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New Male Circumcision Device for HIV Prevention Studied by NewYork-Presbyterian/Weill Cornell
August 04, 2008With the recent endorsement by the World Health Organization (WHO) and scientists worldwide of adult male circumcision as an important strategy for HIV prevention, there is increased urgency to develop safe and cost-effective circumcision services. This is especially the case in Africa where HIV/AIDS continues to spread at an epidemic rate.
Studying this method are Dr. Marc Goldstein and physician-scientists at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, who are evaluating an innovative circumcision device developed in China and will initiate a study of the device in Africa in the coming months.
The device, named the ShangRing after its inventor, Mr. Jian-Zhong Shang, consists of two concentric plastic rings that sandwich the foreskin, allowing it to be cut away without suturing and with minimal bleeding. Performed in a clinic under local anesthesia, the procedure takes less than five minutes, compared with approximately 20 to 30 minutes for a traditional "free hands" circumcision that requires suturing. The patient returns in one week for device removal.
"Circumcision with this technique promises to be faster, safer and more acceptable to patients than conventional surgical circumcision methods," says Dr. Goldstein, the study's principal investigator. He is urologist and specialist in reproductive medicine at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, the Matthew P. Hardy Distinguished Professor of Reproductive Medicine and Urology at Weill Cornell Medical College, and senior scientist at The Population Council, Center for Biomedical Research, located on the campus of The Rockefeller University.
The hope is that with these advantages, circumcision will become more commonplace (currently only between 15 and 50 percent of sub-Saharan males are circumcised). Its advantages include reduced risk of a variety of sexually transmitted diseases (STDs), notably HIV.
"Circumcision is the only new HIV prevention method to demonstrate consistent efficacy in randomized controlled trials," notes co-principal investigator Dr. Philip S. Li, associate research professor of urology and reproductive medicine and director of microsurgical research and training at the Center for Male Reproductive Medicine and Microsurgery at Weill Cornell Medical College.
Three randomized controlled trials in Kenya, Uganda and South Africa reported a protective effect (up to 60 percent) of circumcision against HIV infection. The World Health Organization, the Joint United Nations Programme on HIV/AIDS (UNAIDS), and other global reproductive health organizations such as EngenderHealth have recognized circumcision as an important method to reduce HIV infection.
The ShangRing has been used to circumcise several thousand Chinese men since 2005. Preliminary reports of 1,200 patients indicate good results with minimal complications. The ShangRing, with 15 patents pending in 85 countries, is currently available only in China. FDA evaluation is under way.
"The beauty of this device is its simple, innovative design," says Dr. Howard Kim, a fellow in male reproductive medicine and microsurgery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and member of the Weill Cornell team that traveled to China to learn this new technique. "Although many male circumcision devices are available, they have not gained widespread acceptance due to high complication rates or difficulties with surgical technique."
"Even non-physician health care providers will be able to learn this procedure to safely perform circumcisions in resource-poor regions," adds Dr. Richard Lee, a chief resident in urology at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and another member of the China team.
The NewYork-Presbyterian/Weill Cornell team, in collaboration with the nonprofits EngenderHealth and The Population Council, are planning a small pilot study in Nyanza, Kenya, to test efficacy, safety and acceptability of the technique. Local health providers who perform circumcisions in a clinical setting will be recruited and trained in the procedure by the NewYork-Presbyterian/Weill Cornell team. The pilot study is expected to be followed by a multicenter clinical trial that will compare the ShangRing technique to traditional circumcision methods.
Male circumcision has been performed as far back as ancient Egypt, and the practice has continued through the ensuing centuries for religious, cultural and sociopolitical reasons. Performing circumcision for potential health benefits gained momentum in the 19th century with the advent of anesthesia and the initial epidemiological studies demonstrating lower rates of venereal diseases in circumcised men. Recent studies have shown that circumcised men are at significantly lower risk of urinary tract infections and sexually transmitted infections such as syphilis and chancroid. Additional studies point to lower risk of invasive penile carcinoma, gonorrhea and chlamydia (in female partners).
"Circumcision with this technique promises to be faster, safer and more acceptable to patients than conventional surgical circumcision methods," says Dr. Goldstein, the study's principal investigator. He is urologist and specialist in reproductive medicine at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, the Matthew P. Hardy Distinguished Professor of Reproductive Medicine and Urology at Weill Cornell Medical College, and senior scientist at The Population Council, Center for Biomedical Research, located on the campus of The Rockefeller University.
The hope is that with these advantages, circumcision will become more commonplace (currently only between 15 and 50 percent of sub-Saharan males are circumcised). Its advantages include reduced risk of a variety of sexually transmitted diseases (STDs), notably HIV.
"Circumcision is the only new HIV prevention method to demonstrate consistent efficacy in randomized controlled trials," notes co-principal investigator Dr. Philip S. Li, associate research professor of urology and reproductive medicine and director of microsurgical research and training at the Center for Male Reproductive Medicine and Microsurgery at Weill Cornell Medical College.
