2012-05-25

Co.Exist

How This Virtually Painless Adult Circumcision Device Could Prevent HIV In The Developing World

Circumcision drastically reduces the chances of contracting the deadly virus. Instead of asking men to submit to painful surgery (ouch!), a new device is generating huge demand in Africa for the simple and painless way it gets the job done.

Circumcision can reduce HIV risk in men by up to 60%. In 2009, there were 22.5 million cases of HIV in Sub-Saharan Africa. There are, in other words, a lot of people in Africa who could benefit from circumcision. And while the World Health Organization and UNAIDS have a goal of circumcising 20 million African men by 2015, only 5% of the target has been met thus far. It’s just not feasible to surgically circumcise 19 million adult men in three years; many African countries are short on surgeons, and the surgery isn’t all that cheap. Plus there is the added challenge of convincing men to have surgeries on their most sensitive of regions.

PrePex, a non-surgical adult male circumcision device that was invented in 2009, might be the one thing that could help Africa reach that 20 million mark. The device requires no injected anestesia, no sutures, no sterile settings, no hospitals, no physicians, and it’s completely bloodless. A well-trained nurse needs to attach it, but the whole procedure can be conducted in under five minutes. It takes a few minutes to attach, the patient leaves, returns in a week, and then it takes just another few minutes to remove (along with foreskin). The process is virtually painless, with just two to five seconds of mild discomfort when the device is detached—think about how a bandaid hurts for a few seconds when it’s ripped off.

The key to the device, which has proven to be significantly safer than surgical circumcision, is in its simplicity. A ring compresses the foreskin, stopping the flow of blood. The foreskin dies in a matter of hours, and it can safely be removed within a week. It’s much like the way umbilical cords are removed from newborns: The cord is clamped to stop circulation, and in a few days it dries up, turns black, and falls off.

"Henry Ford had a quote in the 1930s: 'If I ask my customers what they want, they would say they want faster horses.' The analogy here is that public health officials were struggling to scale up surgical procedures. They were looking for faster, easier ways to conduct surgery. No one really saw that you can create a non-surgical [circumcision] procedure," explains Tzameret Fuerst, CEO of Circ MedTech, the company behind PrePex.

Indeed, potential competitors like the Shang Ring —a two-ring clamp—require surgery.

Last month, 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 UNFPA has already seen 500 circumcisions performed. People have been literally lining up to participate in PrePex studies. At one point in the Rwanda study, organizers had to conduct a lottery to decide who could participate.

Fuerst declines to provide an exact price for the PrePex (it’s currently under negotiations with government officials), but she says that "the highest possible cost is still roughly half the cost of surgery."

PrePex is FDA cleared and CE Mark certified—meaning Circ MedTech could market this device tomorrow in the U.S. and EU if it wanted to—but for now, the company plans to focus on developing countries. "We are laser focused on an imminent burning need," says Fuerst. "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."

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48 Comments

  • concerned cynic

    There is no such thing as nonsurgical removal of the foreskin.
    I do not believe that this device is painless, or free of the risk of infections or accidents impairing future sexual pleasure and functionality.

    Most of all, circumcision is only claimed to make it harder for a clean man to catch HIV from an infected woman. There is some evidence, very much downplayed to be sure, that suggests that clean women are MORE likely to catch HIV from an infected circumcised man.

    The African clinical trials that are the basis for the claim that "circumcision greatly reduces the risk of catching HIV" are a scientific scandal, wishful thinking mascarading as science. See the article by Boyle and Hill in the December 2011 issue of the Journal of Law and Medicine. A fundamental problem is that the trials were cut short after 12-18 months. Hence we have no way of assessing the possibility of risk compensation, or of knowing whether all circumcision does is delay the inevitable. The trials should have been allowed to run at least 5 years, better 10. Hypothesis: the fraction of treatments and controls who are HIV+ tends to converge over time.

  • Guest

    Actually, umbilical cords aren't clamped to stop circulation. Umbilical circulation stops all by itself (which is how most mammals, and even most humans, without manage without clamps).

    There are cases in which you need to clamp and cut the cord urgently, and there are gung-ho obstetricians who clamp because they don't have five or ten minutes to wait, but these cases don't represent what the umbilical cord needs under normal circumstances.

    Normally you just wait until it stops pulsing, and then you can cut when you're ready. No clamp needed. The baby loses no significant blood volume this way (though the placenta might).

    Better analogies might be rubber rings for removing hemorrhoids or the tails and testicles of puppies and sheep.

