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."