By Audrey Quinn
Posting in Healthcare
Circumcision can reduce a man's risk for HIV in Sub Saharan Africa by up to 60%. This adult circumcision device gets the job done without surgery or severe pain.
When I was eight years old, my aunt gave birth to a baby boy perfect in every way, except for a six boneless finger on his left hand. When I met my new cousin a week later, he had a string tied around his now shriveled six digit. The string, my aunt explained, would painlessly starve the troublesome finger of blood until it fell off on its own.
A medical worker clamps the device around the foreskin of a man's penis. The lack of blood supply kills the foreskin within a few hours. A week later the man returns to the clinic to have the device removed. Altogether the application and removal time totals about three minutes. The discomfort of removing the PrePex (and the now detached foreskin) has been likened to that of taking off a bandaid.
Why the need for such a quick low-impact circumcision method for adult men? Studies in African countries with high levels of HIV have found that circumcision reduces a man's risk of contracting the virus by up to 60%. That explains PrePex's target demographic, Sub-Saharan Africa.
Here's where PrePex has a built-in market. The Joint United Nations Programme on HIV/AIDS (UNAIDS) and the U.S. President's Emergency Plan for AIDS Relief plans to fund the circumcision of 80% of men ages 15 to 49 in high-risk African countries by 2015.
As the first non-surgical male circumcision device that involves no injected anesthesia, bleeding, sutures, or sterile settings, PrePex is an attractive product choice for helping to meet that goal. Since its debut in 2009, the device is already well on its way to broad usage, Ariel Schwartz of Co.Exist reports:
Last month, [the World Health Organization] WHO gave Rwanda its approval to scale up the use of PrePex, which has already successfully circumcised 1,200 men in the country. In Zimbabwe, a large PrePex trial funded by the Bill and Melinda Gates Foundation and the [United Nations Population Fund] UNFPA has already seen 500 circumcisions performed. People have been literally lining up to participate in PrePex studies.
PrePex has the certifications to enter the U.S. and E.U. markets, but the company has no plans to do so any time soon.
"We are laser focused on an imminent burning need," PrePex's parent company's CEO told Co.Exist regarding their focus on the Sub Sahara. “Every 16 seconds someone dies of AIDS. We have a rare opportunity to make a monumental impact in the battle against this life threatening disease."
As a recent commenter on my post on HIV vaccines pointed out, debate still exists in the U.S. over the merits of circumcision. A 2008 review of circumcision and HIV studies by Scientific American's Barbara Juncosa came to this conclusion:
Circumcision protects heterosexual men from HIV acquisition via sexual intercourse with the greatest benefits accruing in developing nations that are hardest hit by the epidemic.
But, Juncosa notes, the HIV-preventing benefits of circumcision for homosexual men are less certain.
While male circumcision rates in Sub Saharan Africa continue to rise, male infant circumcision rates have dropped dramatically in the U.S. over the last few years. And while studies show circumcision lowers a man's chance of contracting HIV from a female partner, the question remains whether it also affects his chances of passing the virus on to her.
May 25, 2012
I've given it some thought. The answer is no. A quick, painless circumcision is not going to prevent HIV any better than a slow, painful one. The fact is, circumcision does nothing to prevent HIV. 90% of US adult males were circumcised in the 1980s. We buried nearly a million of them. Ethiopia has a 93% circumcision rate, and a high HIV infection rate. Finland, New Zealand, and Japan don't circumcise. Their infection rates are very low. A painless circumcision, well, when you wake up in the morning, 50% of the skin of your genitals is still gone. Condoms work. They protect both partners. You get to keep all of your body. And with many HIV vaccines being worked on, does a permanent amputation make sense? Especially when circumcised men have to wear a condom anyway? If this was females we were discussing, would we even be discussing it? Circumcised females are less susceptible to HIV.
