Free Essay

Hiv Prevention

In: Science

Submitted By fudgefizz
Words 1177
Pages 5
David R. Tomlinson
Resource limited area in Africa

Circumcision
Removal of the distal part of the foreskin

WWII
We first invaded north Africa
Men that were not circumcised would get balanitis and posthitis
Men with these conditions wouldn’t fight
Eisenhower said from here on out, only circumcised men could go fight
WWII is the reason why so many men in America are circumcised

Egypt 2000 BC
One of their advances was circumcision
Egyptians were some of the first epidemiologists
They removed the foreskin for health benefits
One of the hypothesis is the schistosomiasis organism that meant uncircumcised men were more easily infected

1981 first case report of HIV, which was reported to the WHO
33 million people are currently infected with HIV

HIV
Virus
Doesn’t infect red cells, but infects white cells
Infects the system that’s supposed to defend the system

AIDS
Auto immune deficiency system
Victims die of many different causes because they are susceptible to many different types of invasions
Affects adults and leaves the very young and the very old which doesn’t help stimulate the economy

HIV
Fourth leading cause of mortality world wide
Number 1 killer in SSA
2007, 12 million kids were orphaned by AIDS the numbers keep growing people need antiretroviral drugs for life and need to change the types of drugs

Uncircumcised men had a much higher rate of vascularized STDs, such as syphilis
One of the first physicians to make the connection determined that a lesion on the penis meant that there was a venue for the disease to spread
HIV was most prevalent in countries without the majority of men circumcised -> circumcision helped protect men from contracting HIV

There were three randomized trials – 2 sponsored by NIH
Orange farm in South Africa
Half of men circumcised, half are not
60% in reduction in the risk of acquiring HIV for the men who are circumcised
53% reduction in Kenya
51% reduction in Uganda
10,000 men in the study the efficacy of male circumcision was proven beyond a reasonable doubt

Benefits of circumcision
For men:
Reduces rates of Herpes Simplex Virus
Reduces genital ulcer disease
Reduces high risk HPV infection
Reduces trichomonas
Found that there was no difference between circumcised and non-circumsized men in terms of sexual function
For women:
Reduces genital ulcer disease
Reduces cervical cancer
Reduces induced labor diseases

Prevention
Behavioral intervention (wear a condom)
Limited in that there must be population growth, which requires unprotected sex
Antimicrobials
Preexposure prophylaxis
Two types of HIV vaccines
None of the above reduced HIV incidence

To date there have been 29 biomedical intervention trials, 4 have proven successful and 3 of those included circumcision

Mother-to-child transmission

Male circumcision
Theoretical models show male circumcision in SSA could prevent 5.7 million cases and reduce 3 million deaths over 20 years
Before this, there were no ways to get the disease under control

In the aids conference in 2010
Bill Clinton and bill gates provided further funds to get circumcision available to these populations
Science, politics, and money all aligned on this issue

Both adult males and kids had to get circumcised
There were high rates of complications following from botched operations
There have been complications following from very simple procedures
Necrosis among other diseases
Sometimes the tip of the penis can get amputated
Another issue arrives from the fact that the medical equipment may not be available for the developing nation, and the equipment may be contaminated with HIV

World Health Organization
Infant circumcision review
Wrote manuals on the existing devices and became experts in these devices
Improve use in the existing device and find ways to get these technologies to the developing world
Can’t have mismatched parts, and can’t have retained parts
In both providence and Nigeria, clinicians and researchers were asked to improve these devices
There is a shield to protect the penis head
There is a clamp to ensure some homeostasis
Ensures there is no bleeding
Incorporate a mechanism to fire
Incorporate a circular blade inside the device to remove the need for the scalpel
Blade is delivered by the machine not the provider
The safety lash ensures that the shield is in place
All of the contaminated parts are contained within the device, if it’s thrown on the ground it can’t be used to infect someone else
Once the blade is fired, it cannot be reused again to prevent infection
The device comes in a kit and so stays sterile
Costs $10 because its made with injection mold plastic parts
A design criteria is to make many for a low cost
This was an engineering solution for the third world

Nigeria
Large population: 129 million
9th largest population in the world more circumcision here than in the US in Nigeria, there were more births than in the US and almost all were circumcised, so it’s not just a western idea the procedure was carried out with the light of a lantern as it is likely to be used in the 3rd world there were a number of cases carried out all over Nigeria set up in assembly line fashion

Engineering Design Challenges
The design and production of the device took about 8 years
It takes a long time for medical devices to go from design to inception
The machines were designed at MIT
People needed to see the device before they would fund it
The first failure was the foreskin holder, the ring went in so easily that sometimes it slipped out, the clamp didn’t have time to secure the foreskin
The device was flipped, so the failure became the solution upside down
A shelf was added to keep the foreskin down
The blade wasn’t sharp enough
Razor blade used that was cheap and very sharp
Lever arms were failing
People were cutting the scrotum as well, the penis that the device was being used on was too small
There was a bird cage that prevented the scrotum entering the device and getting cut
The device addressed all the issues in the world that were common with mail circumcision
Everything comes in a kit that is entirely disposable that doesn’t require water or power or additional parts
Can be done with light from the window
The device is only $10 and it’s a one time solution, a HIV vaccine would be much more expensive and it attracts a lot of attention

Botswana has the worst HIV prevalence in the world
1 in 3 people has HIV the incidence of HIV was negatively correlated with the rate of circumcision has some money and can provide unrestricted HIV care to its citizens for life promotion was very important in SSA

Zimbabwe
Much larger population than Botswana mid wives were trained people were desperate for some form of HIV prevention, and so parents were very receptive to the device, they had nothing else to protect their family

Only Zimbabwe and Bostwana have been trained to use the AccuCirc, more countries are to be trained with the device
Initially you train midwives / nurses, and they train others

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