||"Makona, Edgar Dearn" [ profile ]
HIV/AIDS: Adult male circumcision – new developments
Aug 10th, 2011 - 11:12:15
Medical male circumcision has been a World Health Organization
(WHO)-endorsed HIV prevention method for more than four years, with
most countries still using relatively expensive surgical procedures
that require anaesthetic, at least a couple of health workers and a
six-week healing period. However, several new devices could
revolutionize the amount of time, labour and money involved, enabling
countries to rapidly scale up their programmes.
WHO has approved three devices the Gomco Clamp, the Mogen Clamp and
the Plastibell for infant male circumcision, but none for adult male
circumcision. In February 2011, the organization developed a framework
for the clinical evaluation of devices for adult male circumcision.
Some of the devices under investigation include:
The Shang Ring Developed in China, the Shang Ring comprises an inner
and outer ring; the foreskin is placed between them and cut off,
leaving the glans exposed during the seven-day healing period, after
which the device is removed.
Clinical trials in China have found the device to be safe, and a pilot
study in western Kenyas Homa Bay found six mild adverse events
including skin injury, oedema and mild infection when the device was
tested on 40 HIV-negative men.
Several more studies on the Shang Ring are ongoing, including in Kenya
and Uganda, on acceptability, safety and randomized controlled trials
in Kenya and Zambia comparing it to surgical procedures.
The PrePex Device - Developed in Israel, the PrePex uses two rings and
an applicator to restrict blood supply to the foreskin, which is
removed, together with the device, after seven days. This method
requires no anaesthesia.
A study of 40 men in Rwanda found one adverse event at removal of the
device and a healing time of 17 days. More studies are ongoing and
planned in Rwanda and Zimbabwe. The Rwandan government plans to scale
up male circumcision using the PrePex device.
The Tara KLamp - Developed by Gurcharan Singh in Malaysia, the Tara
KLamp has been widely used there for the circumcision of boys,
including in public sector hospitals and circumcision campaigns. The
device clamps on the foreskin so that the blood supply is cut off, and
after seven to 10 days the foreskin is supposed to fall off with the
clamp, but sometimes the clamp has to be surgically removed.
It has also been controversially promoted in Lesotho and South Africa.
In 2009, a randomized controlled trial in Orange Farm, South Africa,
found adverse events of 37 percent in the 35 men in the Tara KLamp
study, against 3.4 percent in the 34 men in the surgical arm. Men
circumcised using the KLamp also reported worse pain. The trial was
stopped early due to the unacceptably high rate of adverse events,
with the researchers noting that, given the high rates of adverse
events in this study and the low number of available studies, we
strongly caution against the use of the TK for young adults, and we
recommend careful evaluation of the procedure when performed on
Nevertheless, Zulu king Goodwill Zwelithini in 2009 endorsed the KLamp
for use in the traditional circumcision of boys in KwaZulu-Natal. It
was used in about a quarter of the 35,000 circumcisions conducted;
little data has emerged on complications. South African activist
group, the Treatment Action Campaign declined to endorse the KLamp,
stating that it was simply too risky for use on male adults and
should not be used in the public health system.
In June 2011, the South African government announced that it would not
be using the Tara KLamp as part of its official male circumcision
scale-up. According to WHO, no further clinical studies of the Tara
KLamp are planned.
ROME, 25 July 2011 (PlusNews)
[This report does not necessarily reflect the views of the United Nations]