  • Robert Stavros

    Some people come to the table with all kinds of prejudices. There seems to be lots of evidence that
    Circumcision does help prevent aids. Why would anyone want to deny people even a modicum of protection from HIV./AIDS? Being hard over one way or the other on Circumcision would be laughable if it weren't so sad. And to accuse the author of "selling out" to a perceived ancestral bias is absurd. I found nothing in the article that would substantiate such an attack and does a lot to diminish any arguments against Circumcision. To me it is a personal preference, and especially adult Circumcision, so whats the gripe? If this method proves to greatly reduce the pain from the process and risk of gangrene than allow people to make their own choice! Not your almost religious phobia of what other people might do with their own penises. Sex has now moved out of the closet and people are free, for now, to make their own choices regarding who the have sex with, how they have sex or if they want to tattoo or pierce their sexual organs. My main comment is, grow up and get over yourself and stop trying to get into other people's business. You don't want to be Circumcised, then don't be. If you do, then do it. And yes, as in most things, parents have the right to decide for their children. But this isn't about infant circumcision, its about adult circumcision and people's right to choose for themselves.

  • Ohara30075

    Robert
    Stavros wrote:  “There seems to be lots of evidence that Circumcision does help prevent
    aids.”

    Not really.  Probably what you have seen is the same
    research hawked in the media over and over again, well past the time it was
    newsworthy.

    “arguments against Circumcision”

    The arguments against circumcision
    easily stand on their own two feet.

    “You don't want to be Circumcised, then don't be.”

    It wasn’t an option for most of us.  We were
    given no say in the matter even though it was our body.  Maybe it’s that we didn’t have the opportunity to experience it that it has become so valuable to
    us.  As we look down every day, we see
    evidence of theft and we wonder.

    “parents have the right to decide for their children”

    I’ve seen this over
    and over again but no one has ever been able to tell me where this is codified
    in law.  Can you?  If it is not codified in law, the “right” does not exist.

    Moreover, if the right does exist,
    why is the only part of the body the parents have this domain over the male
    prepuce?  Why not any other body
    part?  Why not the female parts of
    daughters?  Isn’t that sexist?

  • Robert Stavros

    Talk about people with agendas ...

    Adult male circumcision, in which the foreskin of the penis is
    surgically removed, has emerged as one of the more powerful reducers of
    infection risk. Some studies are finding that it decreases the odds that
    a heterosexual man will contract HIV by 57 percent or more. ... Nature http://www.nature.com/news/can...

  • Guest

    Circumcision does very little in comparison with using a condom, or being more selective about partners. With correct condom use, the odds are already tiny. When your partner doesn't have HIV, the probability is already zero. What good is a 57 per cent reduction of zero?

    Whether a population can have access to condoms, education and free, informed choice of sexual partners are important factors often disregarded by people pushing for circumcision on infection probability grounds.

    In contexts suffering extreme poverty, violent crime and poor education, or an existing high prevalence of HIV, circumcision as public health policy makes fairly good sense.

    But in other contexts, well, talk about people with agendas...

  • Michael Intactivist

    Typically the manufacturers of this devil's devices never tell people that it also can cause Gangrene when things go wrong leading to the amputation of the whole penis and in some cases even death.  

  • Michael Intactivist

    I first thought this article is about the Guillotine as seen on the header. In fact that would reduce the spread of STDs when used on adult males 100% but I think every man would prefer condoms which are almost just as effective and make it possible to still perceive pleasure. This device as seen on this header can however prevent the spread of a penis skin destroying virus known as "Circumciser" if used properly.
     
    The device is also effective in eliminating bacteria that is just as bad as the flesh eating CV (Circumciser Virus). The hostile bacteria are called CT/MDM (Child Torture/Mutilation Device Manufacturer) and it is also effective on eliminating dirt that carries, enables and promotes the C Virus and the CT/MDM bacteria that first gets into parents' ears and eyes which makes them deaf and blind so the C virus and the CT/MDM bacteria can reach and destroy their children’s protective, functional and most pleasurable part of their genitals.

  • Faris Salleh

    I failed to see why there is heated objection to this device.  The device reduces infection by not requiring exposure of the human blood to possible HIV exposed medical equipment.  In many countries in Africa, the population is of the Islamic faith.  Circumcision is something that is encouraged.  In some sects it is required.  In children circumcision reduces infection of the urine tract.  This devices helps those of the faith to reduce exposure to possible infection.

