Prevention alert: HIV incidence can be reduced by 60%! Headlines raced around the globe with these statistics - heavy with promise for a new era in HIV prevention interventions. Not many statistics have the honor of being retained by so many, but most who heard that circumcision can reduce the risk of contracting the human immunodeficiency virus (HIV), the number, 60%, stuck in hopeful minds worldwide.
Perosnal views about circumcision aside for those for or adamantly against changing the body, one cannot argue with the protective benefit of male circumcision against HIV.
Voluntary medical male circumcision (VMMC) is not a new prevention intervention. Many randomized clinical trials have shown that removal of the foreskin reduces the risk of contracting HIV. What is new is the techniques for circumcision in resource limited areas. One must first understand surgical circumcision to understand the non-surgical innovations.
VMMC vs. Traditional Circumcision
Tribal circumcisions evoke a visceral reaction from men and women. A traditional male circumcision is a right of passage that is meant to test one's stoicism when faced with excruciating pain. The practice is not meant to be painless and the circumstances may not be hygienic.
Medical male circumcision is a procedure conducted in a clinical setting with a trained healthcare provider using (hopefully) sterilized equipment and local anesthetic. It is a procedure that involves scalpels and stitches. The pain is still a concern and a right of passage for the boys who undergo the procedure. At a voluntary circumcision of a young man in rural Kenya recently the process seemed intense yet relatively simple. The issue is recovery. It takes 7 days to recover from VMMC. This is not a long period of time, but the risk of infection and other adverse events is high. There is also an issue of sexually active men not abstaining from sexual intercourse during their recovery period. This is an issue.
Non-Surgical Circumcision
Innovators who recognized the market for a medical device geared towards making circumcision recovery times less risky in resource limited areas developed a device that removes the cutting associated with circumcision. Without cutting one does not have to worry as much about any potential lapses in sterilized surgical equipment, post-operative infections, and intercourse during recovery time. Devices such as the ShangRing or PrePex are rings that are placed in such a way to block the blood flow to the foreskin for 7 days. This essentially causes the skin to die and fall off. The rings are placed by healthcare workers trained to apply them. After 7 days the ring is removed by the healthcare worker and any excess dead skin is trimmed with scissors.
Male circumcision is a controversial topic in many societies. Many believe it to be a form of mutilation and others believe it to be an important cultural practice. In some tribes it is a mark of belonging to a certain tribe. For those that do not circumcise it is for the same reason, to be unique and consistent in tradition. Interventions that clearly are in competition with tradition are controversial. Voila! Circumcision. The evidence for the ways in which circumcision is beneficial for HIV prevention is plentiful. There is frustration about the glacial pace of VMMC implementation in areas affected by HIV/AIDS. There is limited information on how non-surgical circumcision is being received in the field, but the general sentiment is positive. The practical element seems more elusive.
Whatever one's opinion might be; the findings are interesting, the challenges for/against are fascinating, and the future is full of possibilities.
-Jasmine Buttolph, MPH
