PAPUA: Male cutting imposed

Jakarta Post
June 30, 2015

Painless circumcision method introduced to curb HIV spread

by Nethy Dharma Somba
The Papua AIDS Eradication Commission (KPAD) began to distribute 1,800 PrePex circumcision devices to residents on Monday in four regions in a bid to reduce the risk of HIV infections in the province.

The device, made of elastic rings and placed on male genitals for seven days before it is released, has been considered practical and easy to use and can provide a non-surgical, medical means to achieve adult male circumcision.

Papua KPAD secretary Constant Karma said that the 1,800 PrePex units, which were donated by the US-based Clinton Foundation through the Clinton Health Access Initiative (CHAI), would be distributed to Jayapura, Jayawijaya, Paniai and Manokwari, starting Monday.
[No mention of informed consent.  Papua is under military occupation by Indonesia and the rights of local people are severely curtailed. Is this just another example?]

“This is only the first stage. For the second phase, we will receive another 10 million PrePex units [from the foundation],” Karma said on Monday on the sidelines of a free circumcision service held to introduce PrePex use at the regional administration-run hospital RSUD Dok II Jayapura.
[The population of Papua is 3.5 million. Who are the other 8.25 million Prepexes for?]

The hospital, according to Karma, would open such a service until Friday.

In 2007, the World Health Organization and UNAIDS argued that circumcised men could reduce the risk of HIV infection by approximately 60 percent in high-risk areas.

The spread of HIV infections in Papua is alarming, according to the Papua KPAD. HIV in Papua is mainly transmitted through unsafe sexual intercourse. [And mainly from men to women, to whom male genital cutting offers no protection and may increase the risk.]
 
Unlike regular circumcision surgery, PrePex-assisted circumcision is much easier to perform. After the male genitalia is cleaned and measured, anesthesia cream is applied on the tip of it to get rid of a tingling sensation.

Then the PrePex, which is a set of two rings, one black and one white, is inserted onto the genitals according to the respective size.

The white ring is put inside the genital skin while the black one is put around the outer skin. The rings will clamp the skin, stopping the flow of blood, nerves and nutrition to the skin that will be cut off.

“As the flow of the blood, nerves and nutrition stops, the skin will automatically feel nothing so that no pain will be felt and no blood will come out,” said Suwardi, one of the hospital doctors who assisted in Monday’s circumcision service. [This is optimistic to say the least. The sensation caused by a tourniquet of any kind can be intensely painful. Pain and blood are far from the only downsides of genital cutting.]
 
After the rings are attached, patients could engage in normal activities and then return to the hospital a week later to have the dead skin cut off and the rings released, said Karma, who was also among the patients.
...

RWANDA: Boy dies, another has fistula after cutting

Inyenyeri News (Rwanda)
December 18, 2014

Rwanda: Families blame Circumcision for [Sickness and] Death of Children

by Venuste Mfitmana
Two families in Burera District whose children developed medical complications after undergoing circumcision recently have expressed their concerns over the safety of the procedure.

The parents of a six-year-old boy claim their son is suffering from urethrocutaneous fistula, an unusual developmental anomaly in children who present with an abnormal opening on the ventral aspect of the penis with a normal foreskin. [Obviously cut-and-pasted from a medical textbook. Urethrocutaneous fistula is also a known complication of circumcision.]

The medical complication came after the boy underwent circumcision during a campaign by the military that was held at Bungwe Health Centre in Burera in October.

This is likely to undermine government efforts to promote circumcision as one way of preventing HIV transmission.

The Ministry of Health launched free male circumcision programme in October 2011. However, last year, the ministry launched a national drive to “non-surgically” circumcise 700,000 boys and men aged 15 to 49 by the end of 2016.

The procedure involves using a plastic device called PrePex that comprises two rings and an elastic band that cuts off blood supply to the foreskin, which shrivels and is removed with the band after a week. [This may be knifeless, but it is still surgical.]

The boy’s parents have however alleged that the child received inadequate medical attention and poor treatment while he was suffering.

“After a few days of circumcision, our child started having complications every time he urinated, with pus coming from the wound where he was operated” the boy’s father said. “He also felt pain in his bladder, then urine started dripping through two small holes from his penis since his urinal valve (urethra) was damaged during surgery.

“When we realised that the problem was worsening and Bungwe Health Centre was no longer able to treat him, we were transferred to Butaro Hospital but they also failed to handle the problem.”

The case was later referred to Rwanda Military Hospital in Kanombe, Kigali. However, the aggrieved family claims the boy did not receive treatment at the hospital. Instead, they were advised to return to the hospital after six months.

“We believe there was carelessness in circumcising our child,” the mother added. “We are worried that our son’s condition may deteriorate in the absence of medicines and develop more complications.”

However, Dr Africa Gasana, a urological surgeon at the military hospital, who received the patient, explained to Rwanda Today why the child was not treated then.

“We gave the child six months to allow the wound to heal because we cannot operate on him when it is still fresh,” Dr Gasana said. “It is not the first time we have treated such ailment.”

