A new device called the PrePex could improve the way South Africa addresses male circumcision and HIV in the future.
A session on this topic took centre stage at the sixth South African Aids Conference which is currently underway in Durban. A panel of experts reiterated the significance of HIV prevention as one of the key elements in strengthening the fight against the virus in South Africa.
Clinical trials conducted in South Africa have shown that Medical Male Circumcision (MMC) reduces the susceptibility to HIV infection in circumcised men by up to 50 to 60%. MMC is the most cost-effective preventive approach and only requires a once-off procedure.
On May 31, 2013, the World Health Organisation pre-qualified the use of a new device for the purpose of adult male circumcision for HIV prevention. The PrePex has been assessed and indeed meets international standards. This gives South Africa and other countries the green light to adopt this non-surgical device for HIV prevention purposes.
South Africa has been following the Forceps Guided method which is a surgical circumcision procedure also known as medical male circumcision (MMC). However, it is important for health authorities to continue introducing new ways to reduce the number of new infections in this country in addition to existing methods such as continued use of condoms.
The Department of Health is keen on procuring the device for the purpose of large scale procedures for males aged 18 and older. Dr Ntlotleng Mabena from the Centre for HIV/Aids Prevention Studies (CHAPS) confirms that South Africa is excited about this and is currently in negotiation for procuring the PrePex as well as funding for pilot studies across the country.
The prepex was on Tuesday demonstrated and News Research learns that a circular-in-shape device will be inserted in the foreskin and will remain there for a period of seven days. This process will gradually cut off blood supply on the foreskin and will then be removed after a week. At this stage the patient’s foreskin is dead tissue, also described as a “dried prune”. The skin will then be cut off.The department is proud to share the benefits of the PrePex and anticipates acceptability by communities for the use of this device as part of primary healthcare services. With the use of the PrePex there is no bleeding nor is there a risk of infection to the penis. The patient will then undergo secondary healing which means that the skin automatically heals itself.
It is voluntary at this stage and with no disrespect to the rituals that surround traditional male circumcision
There is very little pain and discomfort associated with the use of the PrePex. South Africa needs to circumcise 4.3 million males from 2013 to 2016. The official introduction of the PrePex to South Africa will also mean a few challenges that need to be addressed.
The Department of Health cautioned there are alarming cost implications involved. The department will need to retrain health workers on how to safely and efficiently perform male circumcision using the PrePex. There are also issues around infrastructure and the distribution once South Africa has acquired the device.
Many countries such as Rwanda, Botswana, Zambia and Zimbabwe have already adopted the use of the PrePex. Dr Thobile Mbengashe, Chief Director of HIV/Aids at the National Department of Health noted that some of the first areas where pilot studies will take place are the North West, Mpumalanga and Gauteng.
Mbengashe mentioned that the PrePex is an excellent approach to issues around circumcision however, discussions with traditional leadership is required in order to possibly introduce this device in the traditional circumcision community. “We are introducing the use of this devise with a human rights approach. We do not want to force anyone.
“It is voluntary at this stage and with no disrespect to the rituals that surround traditional male circumcision.” It remains to be seen on how South Africans will respond to the PrePex. The conference is an opportunity to explore future prospects in the treatment and prevention of HIV/Aids, particularly in South Africa, held under the theme “Building on Success: Integrating Systems”.
Based on developments on the PrePex, it promises to be an interesting and insightful week ahead. Health Minister Dr Aaron Motsoaledi will speak later on Tuesday afternoon at the official opening of the conference.