Dagi Kimani
24 August 2008
Nairobi — WHEN RESEARCH IN KENYA, Uganda and South Africa showed that circumcision could reduce the risk of infection with HIV for men by as much as 60 per cent, the question that arose was how the procedure could be rolled out universally in poor countries in a safe and cost-effective way.
That concern underlined several serious realities on the use of the procedure as a tool to fight the spread of HIV/Aids.
The first of this is that in many poor countries, the medical infrastructure to roll out the procedure is not available. Most Aids hard-hit countries simply do not have adequate medical personnel and resources to run a national circumcision programme.
What this meant is that if the procedure was promoted as a safety measure against HIV, circumcisions could be carried out by untrained personnel in unhygienic conditions, raising the risks of infection through the sharing of surgical knives and such consumables as gloves.
Additionally, those circumcised in these circumstances would not have the benefit of counselling, which would impress upon them that the procedure was not vaccination, and that they were still susceptible to the virus if they engaged in risky behaviour, especially before healing.
Now, a new device could help health workers in poor countries surmount some of these challenges. Known as the ShangRing after its Chinese inventor, Jian-Zhong Shang, the device consists of two concentric plastic rings that sandwich the foreskin, allowing it to be cut away without suturing and with minimal bleeding.
The ShangRing is currently only available in China, although 15 patent approvals are pending in nearly 100 countries. Reproductive health experts from the New York-based Presbyterian Hospital/Weill Cornell Medical Centre led by Dr Marc Goldstein are expected to start a small field trial of the device in Nyanza, Western Kenya later, in the year in collaboration with EngenderHealth and The Population Council.
During the pilot study, local health workers who perform circumcisions will be recruited and trained in the procedure by Dr Goldstein's colleagues. The initial study will then be followed by multi-centre clinical trials that will compare the ShangRing technique to traditional circumcision methods, again in Western Kenya but also elsewhere in the region.
ACCORDING TO ITS PROPOnents, putting on the device at a clinic under local anaesthesia takes a medical worker about five minutes, compared with about 20-30 minutes for the traditional circumcision procedure that involves cutting, toiletry and suturing. Patients using the circumcision device return to the clinic for its removal after a week.
"Circumcision with this technique promises to be faster, safer and more acceptable to patients than conventional surgical circumcision methods," said a statement by Dr Marc Goldstein, who together with reproductive health specialists at the New York-based Presbyterian Hospital/Weill Cornell Medical Centre are evaluating the device.
The ShangRing has already been used to circumcise several thousand Chinese men since 2005, where preliminary reports of 1,200 patients indicate good results with minimal complications.
According to Dr Goldstein and his colleagues, a key advantage of the ShangRing is that it can be used to conduct circumcisions by even the lowest ranking medical worker, as long as they are trained on the technique.
"The beauty of this device is its simple, innovative design," said Dr Howard Kim, a colleague of Dr Goldestein and an expert in male reproductive medicine and microsurgery.
"Although many male circumcision devices are available, they have not gained widespread acceptance due to high complication rates or difficulties with surgical technique."
The use of circumcision for protection against HIV/Aids became accepted when three randomised controlled trials in Kenya, Uganda and South Africa reported a protective effect of up to 60 per cent against infection.
This success rate led the trials to be discontinued mid-stream as the researchers involved advised all uncircumcised subjects to undergo the procedure.
The World Health Organisation and the Joint United Nations Programme on HIV/Aids (UNAids) have since recommended that the procedure be adopted, together with the ABC strategy, as one of the approaches to prevent the spread of HIV.
LAST WEEK, KENYA'S PRIME Minister, Raila Odinga, added his weight to the growing campaign to have all males in Kenya circumcised as a preventative procedure against HIV, saying that the science behind the drive was beyond reproach.
Mr Odinga's statement was significant because he comes from the Luo community of Western Kenya, which traditionally does not circumcise. Senior elders from the community have resisted the adoption of the procedure.
"I agree with the research findings entirely," Raila said at a rally in Teso in western Kenya, where the local community too does not circumcise. "Communities that have not been circumcising their people should go for it, but do so in hospitals where safety is assured."
Anthropologists say that male circumcision goes as far back as ancient Egypt and has been conducted by various communities over the years for religious, cultural and socio-political reasons.
Performing the procedure for health benefits first gained prominence in the 19th century when doctors noticed lower rates of venereal diseases in circumcised men.
This period also coincided with the introduction of anaesthesia, which made the surgical procedure less painful.
Be the first to Write a Comment!
Copyright © 2008 The East African. All rights reserved. Distributed by AllAfrica Global Media (allAfrica.com). To contact the copyright holder directly for corrections — or for permission to republish or make other authorized use of this material, click here.
AllAfrica aggregates and indexes content from over 125 African news organizations, plus more than 200 other sources, who are responsible for their own reporting and views. Articles and commentaries that identify allAfrica.com as the publisher are produced or commissioned by AllAfrica.