Here in New Zealand, we've been using a device like the PrePex for decades, on sheep, but not on their foreskins. It's called an Elastrator. The claim that circumcision protects against HIV only applies to infection of men from women. Condoms strongly protect both sexes. The protection of circumcision - if any - is slightly more than tossing a coin and rolling over and going to sleep if it comes up "tails". Yes, if any: In 10 out of 18 countries for which USAID has figures, more of the circumcised men have HIV than the non-circumcised. This needs to be explained before blundering on with mass-circumcision campaigns. Meanwhile Wawer et al. (Lancet 374:9685, 229-37) started to find that circumcising men might INcrease the risk to women. Following couples with HIV+ men, of "92 couples in the intervention [circumcised] group and 67 couples in the control group ... 17 (18%) women in the intervention group and eight (12%) women in the control group acquired HIV during follow-up (p=0??36)." But having failed to find any benefit, they cut the trial short "for futility" before any ill-effect of circumcision could be confirmed. Circumcision has been a "cure" in search of a disease, an intervention looking for an excuse, for generations, and people are much too ready to think that whatever the question, circumcision must be the answer.
You're right Starman 1695. The virus is passed through body fluids such as semenial fluids in ejaculate. A circumcised man ejaculates just as an uncircumcised man does so the virus is passed completely unaffected by the presence or absence of a foreskin. It simply makes no sense! That is what the promoters are doing, giving senseless information that is devoid of reason and logic.
starman1695- Good question. Here's how researchers think circumcision could affect a man's risk of contracting HIV: Most of our skin is covered in a thin layer of protective keratin, that's also the material that makes up our hair and fingernails. But on the inner surface of the foreskin, this keratin layer is very thin. Foreskin also contains a high concentration of Langerhans cells, which are HIV's main targets for transmission. So, foreskin provides the virus easy access to a big group of its favorite cells, without much keratin protecting them. Secondly, the moistness area under the foreskin has a higher concentration of microbes, which stimulates an immune response that brings HIV's target immune cells closer to the surface. And third, by trapping the fluids from a sexual partner, foreskin lengthens that amount of time that potentially infectious fluid remains in contact with a man's skin.
Generations of near-universal circumcision has delivered the U.S. the highest rates of HIV/AIDS in the developed world. What's going on the the 'circumcision business is scientific, medical and financial fraud. http://blog.practicalethics.ox.ac.uk/2012/05/when-bad-science-kills-or-how-to-spread-aids/
The problem with your logic and reasoning is that the langerhans cells secrete an enzyme called "Langerin." Langerin has been shown to be highly effective at attacking the HiV virus. The foreskin also secretes an enzyme called lysozime that is the body's second line of defense. Circumcision negates these defenses.. The lips also have high concentrations of langerhans cells. Should we cut off baby's lips to protect them from HIV? If not, why not? And, should we be cutting off genital parts trying to achieve the results? The moistness is also present on the female genitalia. Should the labia be excised to make the woman less susceptible? If not, why not? Make a strong case if you can. By the way, the keratin you speak of also deeply buries the nerve endings and has a negative effect on the man's sexuality. Is this an acceptable trade-off for all men? Should the men not have any say in this? The HIV virus is extremely fragile. Just a few moments exposure to the environment will kill it. Why would just a soap and water clean up after sex not be a better solution?
Scientists at the Pharmaceutical companies have been working on a vaccination/treatment for HIV for more than 30 years. They've had some near misses. There were some that actually got to the clinical trial stage and even though they failed, they did provide significant protection while not meeting the bar. With each of these "near misses," they learn a little bit more about the virus and what it will take to defeat it. They will increasingly become more and more aware of the correct formulation for a vaccine to defeat it. The proponents of circumcision have tried to characterize it as a vaccine but it fails this miserably. With an 80% circumcision rate among sexually active adults in The US, the US also has the highest HIV rate in the industrialized world. It simply does not work as promised. Do a bit of calculation and see the expected outcome of an intervention with 60% plus efficacy. When the vaccine against polio was introduced, it only had a 70% efficacy rate but wiped out polio in a single generation. Now, HIV is much harder to transmit than polio, much harder. HIV has to be transmitted via intimate contact. Polio could be transmitted simply by being in the same room with an infected person or touching a contaminated object. HIV can not be transmitted this way. If circumcision had the claimed efficacy, there would be no HIV in The US. It would be constantly running into roadblocks and would soon die out.