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Monday, February 6, 2012

Fight Against AIDS Inspires Innovation in Male Circumcision

According to the 2010 UNAIDS Global Report on AIDS epidemic, the number of annual AIDS-related deaths worldwide is steadily declining from the peak of 2.1 million in 2004 to an estimated 1.8 in 2009.

Fundamentally, this decline reflects wider access and availability of antiretroviral (ARV) therapy. In 2011, a study funded by National Institutes of Health confirmed that treating HIV-positive people with ARV drugs reduces the risk of transmission to HIV-negative sexual partners by 96%. The effects of ARV therapy has been especially important in sub-Saharan Africa, where AIDS-related deaths have declined by 20% between 2004 and 2009.

But there is a new arsenal in the fight against HIV/AIDS. Three studies have shown that circumcising adult heterosexual men reduces the chances of infection by 60%. Circumcision works because it removes the foreskin, which has many Langerhans cells. Langerhans cells pick up viruses and present them to the immune system, which are attacked by HIV.

The goal is to circumcise 20 million men in Africa 2015. However, using conventional procedures, only about 600, 000 have been circumcised. Using conventional procedures, it takes a skilled surgeon 15 minutes to circumcise one male. Moreover, Africa is desperately short of surgeons.

At this rate it is unlikely that the 2015 goal will be met. Public health experts are now seeking ways to make the make circumcision faster, cheaper and safer. Two devices that could fit this bill have been identified. Bill and Melinda Gates Foundation is supporting the efforts of World Health Organization to evaluate PrePex and the Shang Ring.

From the initial safety studies, PrePex is clearly faster, less painful and is associated with less bleeding. More importantly, PrePex is easy to use and can be put in place and removed by a nurse with just three days of training. Experts believe that three-two nurse teams using PrePex could circumcise 400 men a day, compared to the 60 - 80 a surgeon does using the conventional procedure.

PrePex’s ultimate cost is still being negotiated with donor agencies and foundation but may range between $15 and $20.

See article by Donald G. McNeil Jr. in the New York Times

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