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Chris Hartlove

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Ring Around the HIV

by Maryalice Yakutchik

Male circumcision is proven not only to protect men against HIV, reducing their risk up to 60 percent, but also to benefit women by cutting their risk for infections other than HIV. Still, efforts to scale up the procedure where it’s most needed have lagged.

Now, new alternatives could be the key to making male circumcision more widely available, affordable and acceptable, says Ronald Gray, MD, MSc, a professor of Epidemiology who has conducted NIH-funded trials of male circumcision for HIV prevention in rural Uganda.

Gray and his team are evaluating two devices—the Shang Ring and the PrePex—that address the major constraints thwarting progress in places ill-equipped to handle the need and demand for male circumcision.

The main components of the plastic devices are inner and outer rings that a minimally skilled health care practitioner can apply in minutes, simply by placing the foreskin between the rings. The Shang ring is applied under local anesthesia, and the foreskin removed surgically. The device remains in place and is removed after one week. The PrePex does not require anesthesia; it remains in place for a week during which the foreskin tissue dies naturally from lack of blood supply and is removed with the device. The devices cost between $15 and $20—less than half of a conventional male circumcision in rural Uganda.

“In men, circumcision reduces their HIV risk by removing target cells used by the virus, and possibly by changing the bacterial flora on the penis,” Gray explains. “If these devices work, they could greatly expand our ability to provide circumcision services, primarily in Africa.”