| From: |
"Makona, Edgar Dearn" [ profile ] |
| Subject: |
Rwanda tests promising new Male Circumcision Device
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| Sent: |
Jun 7th, 2011 - 05:09:28 |
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Courtesy: Scientific American,
The African nation of Rwanda recently set a goal of circumcising an
estimated two million adult men by the end of 2012 to fight the spread
of HIV, and is investigating a new nonsurgical device that is said to
allow practitioners to perform the procedure in less than four
minuteswithout anesthesia.
The patent pending PrePex device includes an elastic mechanism that
fits around an inner ring, trapping the penis foreskinthe loose fold
of skin that covers its glanswhich cuts its blood supply. The
foreskin thereby dries up and is removed after a week. Neither
anesthetics nor sterile settings nor sutures are requiredand no blood
is lost, according to health authorities studying the device. After
the procedure the Rwandan government guidelines suggest that patients
abstain from having sex for six weeks, which is also the case after
conventional surgery. This device, it is hoped, could help scale up
Rwanda's mass circumcision initiative.
Since 2007 World Heath Organization and the Joint United Nations
Programme on HIV/AIDS (UNAIDS) have promoted adult male circumcision
as an additional means to fight HIV transmission in sub-Saharan
countries with a high prevalence of the virus, low levels of male
circumcision, and generalized heterosexual HIV epidemics. The
rationale relies on studies suggesting that circumcised men reduce
their own risk of HIV infection by about 60 percent.
Campaigns of mass circumcision have thus been launched in various
countries, including Rwanda, where HIV prevalence is 3 percent but
only 12 percent of adult males are currently circumcised. "If we only
circumcise newborns, the effects will start in 15 years. We have to
face the problem now," says Agnès Binagwaho, permanent secretary of
Rwanda's Ministry of Health. "We are now offering, alongside
counseling, testing and condom distribution an additional means of
lowering transmission. It's a comprehensive approach."
The major obstacle to adult circumcision in most sub-Saharan countries
remains the lack of medical infrastructures and trained health
professionals to perform the operation. To overcome this, some
countries such as Kenya now allow nurses to perform the surgical
procedure. In others, like South Africa, the different stages are
divided among nurses and physicians, to decrease physician time spent
per procedure.
Now, the concept of a device that can bypass the need for any
anesthesia or sutures is also raising interest. "There's absolutely no
doubt that if one can perform male circumcision without anesthesia,
you save time, money and it requires less expertise," says Kim Eva
Dickson, senior adviser in WHO's HIV/AIDS department.
The price of the PrePex device, manufactured by Circ MedTech,
incorporated in the Virgin Islands, has not yet been established. "The
device was developed to be affordable for public health programs in
Africa and is meant to be cost-saving for the government. The final
price depends on quantities," said company CEO Tzameret Fuerst.
In March 2011 data on the first 40 patients from the safety and
efficacy study was presented at the 18th Conference on Retroviruses
and Opportunistic Infections in Boston. According to the researchers,
all participants experienced excellent healing. "There was a 100
percent compliance rate, and the whole pain-management protocol in the
study was two ibuprofens for the two to three hours of discomfort that
follow the placement of the device," Binagwaho says. "It can be done
anywhereunder a tent, in a classroom on the weekendsby a staff that
is rapidly trained." The Rwandan government is currently training
health care workers to perform the operation.
Dickson, who visited the site during the trial, agreed that initial
results are encouraging. "We saw it done, and when we spoke to people
who went through the procedure they seemed satisfied and the cosmetics
looked good," she said. "I think there is potential, but we need more
research evidence before we can approve of this method."
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