Three randomized controlled trials in Kenya, Uganda and South Africa reported a protective effect (up to 60 percent) of circumcision against HIV infection. The World Health Organization, the Joint United Nations Programme on HIV/AIDS (UNAIDS), and other global reproductive health organizations such as EngenderHealth have recognized circumcision as an important method to reduce HIV infection.
The ShangRing has been used to circumcise several thousand Chinese men since 2005. Preliminary reports of 1,200 patients indicate good results with minimal complications. The ShangRing, with 15 patents pending in 85 countries, is currently available only in China. FDA evaluation is under way.
"The beauty of this device is its simple, innovative design," says Dr. Howard Kim, a fellow in male reproductive medicine and microsurgery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and member of the Weill Cornell team that traveled to China to learn this new technique. "Although many male circumcision devices are available, they have not gained widespread acceptance due to high complication rates or difficulties with surgical technique."
"Even non-physician health care providers will be able to learn this procedure to safely perform circumcisions in resource-poor regions," adds Dr. Richard Lee, a chief resident in urology at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and another member of the China team.
The NewYork-Presbyterian/Weill Cornell team, in collaboration with the nonprofits EngenderHealth and The Population Council, are planning a small pilot study in Nyanza, Kenya, to test efficacy, safety and acceptability of the technique. Local health providers who perform circumcisions in a clinical setting will be recruited and trained in the procedure by the NewYork-Presbyterian/Weill Cornell team. The pilot study is expected to be followed by a multicenter clinical trial that will compare the ShangRing technique to traditional circumcision methods.
Male circumcision has been performed as far back as ancient Egypt, and the practice has continued through the ensuing centuries for religious, cultural and sociopolitical reasons. Performing circumcision for potential health benefits gained momentum in the 19th century with the advent of anesthesia and the initial epidemiological studies demonstrating lower rates of venereal diseases in circumcised men. Recent studies have shown that circumcised men are at significantly lower risk of urinary tract infections and sexually transmitted infections such as syphilis and chancroid. Additional studies point to lower risk of invasive penile carcinoma, gonorrhea and chlamydia (in female partners).
Male Circumcision Current Events and Male Circumcision News RSSCircumcision rates lower in states where Medicaid does not cover procedure
Hospitals in states where Medicaid does not pay for routine male circumcision are only about half as likely to perform the procedure, and this disparity could lead to an increased risk of HIV infection among lower-income children later in life, according to a UCLA AIDS Institute study.
Male Circumcision May Decrease Risk of HPV Infection and Cervical Cancer
Two new studies suggest that male circumcision may assist in the prevention of human papillomavirus (HPV) infection, particularly infection with the high-risk subtypes associated with cervical, penile, and other cancers.
Circumcision Reduces the Risk of HIV Infection in Heterosexual U.S. Men
A new U.S. study has found that being circumcised significantly reduced the risk of HIV infection in heterosexual African American men known to have been exposed to the virus.
Male circumcision efforts lag in Africa despite evidence of dramatic impact in preventing HIV
With millions of lives at stake over the next two decades, researchers and advocates at the AIDS 2008 Conference today called on the global health community to ramp up male circumcision to significantly reduce risk of HIV infection in Africa, and to move quickly to integrate the life-saving procedure into other comprehensive efforts to prevent transmission of the disease in the vulnerable nations of eastern and southern Africa.
Is infant male circumcision an abuse of the rights of the child?
Circumcision is one of the commonest surgical procedures performed on males. Opponents argue that infant circumcision can cause both physical and psychological harm, while recent evidence shows that circumcision is medically beneficial.
The release of new data from the HVTN 502 HIV vaccine study
The new analyses revealed today from the STEP HIV vaccine clinical trial are both disappointing and puzzling. At this time, the data offer no clear explanations as to why the vaccine showed no measurable efficacy or why among individuals with background immunity to the adenovirus vector, there were more HIV infections in the vaccinees as compared to those in the placebo group.
Male circumcision for HIV prevention and more
Three clinical trials in Africa found that adult male circumcision reduced the risk of men acquiring HIV infection from heterosexual sex by 51-60%.
Male circumcision overstated as prevention tool against AIDS
In new academic research published today in the online, open-access, peer-reviewed scientific journal PLoS ONE, male circumcision is found to be much less important as a deterrent to the global AIDS pandemic than previously thought.
Scientists, public health leaders call for coordination in HIV prevention research
HIV prevention research was responsible for the recent revelation that male circumcision can play an important role in protecting men from infection with the deadly virus.
Circumcision: A proven strategy to prevent HIV
Male circumcision significantly reduces the risk of acquiring HIV in young African men, according to a study led by University of Illinois at Chicago professor of epidemiology Robert Bailey.
