All external experts interviewed agreed that the device must be further investigated before it can be used systematically. "I've examined the PrePex. It's very promising in that it's very rapid to apply—two to three minutes, compared to the 20 minutes required for surgical circumcision," says Tim Farley, a scientist with WHO's Department of Reproductive Health and Research.” One of the problems is that there could be rare events that occur but it’s very difficult to detect those within this sort of limited studies. So the product needs to be studied in a larger number of men, and we will have to continue to monitor the safety and acceptability of the device.”
Rwanda will present safety and efficacy data on 50 patients at the American Urology Association in May 2011, and a randomized, controlled trial with 150 participants, designed to compare PrePex with the conventional surgical method is currently ongoing.
Today, clamping systems approved by the WHO are for use in infant circumcision. They include the Mogen clamp, the Gomco clamp and the Plastibell.
In 2004 the TaraKlamp (TK), a device that requires anesthesia, was tested among adults in South Africa. Despite initial enthusiasm, the study revealed high complication rates. Of 69 participants, 34 men were randomized to conventional surgery and 35 to the TK approach. Less favorable outcomes were systematically associated with the latter method.
Public sector facilities in some South African provinces, however, are using the device today.
Another apparatus currently being investigated among male adults in various sub-Saharan countries is the China-developed Shang Ring. This device, which requires local anesthesia, has proved safe, effective and acceptable in a small study involving 40 patients, published in the February 2011 issue of the Journal of Acquired Immune Deficiency Syndromes. A randomized control trial involving 400 male adults, comparing the Shang Ring with standard surgical methods, is expected to launch in Kenya and Zambia.
As the number of devices being tested is increasing, in January 2011 WHO set up an independent advisory committee. "The committee will systematically review new data on devices and advise on whether additional studies are needed before a device can be recommended for use in the scale-up of male circumcision programs," says Catherine Hankins, UNAIDS chief scientific adviser. "This is a minor operation, but on a major organ. We don’t want to lose any penises."
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Add Comment"It's only innovation which will change the face of the fight against HIV in the world" said today the Number 1 of UNAIDs Dr Michel SIDIBE, who came to see on live how well performing and revolutioning is this device. Michel Sidibe came in Rwanda and visited today the center of "Excellence of Prepex - Rwanda" at Nyamata Hospital in Bugesera District, Eastern Province. In this visit he was with the Permanent Secretary in the Ministry of Health, Dr Agnes Binagwaho and the 2 investigators Dr Corine Karema and Vincent Mutabazi, from TRACPlus which is the institution leading the comparison study between Prepex and the surgical circumcision. The preliminary findings of this study are promising showing an economic saving and a reduction by five the time of performing this procedure that require no anaesthesia neither a sterile environment. When Dr Sidibe walked out of the operating room, more than 30 young men and school students were waiting to be circumcised with the Prepex device as this is another way to get the Rwandan youth responsible of HIV prevention! This week 20 experts of African countries also visited Rwanda to see on live this incredible device. Rwanda is the place where scientific evidenced based revolutions happen for the health sector and for Africa this is just a piece which will save lives by reducing HIV transmission among the youth which is the future of the world.
Reply | Report Abuse | Link to this"The foreskin thereby dries up and can be safely removed after a week."
Reply | Report Abuse | Link to thisThe foreskin thereby slowly dies, and the necrotic tissue can be torn out after a week.
I'm surprised it's not more painful. Are there risks of blood cloths or infections if the device is removed prematurely?
It'll be interesting to see a comparison of the results to those of the surgery.
"Rwanda, where HIV prevalence is 3 percent but only 12 percent of adult males are currently circumcised."
Reply | Report Abuse | Link to thisMore to the point, the HIV rate among non-circumcised men is 2.1%, but among circumcised men it is 3.8%, according to USAID: http://www.measuredhs.com/pubs/pdf/CR22/CR22.pdf
So how can circumcising men reduce their HIV rate?
A Uganda study (by circumcision advocates) started to show that circumcising men increases the risk to women, but they cut it short before it could reach statistical significance. (Lancet 374:9685, 229-37)
The device in question will certainly work. Something similar has been used in Australia and New Zealand for years to castrate sheep.
HIV is not actually a death sentence. It is a disease that can be managed and be controlled by the individual who acquired it allowing him to live a long normal and productive life like anyone else. POZmingle the largest dating and support site for HIV singles claim that they have 200,000 HIV members, Most of them are here to find understanding, support and love. It is really a good thing that encourage each other, Leading a healthy life.
Reply | Report Abuse | Link to thisIs there really causation? Data that Hugh Young cites seem to show that the correlation is the other way round.
Reply | Report Abuse | Link to thisI hope nobody is going around implying that this can prevent AIDS! That would be a sure recipe for people to get this done and proceed to take up more risky behaviour and worsen the situation.
Ladies be careful. The hardened skin that developes on the circumcised penis will increase your rates of vaginal erosion leading to increased health risks and total Hystorectomies. 60% reduction rate means the other men who get circumcised and get HIV anyways will more likely increase the rates the women get HIV over time bringing their population levels closer to extinction. It is only the Pro circumcision religious scientists that believe Circumcision is benifitial, not truthful scientists. Don't let them fool you into allowing to be done to infants and children because if done before puberty it messes with normal reproductive brain chemistry development.
Reply | Report Abuse | Link to thisMr. Rhodes,
Reply | Report Abuse | Link to thisCome to Brooklyn, NY and take a stroll in Williamsburg or Boro Park. Families there typically have eight,ten, twelve children, sometimes more. All the fathers were circumcised as infants. Is that what you call messing with normal reproductive bran chemistry? Do you have data showing that wives of circumcised men have more vaginal erosion and total hysterectomies than wives of uncircumcised men? The jury is out on any health benefits, but that's not why we do it.
As for AIDS, the problem is sexual promiscuity, not the presence or absence of the foreskin. Stick to one woman who sticks to you and the rate of AIDS
Sorry, pushed the wrong button. . .
Reply | Report Abuse | Link to thisStick to one woman who sticks to you and the incidence of AIDS and all other venereal diseases falls to near zero. That's where it's been among Orthodox Jews for as long as anybody was keeping count.