Tag Archives: sub-Saharan Africa

Reducing HIV infection rates through non-surgical circumcision

29 Jul

The World Health Organization (WHO) estimates that over 34 million people are currently infected with HIV/AIDS. More than two-thirds of all people living with HIV are in Sub-Saharan Africa. There are many initiatives working to reduce infection rates in Sub-Saharan African countries, and one of the new exciting innovations is a device for non-surgical male circumcision.

Male circumcision reduces the likelihood of HIV transmission by approximately 60% when engaging in vaginal sex (WHO, 2013). However, the surgical procedure is painful and uncomfortable for men, and is said to reduce sexual pleasure. To increase the amount of voluntary medical male circumcision (VMMC), the WHO has prequalified PrePex, a device for non-surgical male circumcision in May of this year.

For the procedure, an inner ring and an elastic ring are placed on the penis by a PrePex operator. The inner ring keeps the foreskin from retracting, and the elastic ring gently compresses the foreskin to stop the flow of blood so that it loses sensation and dries out. This is a usually painless procedure, and the man returns seven days later to have the dead foreskin and the device removed.

PrePex does not require anesthesia or stitches, which means that medical workers other than doctors (i.e. nurses or traditional health workers) can be trained to do the procedure. Anyone who completes a three-day PrePex certification programme can be a PrePex operator. Although it is up to each country to develop their own policies on who can become a PrePex operator, technically it does not have to be a medical practitioner. This means that traditional circumcisers (who rarely have formal medical training) could potentially be taught to be PrePex operators. This has the potential to reduce the amount of deaths and complications due to infections from improper surgical circumcisions. PrePex is also safer and faster than the traditional surgical method and significantly reduces pain and discomfort, which means that men are more likely to voluntarily undergo the procedure.

There are also some downsides to PrePex. The device needs to be worn for a week and requires two visits to a Prepex operator (one for placement and a second for the removal). The healing time from the procedure is 8 weeks (2 weeks longer than surgical circumcision) during which the man cannot have sex. Additionally, the device has only been prequalified for men over 18 years or older (although trials for boys ages 10 to 17 are in progress).

The biggest downfall of circumcision is that it can sometimes give a false sense of security, reducing the usage of condoms. It is vital that any male circumcision be just part of a comprehensive HIV prevention package, which includes education about safer sex procedures, the distribution and education of condoms and HIV testing and counseling.

If devices such as PrePex become popular and easily accessible, there is great potential to increase the amount of VMMC and hopefully reducing HIV infection rates.