SOUTH AFRICA: Prepex device not suspended

Mail & Guardian (South Africa)
August 21, 2014

Department refutes political link to Israeli circumcision product approval

by Mia Malan, Amy Green
An Israeli male circumcision product has not been put on hold, says the South African health department.

The health department has denied media reports in a national newspaper last week that plans to introduce the non-surgical medical male circumcision device, PrePex, to the government’s medical male circumcision programme, have been put on hold because it’s an Israeli product.

According to the department’s medical male circumcision programme manager, Dayanund Loykissoonlal, no decision has been made yet. “The minister will make his decision on the basis of our research findings, which will be concluded in February 2015. We need to make sure that whatever device we implement in the country must be safe and effective for South Africans to use. It must do what it’s supposed to do – it must be effective for HIV prevention.”

PrePex consists of an elastic band that compresses the foreskin, restricting blood supply until the foreskin dries and can be cut off after a week of the device being administered, without stitches, bleeding or anaesthetic.

Endorsed by WHO
Trade union Cosatu has called for a boycott of Israeli products and has voiced its objection to PrePex because of its Israeli origins. But Loykissoonlal says research results, and not politics, will determine the department’s decision on whether or not to introduce the device. PrePex was the first non-surgical male circumcision device to be endorsed or ‘prequalified’ by the World Health Organisation (WHO) in May 2013.

Research has shown that medical male circumcision – the removal of the entire foreskin of the penis – can [perhaps] reduce a male’s risk of contracting HIV through heterosexual sex by [up to] 60%.
South Africa first introduced medical male circumcision in 2010, and has since circumcised 1.4-million men. The government’s national strategic plan on HIV for 2012 to 2016 aims to have medically circumcised 80% of men between 15 and 49 – or 4.3-million men – by the end of the 2015/2016 financial year.

Modelling studies published in the medical journal Plos Med in 2011 showed that if South Africa reaches this target, more than 20% of new HIV infections – or one million could be averted by 2025. According to study projections, about five medical male circumcisions are needed to prevent a single case of HIV infection. [This "modelling" is all based on a total of 73 circumcised men who did not get HIV, while 64 did, out of 5,400 circumcised in three trials.]

South Africa is however not on track with reaching this target, and, is looking at ways to speed up the programme. The introduction of a non-surgical device, in addition to surgical procedures where doctors cut off the foreskin, is one such way.

PrePex is currently being tested in eight pilot sites in Gauteng, Mpumalanga and North West to test the feasibility of introducing the device as part of its medical circumcision campaign.

“We have completed the first phase of the research, in line with WHO recommendations, looking at the pilot implementation of the device. We still have the other two phases, the passive and active surveillance, left to do. Active surveillance is putting the device out there in the actual health settings and doing about 1 000. PrePex placements on clients and following them up rigorously. And passive is looking at another 9 000.”

Earlier story

SOUTH AFRICA: Israeli circumcision device boycotted

Right action, wrong reason

Times Live (South Africa)
August 14, 2014

Circumcision clip faces chop

by Rea Khoabane and Reitumetse Pitso
The Department of Health's plan to make the male circumcision device PrePex available has been put on ice - because it is an Israeli product.

The device was to have been introduced at clinics and hospitals next year to help fast-track male circumcision, which has been shown to reduce the likelihood of a man contracting HIV.

The department has a target of 4.3 million male circumcisions by 2016.

The department's deputy director-general for medical male circumcision, Dayanund Loykissoonlal, said the launch was being affected by the conflict between Israel and Hamas in the Gaza Strip, which has led to trade union federation Cosatu calling for a boycott of Israeli products.

Loykissoonlal said that though medical male circumcision needed boosting, and PrePex was a good option, "we don't want Cosatu on our backs about this".

Cosatu spokesman Patrick Craven said the federation welcomed the department's decision to delay introducing the device.

"We're going to put pressure on businesses to prevent anything that comes from Israel being sold in this country," Craven said.

Mpho Maraisane, a director of the Aurum Institute, an HIV and TB consultancy, said the institute was involved in testing the device.

In the past two months it has run three studies in Gauteng, Mpumalanga and North West.
Eight hundred men were circumcised using the Israeli device.

Maraisane said the institute was unaware of the call for a product boycott.

The device was developed by Israeli healthcare company Circ Med Tech and has been prequalified and endorsed by the World Health Organisation.

The device consists of an elastic band that compresses [crushes] the foreskin against a rigid plastic ring.

The elastic band cuts off the blood supply to the foreskin, which loses sensation and withers[, rots - with an unpleasant smell - and dies].

The device has to be worn for a week, after which the dead foreskin is cut away by a doctor.