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Male circumcision to fight HIV: Could there be a better way?

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In the continued fight against HIVAIDS, Zimbabwe, through the Ministry of Health and Child Welfare and Population Services International (PSI) have set a goal of circumcising 1.2 million men by 2015. Since the launch of PSI’s, GetSmart or Pinda Musmart male circumcision campaign in 2010, about 40,000 men have gone under the knife. Other countries are following Zimbabwe’s example and getting behind the male circumcision, in fighting HIV. Rwanda is another country that has most recently jumped on the male-circumcision bandwagon, and they have done so in a most innovative manner.

Rwanda is introducing a painless, non-surgical circumcision that causes no bleeding!

Read more below:

Circumcision has been shown to lower the risk of HIV transmission and infection in Africa. Now, a new device known as the PrePex enables circumcision to be performed without surgery or any blood loss, by nurses, who don’t need extensive training to use the apparatus.

The Rwandan Government has completed its third trial of PrePex with nearly 600 volunteers and has concluded the device is a safe and efficient way of performing circumcisions. It now aims to reduce new HIV infections by fifty percent, in part through a campaign to circumcise two million adult men over the next two years.

The results were presented at the 16th International Conference on AIDS and Sexually Transmitted Infections (STIs) in Africa (ICASA).

Michel Sidibé, Executive Director of UNAIDS said:

“Innovation is key to achieving our target of 20 million voluntary adult male circumcisions by 2015 and saving millions of lives. Devices such as PrePex have the potential to facilitate safe and rapid scale up of male circumcision for HIV prevention, an urgent need in Sub Saharan Africa.

We commend the government of Rwanda for progressing the science of HIV prevention for the benefit of the region.”

An evaluation from the World Health Organization said the study of the PrePex device provides further clinical evidence that circumcision performed by nurses when using the PrePex device is fast, safe and effective, enabling a bloodless procedure that requires no injected anesthesia, no sutures and no sterile settings.

Agnes Binagwaho, MD, M(Ped) PhD hc, The Minister of Health of Rwanda said:

“We are unwilling to allow our health system resource challenges to dissuade us from our mission: to create a healthier, HIV-free Rwanda. We are committed to finding innovative, safe and effective solutions to make this happen …

This study shows that with the non-surgical PrePex device we can safely task-shift circumcision from surgeons and family physicians to nurses, which if nationally scaled up, would make a significant contribution to our public health system.”

Controversy regarding circumcision and HIV risk
There has been some controversy regarding the effectiveness of circumcision to prevent the spead of the HIV virus. Circumcision rates are far higher in the United States than in Western Europe, yet HIV cases remain stubbornly higher in the US and W. Europe, contrary to what might be expected if circumcision is so effective.

While many doctors are in agreement as to its effectiveness in Africa, the topic has its detractors that range from those demanding more research and scientific proof, some who point to contradictory findings from several studies, to wild conspiracy theories.

How does the device work?
The device basically works by stopping the flow of blood to the foreskin. It remains in situ for a week, after which time it is removed along with the foreskin that has died due to lack of circulation.

The average time for installation of the device is less than three minutes, with the advantage that it doesn’t involve surgery or cause blood loss, and thus can be performed by nurses.

The device and procedure, which can be performed in a regular doctor’s consulting room has an AE rate of 0.34% (2 out of 590), and the total study adverse event (AE) rate when performed by nurses was 0.83%. All resolved with minimal intervention, and the AE rate was lower than previously reported AE rates for surgical male circumcision when performed by surgeons (4.8%).

In Rwanda there are only 300 trained physicians for around 10 million people, and nearly 90 percent of the population live in rural areas that lack sterile facilities.

Analysis shows that scaling up circumcision via surgical procedures would drain resources from surgeons who work in vital life saving areas, not to mention the likely resistance from the local population.

The study was approved by the Rwanda National Ethics Committee and was conducted in Kanombe Hospital, Kigali Rwanda, between July 2011 and October 2011.


5 comments to “Male circumcision to fight HIV: Could there be a better way?”

  1. Comment by Tom Tobin:

    So what if a circumcision is now painless and bloodless? At the end of the day, you are still missing half the skin, and 60% of the nerves of your genitals. Are you calling this progress?
    Think for a moment. If circumcision worked to prevent HIV, wouldn’t Ethiopia, with 100% male circumcision, be AIDS-free? Instead, it has a very high infection rate. The US is mostly circumcised. Again, its HIV infection rate is one of the highest.
    A handful of studies by pro-circumcision non-medical doctors advocating circumcision does not make for a sound policy. Groups like yourself jump in, with no understanding, and throw money and resources at it. So, in a few years, we will have a circumcised Africa, and an HIV/AIDS rate as high as ever.
    Condoms work. They protect both partners.

  2. Comment by Mark Lyndon:

    Rwandan men are *more* likely to have HIV if they’ve been circumcised:

    2.1% of intact Rwandan men have HIV
    3.5% of circumcised Rwandan men have HIV

    (figures from measuredhs dot com)

    Other countries where circumcised men are *more* likely to be HIV+ are Cameroon, Ghana, Lesotho, Malawi, and Swaziland. That’s at least six African countries where men are more likely to be HIV+ if they’ve been circumcised, and yet they’re promoting circumcision to prevent HIV. What will it take to stop this madness?

  3. Comment by Hugh7:

    You don’t hae to look to the US or Western Europe, or invoke wild conspiracy theories to be skeptical about circumcision. The HIV rate among non-circumcised Rwandan men is 2.1%, but among circumcised men it is 3.8%, according to USAID: http://www.measuredhs.com/pubs/pdf/CR22/CR22.pdf So how can circumcising men reduce their HIV rate? Rwanda is only one of 10 countries with more of the circumcised men HIV+, out of 18 countries for which there are figures. This should at least be explained before undertaking mass circumcision campaigns with all their costs, risks and harms. (Many men say their foreskin is their most pleasurable part).

  4. Comment by Hugh7:

    And the figures for Zimbabwe (in 2005) are non-circumcised men 14.2% HIV+ , circumcised men 16.6% HIV+.

  5. Comment by Blaz:

    Bt as far as im concerned this practice must be done to boys as early as before puberty age,why :at this stage they are not yet sexually active,then by the time they do it(sex) they wanna reduce the risk rather than circumscising men who have deceptively warmed their bodies to the hearts of the world and are already h.i.v+.