14 August, 2015 03:18

Simple device offers men circumcision with no surgery, anesthetic

Studies show cutting off foreskin reduces HIV infection risk in heterosexual men.

About 100,000 African men have undergone voluntary medical circumcisions for HIV/AIDS prevention with a simple device that requires no doctors, stitches, surgery or anesthetic.

The PrePex disposable device uses an elastic ring that compresses the foreskin enough to cut off circulation, killing the foreskin tissue after about a week. At that point, males attend a clinic to have a specially trained nurse snip away the dead tissue. Healing is said to occur about 21 days after removal, and complications are said to occur in under one per cent of cases.

The device, described in the New York Times a few years ago as simpler to assemble than a McDonald’s Happy Meal toy, is being promoted to 6,000 HIV/AIDS experts from 125 countries in Vancouver this week attending the International AIDS Society conference.

The World Health Organization has helped facilitate research on the device and a circumcision agenda in countries with HIV/AIDS epidemics and low rates of circumcision. That policy followed at least three studies showing that male circumcision reduces HIV infection risk in heterosexual men by about 60 per cent.

According to WHO:

“WHO/UNAIDS recommendations emphasize that male circumcision should be considered an efficacious intervention for HIV prevention in countries and regions with heterosexual epidemics, high HIV and low male circumcision prevalence.

“Male circumcision provides only partial protection, and therefore should be only one element of a comprehensive HIV prevention package which includes: the provision of HIV testing and counselling services; treatment for sexually transmitted infections; the promotion of safer sex practices; the provision of male and female condoms and promotion of their correct and consistent use.”

Adi Kadussi, spokeswoman for Circ MedTech, the Israeli “social enterprise” company that invented and distributes the devices, said 600,000 of them have been delivered to 14 countries in Africa where more than 25 million people have HIV or AIDS.

“Thirty-six million people have HIV/AIDS in the world and two-thirds of them are in sub-Sahara countries so these are the places where WHO and the United Nations have recommended voluntary male circumcision as a priority to save lives,” she said, adding the Bill and Melinda Gates Foundation sponsored early clinical trials on the device. Since favourable results were published in various medical journals, the devices have been bought (for $12 apiece) by numerous countries and HIV/AIDS organizations.

There are five sizes for adult males, four for adolescents between age 13 and 17 and four sizes for infants, although the use of the device for infants is still in the research phase.

Sun Health Issues Reporter, pfayerman@vancouversun.com

Penis circumcision in the context of HIV infections:

The foreskin (the retractable fold of skin covering the head of the penis) has been shown to be highly vulnerable to HIV infection. Circumcision of the penis provides protection against HIV infection for heterosexual men but not for most men who have sex with men. Penile circumcision does not appear to protect women from HIV transmission.

Penile circumcision provides protection for HIV-negative men who are at risk of HIV infection through vaginal sex with women. Research in eastern and southern Africa found that circumcised heterosexual men were about 60 per cent less likely to become infected with HIV than uncircumcised men.

Circumcised men are also at reduced risk of sexually transmitted infections like syphilis and human papillomavirus (HPV).

Penile circumcision does not provide protection for HIV-negative women who are at risk of infection through vaginal sex with men. Penile circumcision does not appear to protect HIV-negative men at risk of HIV infection through insertive and receptive anal sex (topping and bottoming) with other men. There is some evidence to suggest circumcision may protect HIV-negative men from HIV if they engage in only insertive anal sex (topping).

How does circumcision of the penis reduce the risk of HIV infection?

The foreskin traps and holds bacteria and other pathogens and is said to be one of the conduits by which HIV enters a man’s body during sexual intercourse.

The foreskin is vulnerable to HIV infection because it’s so delicate and can sustain small scrapes, ulcers (tears) and inflammation during sex. HIV enters the body through the weakened spots. The latest research also shows there are more Langerhans cells in the foreskin and HIV is attracted to such cells.

Lastly, HIV-infected fluids can become trapped under the foreskin, remaining there after sex.

Why is circumcision less beneficial for men who have sex with men?

Circumcision doesn’t protect an HIV-negative man when he is on the bottom because HIV enters through the anus, and not the foreskin of the penis. In addition, since the risk of transmission is so much higher when a man is on the bottom, rather than on top, circumcision may not protect him, even if he bottoms only occasionally.

Where is penile circumcision being promoted as a method of HIV prevention?

The World Health Organization (WHO) recommends voluntary adult penile circumcision as a method of HIV prevention in countries with heterosexual HIV epidemics, an HIV prevalence over 15%, and low circumcision prevalence. Programs that offer circumcision to adult men are being expanded in many countries throughout Eastern and Southern Africa.

Circumcision is not recommended as a method of HIV prevention in Canada because the HIV/AIDS epidemic here is mostly concentrated in gay men and people who use injection drugs. Only about 10 per cent of Canadian babies have been circumcised in recent years.

Sources: CATIE (Canadian AIDS Treatment Information Exchange); U.S. Center for Disease Control; and the Lancet

The Vancouver Sun

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