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AIDS Prevention Inspires Ways to Make Circumcisions Easier

Monday, January 30, 2012

The day of the assembly-line circumcision is cartoon closer.
Now that three studies accept apparent that circumcising developed heterosexual men is one of the best able “vaccines” adjoin AIDS — abbreviation the affairs of infection by 60 percent or added — accessible bloom experts are disturbing to acquisition agency to accomplish the action faster, cheaper and safer.

The ambition is to circumcise 20 actor African men by 2015, but alone about 600,000 accept had the operation appropriately far. Even a accomplished surgeon takes about 15 minutes, best African countries are badly abbreviate of surgeons, and there is no Mohels After Borders.

So donors are pinning their hopes on several accessories now actuality activated to acceleration things up.

Dr. Stefano Bertozzi, administrator of H.I.V. for the Bill and Melinda Gates Foundation, said it had its eyes on two, called PrePex and the Shang Ring, and was acknowledging efforts by the World Bloom Organization to appraise them.

Circumcision is accept to assure heterosexual men because the foreskin has abounding Langerhans cells, which aces up bacilli and “present” them to the allowed arrangement — which H.I.V. attacks.

PrePex, invented in 2009 by four Israelis afterwards one of them, a urologist, heard an address for doctors to do circumcisions in Africa, was accustomed by the Food and Drug Administration three weeks ago. The W.H.O. will accomplish a accommodation on it soon, said Mitchell Warren, an AIDS-prevention able who carefully follows the process.

From the antecedent assurance studies done so far, PrePex is acutely faster, beneath aching and added analgesic than any of its accepted rivals. And it relies on the simplest and least-threatening technology — a elastic band.

The bandage compresses the foreskin adjoin a artificial arena slipped central it; the foreskin dies aural hours for abridgement of claret and, afterwards a week, avalanche off or can be abrupt off “like a fingernail,” said Tzameret Fuerst, the company’s arch controlling officer, who compared the action to the butt of an umbilical cord’s abbreviating up and bottomward off a few canicule afterwards it is clamped.

It is done with contemporary analgesic cream, and there is usually no bleeding. And PrePex can be put in abode and removed by nurses with about three days’ training.

The rings appear in bristles sizes, A through E, Ms. Fuerst said, “and you won’t accept how high-tech the elastic bandage is.” Each admeasurement charge administer aloof abundant burden to cut off claret breeze after actuality bound abundant to account pain.

The W.H.O., Mr. Warren said, is additionally evaluating the Shang Ring, a artificial two-ring catch developed in China to amusement altitude in which the foreskin becomes so bound that it cuts off urination.

However, it requires acid off the balance foreskin above the clamp, which agency the circumciser charge inject anesthetics anon into the penis and groin, delay for them to booty effect, actualize a antiseptic surgical acreage and be accomplished in accessory surgery.

“The Shang is not as fast, but it’s faster than full-fledged surgery,” Mr. Warren said. “And it hasn’t submitted as abundant assurance data.”

In a assurance abstraction presented at an AIDS appointment aftermost month, scientists from Rwanda’s bloom admiral said they had acclimated PrePex to circumcise 590 men. Alone two had “moderate” complications; one was anchored with a distinct suture, and one appropriate a new bandage in a altered spot.

According to Dr. Jason Reed, an epidemiologist in the all-around AIDS analysis of the Centers for Disease Control and Prevention, 2 of 590, or 0.34 percent, is a tenth the archetypal aggravation amount of surgical circumcision.

None of the men became infected.

On the 10-point affliction scale, they appear on boilerplate alone about 1 back the arena was placed and alone 3 back it was removed (about the aforementioned akin of affliction acquired by erections during the anniversary they wore it).

By the end of the study, the two-nurse teams could do a action in three minutes.

By contrast, Dr. Reed said, the best surgical “assembly lines” — a convenance actuality pioneered in Africa with American aborigine abutment — can get bottomward to seven account per patient, but alone by accepting six nurses and a surgeon into a bound harmony.

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