    If one was to co exist with others, one must accept difference in their belief system.  That's the underlying tone in this article.  Apparently the WHO has accepted it as something that the community in Africa requires.

    This article is clear to the unprejudiced.  So what if she was Jewish?  She shares and I thank her for that.  If she would accept thanks from a Muslim brother.

  • Kitty Tiger

    I didn't say anything about your agenda. I just pointed out that you got defensive when someone accused you of being Jewish. Whether you are or you aren't isn't so much the issue as shoddy journalism, thats something that you can't deny

  • Ariel Schwartz

    I suggest you read the original comment I was responding to, which suggested that I might have some nonsense agenda because of my name. I could care less whether you or anyone else thinks I'm Jewish, Muslim, Christian, or the Flying Spaghetti Monster himself. 

  • Kitty Tiger

    Ariel, to assume that you are Jewish is not racist.... I bet you're really regretting writing this article. I think your credibility as a journalist has taken a big hit. Im sorry that you made the mistake to write about something that is so easily discredited and most people find laughable. Circumcision doesn't prevent AIDS or HIV in any way.  It is a false crutch that will actually lead to a greater spread of HIV, as men get circumcised and are led to believe they are immune, they will then go on to practice risky sexual behaviors and end up dead with a whole fleet of women that they have infected with their "improved" penis. 

  • Ariel Schwartz

    No, but to assume that I have an "agenda" because of my name is. I don't regret writing this. Thanks.

  • Ohara30075

    Ariel Schwartz wrote:   I'm sorry that you don't like what I wrote.”

    It is beside the point whether
    someone likes what you wrote or not.  The
    point is that it be accurate and does not involve advocating for something.

    Imagine this:  What would you think if I wrote a piece
    explaining a new device that made female circumcision bloodless and painless? That
    it could cut the incidence of cervical cancer by 60%?  And the goal was to circumcise 80 million
    American women in the next 5 years?  What
    if I wrote that attaching this miraculous device only took moments and was
    completely bloodless, painless and without adverse effects and complications?

    What if I compared this miraculous
    device to a band-Aid?  What if I wrote it
    could be attached in only a few minutes?

    What if I wrote that the labia
    would simply turn black and fall off? 
    What if I used a tactic called “appeal of authority”quoting famous people as to the effectiveness and efficiency of the device
    as you have?

    What if I were using scare tactics
    to convince the reader this was a good idea? 
    Research has shown that circumcised females are at less risk of
    contracting HIV.

    Finally, what if I were Muslim and
    making these comments?  I assume you are
    Jewish from the name.  Would you think I
    had an agenda?

    I am sure you would not like me
    writing those things but you are writing the same kind of things and want them
    to stand unchallenged.

    You see, I am a victim of what you
    are advocating for and it has had a detrimental effect on me just as female
    circumcision has detrimental effects on women. 
    Of course, I don’t like it!

  • Ohara30075

    Ariel Schwartz wrote"    "Be careful when you start making assumptions about someone's race/religion/culture. I never asked what I wrote to stand unchallenged. But I also won't respond to racism."

    Yes, I did make an assumption.  I'm guilty but we observe and from those assumptions, we make judgments.  It is a defensive measure.  If I saw a heavily tattooed man with long hair, boots and riding a motorcycle, I would make assumptions.  That is not racism in any form.  Judiasm is not a race but a religion.

    We make these assumptions to understand people and their motives and their intents.  I understand that Jews hold the rite of circumcision as very important and accept that.  I know it can color thinking processes and reason and logic.  I make it a point to not argue with Jews on this topic if I can help it but I also will not stand silent when erroneous or misleadiing information is presented.

    I also will not try  to change Jews minds about this.  I will present well researched information and offer it up to anyone who wants to read it.  If I change their thinking, so be it.  If I don't, so be it as well.  This is something that everyone has to make their own mind up about.  Some accept truth and some don't.  I have no control over that.

  • Ariel Schwartz

    Be careful when you start making assumptions about someone's race/religion/culture. I never asked what I wrote to stand unchallenged. But I also won't respond to racism.

  • Ty Jones

    The following people need to be contacted immediately about this article:

    Editor
    Robert Safian
    editor@fastcompany.comExecutive Editors
    Noah Robischon 
    nrobischon@fastcompany.comRick Tetzeli
    tetzeli@fastcompany.comManaging Editor
    Lori Hoffman
    lhoffman@fastcompany.comDeputy EditorDavid Lidskydlidsky@fastcompany.com