Can New Circumcision Devices Help Fight AIDS in Africa?

Circumcision can help drop the rate of HIV infection in Africa. The challenge is getting more men snipped more quickly.

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The Prepex, recently approved by the FDA, is device for non-surgical adult male circumcision for HIV.

It’s a lofty, but vital goal. Africa wants to circumcise 20 million men by 2015 to help curb the AIDS epidemic plaguing the continent. Studies show that the procedure is one of the most effective “vaccines” against HIV, reducing the risk of infection in men by at least 60%, the New York Times reports.

However, only about 600,000 men have had the operation so far and the clock is ticking — every missed day means more chances for infection. The main obstacle lies in a shortage of surgeons to provide circumcision, and provide it quickly. According to the Times, it takes a skilled surgeon about 15 minutes per circumcision and such doctors are hard to come by in Africa.

Now, new circumcision devices on the market may help fill the demand. PrePex and Shang Ring are two devices under evaluation by the World Health Organization (WHO) to speed the process, Dr. Stefano Bertozzi, director of HIV for the Bill and Melinda Gates Foundation told the Times.

The FDA approved PrePex just a few weeks ago. It was invented in 2009 by four Israelis, one a urologist who heard the plea for surgeons in Africa. Out of all similar devices, PrePex is so far the quickest, least bloody and least painful. It’s also remarkably simple — its technology is based on a rubber band. According to the Times:

The band compresses the foreskin against a plastic ring slipped inside it; the foreskin dies within hours for lack of blood and, after a week, falls off or can be clipped off “like a fingernail,” said Tzameret Fuerst, the company’s chief executive officer, who compared the process to the stump of an umbilical cord’s shriveling up and dropping off a few days after it is clamped.

(You can watch a video of PrePex being used on an adult patient here, but be warned, the images are explicit.)

According to Dr. Jason Reed, an epidemiologist in the global AIDS division of the Centers for Disease Control and Prevention, PrePex could increase circumcisions to 400 a day, compared to the current 60 to 80. The device can be placed and removed in minutes by trained nurses.

The WHO is also considering the Shang Ring, a Chinese device with a plastic two-ring clamp. Unlike PrePex, the Chinese contraption requires the medical provider to cut excess foreskin beyond the clamp, which means injections of anesthetics are needed, as well as enough training for the provider to perform minor surgery.

“The Shang is not as fast, but it’s faster than full-fledged surgery,” AIDS-prevention expert Mitchell Warren told the Times. “And it hasn’t submitted as much safety data.”

Although there are a few other devices on the market, PrePex and Shang Ring are the most promising. If approved for use by WHO, the devices could be fundamental in helping Africa meet its goal.