Rwanda is introducing a new tool in the fight against HIV/AIDS: an innovative device that makes male circumcision safer and more efficient. If adopted on a large scale, it has the potential to sharply decrease the number of new HIV cases.
There is a war against HIV infection and AIDS. This instant blood test reveals the winners and losers. For these teenagers, it's good news - the line in the top box means they're not infected. But the even better news is that they can reduce their chances of ever becoming HIV positive by taking one simple step, a step that could save millions of lives around the world. Circumcision.
DR. AGNES BINAGWAHO [Permanent Secretary, Ministry of Health, Rwanda]
Circumcision is the most efficient tool to fight HIV/AIDS. When you are circumcised, you have a 60 percent decrease in the risk to be infected against somebody who is not circumcised when you have risky sex.
This large protective effect was demonstrated by three clinical trials in Sub-Saharan Africa involving 11,000 men. They showed that circumcision reduces HIV infection in heterosexual relationships. This proven effectiveness has prompted the Rwandan Minister of Health to set an ambitious goal.
DR. AGNES BINAGWAHO
Our target is to circumcise two million men, adolescent, adult and children, newborn, by the end of 2012.
But how can circumcision on this scale be achieved in countries like Rwanda, where the hospitals and professionals skilled in anesthetics and surgery are in very short supply? Tzameret Fuerst heads a company that has created Prepex, the only circumcision device ready to market which doesn't need anesthetic.
TZAMERET FUERST [CEO, PrePex]
The Prepex device has been tested in Rwanda for the past year, and the outcome of these studies is a device that can conduct adult male circumcision with no needles, no knives, no loss of blood, safe, simple, and cost-saving adult male circumcision in resource limited settings. The device works on a very simple principle. We essentially stop the flow of blood to the unwanted tissue, which is the foreskin, and the foreskin over the course of a week will dry up, become very, very dry, and then after a week you'll cut that foreskin off in the same way that you'll cut your nails.
The exposed skin becomes tougher, and acts as a stronger barrier against HIV. Jean Paul Bitega, the military surgeon in charge of the Prepex study, explains.
LT COL JEAN PAUL BITEGA [Head of Clinical Affairs, Kanumbe Military & District Hospital]
A person living without shoes, they have very hard skin. They are walking on stones every day without any wounds. So it's the same thing with the penis. Once you remove the foreskin the probability to have a wound is less.
In a country where there are only three hundred doctors for a population of ten million, Jean Pauls skills are too valuable to be used exclusively for circumcision. Prepex's simplicity means that nurses can replace the doctor after just one week of training. The first task of the nurses is to choose which of five sizes to use. Once the circumcision line is marked, fitting the device is very straightforward.
You place this ring at the base of the penis, insert this ring under the foreskin, so now the foreskin is completely covering the inner ring, bring this elastic ring right on top, and release. The foreskin is trapped under the elastic band stopping the flow of blood to the unwanted foreskin tissue.
The process may look simple, but it should only be done by trained medics. All the men receive group and individual counseling about safe sex.
Its important to remind ourselves that male circumcision is not the silver bullet. It's 60 percent, it's not 100 percent, which is why it's important that it's implemented as part of a comprehensive HIV prevention strategy.
After a week, the men return to have the device removed.
The foreskin will be safely removed using blunt edged scissors that cannot harm the glands, cannot harm the penis in any way. During the whole procedure, really the only point of pain or discomfort is when you're extracting the inner ring, which will be like removing a bandage on a wound. It will be two seconds of pain and pop it's out.
Im delighted because I didnt feel any pain. I continue to do my job normally with no problem. I am not inconvenienced at all.
Before the circumcision it was very ugly to see but now my penis is improved. It's very smart!
DR. AGNES BINAGWAHO
People leave the circumcision with a smile. Nobody does the traditional expression when you have circumcision, this doesn't happen.
An earlier study of three hundred men has proved that this method is safer, faster and cheaper than conventional surgical circumcision. And it's urgently needed.
Every 16 seconds someone dies of AIDS. So the impact is phenomenal. We're talking about roughly 4 million lives that can be saved over the next decade or so.
DR. AGNES BINAGWAHO
My dream is for Rwanda, and Africa and even the rest of the world as a whole, being more safe by having the males circumcised and have less risk to be infected by HIV.