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Safe, Voluntary, Informed Male Circumcision and Comprehensive HIV Prevention Programming: Guidance for Decision-makers on Human Rights, Ethical and Legal Considerations (Unaids Publication) by World Health Organization (Publisher) Throughout the world HIV prevalence is generally lower in populations that practise male circumcision than in populations where most men are uncircumcised. This has been observed over the years of the epidemic and has been confirmed by three randomized controlled trials concluded in 2005-2006. The results have led to the conclusion that male circumcisionis and effective risk-reduction measure for men and should be used in addition to other known strategies for the prevention of heterosexually acquired infection. This book provides guidance to decision makers on human rights, ethical and legal considerations that need to be addressed before planning to provide male circumcision services within the response to HIV. |
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Whose Body, Whose Rights? - Examining the Ethics and the Human Rights Issue of Infant Male Circumcision (Censored Version) In a new era of children's rights, this independently produced two-part social issue documentary compassionately explores genital mutilation of unconsenting children, euphemistically termed "circumcision." It boldly and responsibly addresses these vital issues long overdue for inner reflection and cultural self-examination: history and medical ethics, consequences of circumcision, evolving religious attitudes, legal and constitutional issues, foreskin functions, men's awareness and uncircumcision, medical conscientious objection, children's rights. Recipient of the Creative Excellence award at the 1996 U.S. International Film and Video Festival, Honorable Mention at the 1996 Philadelphia Film Festival, and Best of Festival at the First Annual Stark Video & Film Festival (1997)." (Viewer... |
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Cut: Slicing Through the Myths of Circumcision (Home Use) Directed By: Eliyahu Ungar-Sargon Also With: Eliyahu Ungar-Sargon (Producer), Eliyahu Ungar-Sargon (Writer), Pennie Ungar-Sargon (Producer) Cut is a film that traces the intellectual journey of a man struggling to come to terms with his Jewish identity in the 21st century. Through the lens of circumcision, a central and ancient Jewish ritual, Cut asks the viewer to contemplate what happens when the Jewish tradition collides with the modern values of autonomy and individuality. Using the latest in scientific research, as well as conversations with rabbis, historians, and activists, Cut asks difficult questions about male circumcision and provides a rare emotional and intellectual experience. The filmmaker offered the following statement about Cut: "My intention with this film was to educate, enlighten, entertain, and ultimately raise the level of discourse on an important, but rarely discussed topic. A large part of Cut... |
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Circumcision Song Libinza Male Singers At Bobaka (Primary Contributor) |
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Cut: Slicing Through the Myths of Circumcision (Home Use) Directed By: Eliyahu Ungar-Sargon Also With: Eliyahu Ungar-Sargon (Producer), Eliyahu Ungar-Sargon (Writer), Pennie Ungar-Sargon (Producer) |
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Male and Female Circumcision: Medical, Legal, and Ethical Considerations in Pediatric Practice by Frederick Mansfield Hodges (Author), Marilyn Fayre Milos (Author), George C. Denniston (Author) Every year around the world 13.3 million boys and 2 million girls have part or all of their external sex organs cut off. Doctors, parents, and politicians have been misled into thinking that these mutilations are beneficial, necessary and harmless. International respected experts in the fields of medicine, science, politics, law, ethics, sociology, anthropology, history and religion present the latest research, documentation and analysis of this world-wide problem, focusing on the ethical, political and legal aspects of sexual mutilation; the cost and burden to healthcare systems; the latest medical research; anatomical and function consequences; religious and cultural aspects; psychological aspects; and the world-wide campaign to end sexual mutilation. |
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Cut: Slicing Through the Myths of Circumcision (Institutional Use: University/College) Directed By: Eliyahu Ungar-Sargon Also With: Eliyahu Ungar-Sargon (Producer), Eliyahu Ungar-Sargon (Writer), Pennie Ungar-Sargon (Producer) Cut is a film that traces the intellectual journey of a man struggling to come to terms with his Jewish identity in the 21st century. Through the lens of circumcision, a central and ancient Jewish ritual, Cut asks the viewer to contemplate what happens when the Jewish tradition collides with the modern values of autonomy and individuality. Using the latest in scientific research, as well as conversations with rabbis, historians, and activists, Cut asks difficult questions about male circumcision and provides a rare emotional and intellectual experience. The filmmaker offered the following statement about Cut: "My intention with this film was to educate, enlighten, entertain, and ultimately raise the level of discourse on an important, but rarely discussed topic. A large part of Cut... |
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Male Circumcision and Initiation in Rural Africa: Autobiography, Culture and Traditions by Amadou Nouhou Diallo (Author) This book not only gives you an idea about male circumcision in rural Africa, but it also gives you a sense of the importance of oral tradition in African societies. From the tale, to the myth while passing by the proverbs and riddles and until the epic narrations, there is always a teaching to pull, a value to instill. The purpose of this book is not to represent oral tradition as the only support of African societies, but to examine the technical innovations adapted to the land and the needs of the humans through discussion and transposition. The modern pedagogue must fear the oral tradition and try to recapture strength and the wealth that it once held, to associate them to his own methods. This Book will also show you that Africa is home to innumerable tribes and ethnic and social... |
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Circumcision Song Libinza Male Singers At Bobaka (Primary Contributor) |
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Cut: Slicing Through the Myths of Circumcision (Institutional Use: Library/Non-Profits) Directed By: Eliyahu Ungar-Sargon Also With: Eliyahu Ungar-Sargon (Producer), Eliyahu Ungar-Sargon (Writer), Pennie Ungar-Sargon (Producer) |
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