In the world of HIV prevention, circumcision is one of the most contentious topics. According to some scientific studies, circumcision can reduce female to male HIV transmission by up to 60%. Nonetheless, circumcision–especially when done as an adult–is an emotionally fraught procedure.
The PrePex, an adult male circumcision device that is purportedly painless (it only triggers mild discomfort, according to proponents) has been around since 2009. Now, the device is getting its first major scale-up in Rwanda, where the Ministry of Health has set a goal of circumcising 700,000 men between 15 and 49 using PrePex’s technology (elastic radial compression) by the end of 2016.
“Rwanda is most definitely pioneers of this innovation, and it is no coincidence that they are the first to begin scale up, following a long and rigorous clinical and regulatory assessment of the World Health Organization with multiple clinical studies reviewed by the Bill & Melinda Gates Foundation, UNAIDS, USAID and WHO,” writes Tzameret Fuerst, co-founder and president of Circ MedTech, the company that makes PrePex, in an email.
The PrePex circumcision procedure requires no surgical tools (it’s up to five times faster than traditional surgical methods, according to a WHO-audited study) and is completely bloodless. A ring compresses the foreskin to stop blood flow, and the foreskin dies hours later. It can be removed within a week. Still, it requires some training to handle. That’s why, three years ago, Rwanda opened up a center to train nurses and surgeons from the 13 other African countries most affected by HIV/AIDS in how to use elastic radial compression technology.
So far, 5,000 Rwandan men have voluntarily undergone the PrePex procedure. “Men ask for PrePex by name. Roughly four times more men have shown up as volunteers to participate in the clinical studies,” writes Fuerst.
While the World Health Organization and UNAIDS have set a goal of circumcising 20 million African men by 2015, the idea of adult circumcision still rankles many people. The squeamishness-inducing procedure is not a replacement for condoms–a fact that could be lost on people who use the PrePex if they don’t also get proper education (Rwanda says that it is coupling distribution of PrePex with counseling on safe sex). At least one study also concludes that circumcision doesn’t prevent HIV transmission between men.
For now, two hospitals in Rwanda will oversee five health centers that provide the PrePex. Price will drop as demand grows, according to Fuerst, eventually becoming as low as $12 per device.
Don’t be surprised if the PrePex quickly shows up in other countries–the device has WHO Prequalification, which means it meets the organization’s safety and efficacy requirements.