ages 15 and 49 would have to be circumcised. But if men believe the procedure involves needles, scalpels and pain, there could be a less than enthusiastic response to having it done.

The World Health Organization is now reviewing trial results of a new device call PrePex, which was used to circumcise more than 1,000 men in Rwanda.

“Essentially, it’s a device designed to compress the foreskin using two rings. And that ultimately by squeezing the skin in a very non-painful way the blood supply to the skin begins to go away and the skin dies, which is what we want. And then it’s able to, sort of, fall off,” said Dr. Steven Kaplan, of New York’s Weil Cornell Medical Center, who is a urologist and co-investigator of the PrePex study.

Did he say non painful?

“When blood supply to an area of skin is removed there’s no pain because the nerve fibers also don’t get blood supply. So that’s why patients tolerate it because when you first think about it you say isn’t that going to hurt? And the answer is no, because the blood supply goes away and therefore the pain goes away as well,” he said.

From start to finish, it can take about a week, maybe less. No surgery is involved, no sharp objects.

The beauty of this is that this can be done in almost any environment. Does not require any anesthetic. Does not require any sterile environment. And that’s what we believe will make this very, very useful and adaptable to large communities throughout the world and, here, particularly Africa,” said Kaplan.

Health professionals, not just doctors, can be trained to use PrePex.

Kaplan said it’s long been known that removing the foreskin of the penis brings a number of health benefits.

“Various types of germs, the virus, bacteria, other types of sexually transmitted diseases, are sort of, if you will, hidden, kept under the foreskin because a lot of times it’s not retracted. It’s not well cleaned. It just becomes really almost an empty alleyway where all these bad bugs can hide,” he said.

Good results

Rwandan Health Minister Dr. Agnes Binagwaho praised the PrePex device following the trial in her country.

“So, it was very successful. First of all, it proved that it was safe. It proved that it was efficient and it proved that it was superior to the surgical male circumcision,” she said.

During the trial, men in the PrePex study were kept in the hospital strictly for observation. The minister says men who had the new procedure were laughing and playing. Men who had the surgical procedure were not.

Rwanda’s HIV prevalence rate is 3 percent. But the results of a new survey are expected in about a month. The health minister said the goal is to circumcise about two million men.

“We want to protect our men against the risk of HIV transmission by circumcising them. And, you know, when you protect men you also protect women. You also protect future children of those women,” she said.

Binagwaho said it isn’t just an issue for Rwanda, but for the whole world.

“I think the line of men who want to be circumcised is bigger than the capacity to circumcise. Because for the time being, the official way to circumcise is the surgical circumcision,” she said.

PrePex is being developed by CircMedTech. The company says the device has been cleared for marketing in the European Union and hopes the World Health Organization will give its approval in early 2012.

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