Jordanian
2013-03-22 20:51:45 UTC
In One Simple Tool, Hope for H.I.V. Prevention
By PATRICK ADAMS
Two plastic rings, a rubber band, and a thread.
PrePex, the new nonsurgical circumcision tool experts believe could revolutionize the prevention of H.I.V. and AIDS in sub-Saharan Africa, is easier to assemble than a toy you might find in a Happy Meal.
Recent studies in Rwanda indicate that the device, which induces necrosis of the foreskin by blocking its blood flow, can be used to cheaply, quickly and safely circumcise adult men in resource-limited settings — places where surgeons are scarce and where, five years after circumcision’s protective efficacy was first proved, millions of men are still in need of the procedure.
On a recent afternoon at Rwanda’s Kanombe Military Hospital, a complex of low brick buildings off a dirt road in a hilly suburb of the capital, Kigali, two nurses curtained off an examination table for a demonstration of the PrePex application process. “It’s very fast, very easy,” said one of the nurses. “I can make it in about two-and-a-half minutes.”
Across the way, half a dozen young men waited their turn in an airy, bare-walled space, while a doctor in crisp camouflage fatigues and black combat boots told them what to expect. “Most of them are not educated, so you have to explain to them the phenomenon of ischemia,” said Lt. Col. Jean Paul Bitega, the surgeon heading up Rwanda’s rollout of the device and principal investigator for the safety and efficacy study that helped Rwanda become the first and only country to secure W.H.O. approval to use it.
Since 2007, health authorities have known that circumcising adult men reduces their risk of acquiring H.I.V. through heterosexual intercourse by 60 percent or more. That landmark finding, firmly established by dozens of observational studies and three randomized controlled trials in South Africa, Uganda and Kenya, has made male circumcision the most promising method of prevention in the anti-AIDS arsenal. According to some estimates, increased circumcision coverage could prevent as many as 2 million new infections over 10 years, and save billions in treatment costs averted.
Stacks of packaged PrePex devices at Kanombe Military Hospital on the outskirts of Kigali, Rwanda, where the first clinical studies of the device were conducted in 2010.Mark Darrough Stacks of packaged PrePex devices at Kanombe Military Hospital on the outskirts of Kigali, Rwanda, where the first clinical studies of the device were conducted in 2010.
“It’s my No. 1 priority in Africa,” Dr. Stefano Bertozzi, the director of H.I.V. and tuberculosis for the Bill and Melinda Gates Foundation, told The Times in late 2011. “It’s clearly the most obvious, most cost-effective intervention we could use to dramatically change the course of H.I.V. in the near future.”
And yet, for all of its obviousness, male circumcision remains a staggeringly under-utilized tool. As of late 2011, a mere 1.3 million medical male circumcisions had been performed in sub-Saharan Africa. While that’s almost double the number for the previous year, it’s well short of the target set by the World Health Organization and the Joint United Nations Program on H.I.V./AIDS (UNAIDS): 20 million men, ages 15 to 49, by 2015.
By PATRICK ADAMS
Two plastic rings, a rubber band, and a thread.
PrePex, the new nonsurgical circumcision tool experts believe could revolutionize the prevention of H.I.V. and AIDS in sub-Saharan Africa, is easier to assemble than a toy you might find in a Happy Meal.
Recent studies in Rwanda indicate that the device, which induces necrosis of the foreskin by blocking its blood flow, can be used to cheaply, quickly and safely circumcise adult men in resource-limited settings — places where surgeons are scarce and where, five years after circumcision’s protective efficacy was first proved, millions of men are still in need of the procedure.
On a recent afternoon at Rwanda’s Kanombe Military Hospital, a complex of low brick buildings off a dirt road in a hilly suburb of the capital, Kigali, two nurses curtained off an examination table for a demonstration of the PrePex application process. “It’s very fast, very easy,” said one of the nurses. “I can make it in about two-and-a-half minutes.”
Across the way, half a dozen young men waited their turn in an airy, bare-walled space, while a doctor in crisp camouflage fatigues and black combat boots told them what to expect. “Most of them are not educated, so you have to explain to them the phenomenon of ischemia,” said Lt. Col. Jean Paul Bitega, the surgeon heading up Rwanda’s rollout of the device and principal investigator for the safety and efficacy study that helped Rwanda become the first and only country to secure W.H.O. approval to use it.
Since 2007, health authorities have known that circumcising adult men reduces their risk of acquiring H.I.V. through heterosexual intercourse by 60 percent or more. That landmark finding, firmly established by dozens of observational studies and three randomized controlled trials in South Africa, Uganda and Kenya, has made male circumcision the most promising method of prevention in the anti-AIDS arsenal. According to some estimates, increased circumcision coverage could prevent as many as 2 million new infections over 10 years, and save billions in treatment costs averted.
Stacks of packaged PrePex devices at Kanombe Military Hospital on the outskirts of Kigali, Rwanda, where the first clinical studies of the device were conducted in 2010.Mark Darrough Stacks of packaged PrePex devices at Kanombe Military Hospital on the outskirts of Kigali, Rwanda, where the first clinical studies of the device were conducted in 2010.
“It’s my No. 1 priority in Africa,” Dr. Stefano Bertozzi, the director of H.I.V. and tuberculosis for the Bill and Melinda Gates Foundation, told The Times in late 2011. “It’s clearly the most obvious, most cost-effective intervention we could use to dramatically change the course of H.I.V. in the near future.”
And yet, for all of its obviousness, male circumcision remains a staggeringly under-utilized tool. As of late 2011, a mere 1.3 million medical male circumcisions had been performed in sub-Saharan Africa. While that’s almost double the number for the previous year, it’s well short of the target set by the World Health Organization and the Joint United Nations Program on H.I.V./AIDS (UNAIDS): 20 million men, ages 15 to 49, by 2015.