On the parents’ fears of the boy developing other complications, the doctor said: “We gave them our phone number so that they can call us in case of another serious problem.

Aggrieved family
However, another aggrieved family claimed that their son died a few weeks after undergoing similar circumcision.

The boy’s father told Rwanda Today that the 19-year-old, who was circumcised using PrePex on October 13 during the same Army Week campaign at the health centre, died suddenly in unclear circumstances.

When he returned to hospital for check-up after a week, he developed medical complications on his way back home.

“On his way home, he felt tired and very sick,” the father said. “That night we took him to Manyagiro Health Centre but he was eventually transferred to Byumba Hospital where he died in the morning.
“When I asked the doctor what killed him, I was told that it was blood pressure.”

He said the boy had not suffered such an ailment before.

Cecile Mujawayezu, the nurse at Bungwe who did the pre-surgery screening on the boy, said he had no pre-existing medical condition.

“I screened the boy but I didn’t find any problem” Ms Mujawayezu said. “A medical autopsy showed he died of blood pressure; maybe he had it before, with low tension, which rose after he was circumcised for unknown reasons.” ["Blood pressure" is only a symptom. Could the boy have died of septic shock?]

However, the Ministry of Health maintains that, going by the procedures and medical examination, the cause of the death is not linked to circumcision.

“All the male procedures that have been undertaken, including outreach and campaigns, have been a success,” said Nathan Mugume, the head of Rwanda Health Communication Centre Division at the Ministry of Health. “They are done by experienced professionals.”

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.

ZIMBABWE: Men are not buying circumcision...

Men aren't buying it...

Newsday (Zimbabwe)
April 14, 2014

Low uptake of male circumcision

by Feluna Nleya
ZIMBABWE has recorded a very low uptake of the voluntary medical male circumcision (VMMC) within and the country is failing to meet targets set every year, the Ministry of Health and Child Care has said.

Speaking at a workshop hosted by the Population Services International (PSI) in Bulawayo last week, Ministry of Health and Child Care Matabeleland South provincial medical director Rudo Chikodzore said the male circumcision programme was lagging behind set targets.

“We are trying to scale up on the circumcision programme as we are working against our targets,” Chikodzore said. “We have been able to achieve only 4,8% of the target and this means we still have a long way to go.”

Last year, Zimbabwe had targeted to circumcise at least 115 000 men, but only managed to have 112 869 men go under the knife.

In 2010, the target was 20 000, but 11 123 were circumcised. In 2011, 36 742 were circumcised against a target of 60 000, while in 2012 only 20 775 against a target of 80 000.
...

She said that high male circumcision should be able to turn around the high HIV prevalence.
“We should be able to avert 42% of new HIV infections through scaling up of MC between 2011-2015. If MC is scaled up, we will be able to avert 150 000 new infections,” Chikodzore said.
  [That's very debatable:]
PSI director for VMMC Ngonidzashe Madidi attributed the low targets to men’s fears of the surgical procedure.

“Men have certain fears of the surgical procedure,” Madidi said. “Many men were shunning the programme because of it being surgical and men have the fear of injections. That is why there is a new method, the Prepex, where we use a device around the foreskin, thereby cutting blood supply to the end. The device is worn for seven days and is only used by adults of 18 years and above.”

Madidi said 161 men have undergone circumcision through the prepex method since March 31 this year.

PSI is using celebrities as brand ambassadors in order to lure more men to be circumcised. The ambassadors include Albert Nyathi who was circumcised last week, Jah Prayzah, Sulumani Chimbetu, Winky D and Fungisai Mashavave-Zvakavapano.

Earlier story

ZIMBABWE: Pain haunts circumcison poster-boy

AllAfrica.com
February 25, 2014

Zimbabwe: Circumcision Pain Haunts Jah Prayzah

by Tawanda Marwizi
Man of the moment Mukudzei Mukombe aka Jah Prayzah has revealed he is having a hard time on stage due fresh circumcision wounds.

The musician was circumcised last week but did not take a break from shows and continues with energetic dances against post-circumcision medical instructions.

Speaking at the sidelines of the 21st February Movement Gala in Marondera on Sunday the musician said he is performing for the love of his fans but he is still in pain.

"I could not abandon my shows that had already been booked and we are going on with stage work but I am in pain," said Jah Prayzah.

The musician was involved in non-surgical PrePex male circumcision and it takes up to two weeks for the initial painful stages to subside.

[All circumcision is surgical. The PrePex method crushes instead of cutting and causes significant pain.]

"I can't divulge the stage of the process is now but what I can say is I am feeling the pain but this should not stop people from getting circumcised. I am braving the pain for the love of my fans," he said.

A health expert from a local circumcision clinic however said people should not be engaged in vigorous activities before circumcision wounds heal.

"People are just encouraged not to get involved vigorous activities because the healing process might be disturbed."

Meanwhile the musician has encouraged men to get circumcised.

"People should just take the responsibility. I might be in pain for this short while but I now know I did this for my healthy safety and for the safety of my partner."