Emille Nzabahimana, a bar tender in Kigali, Rwanda’s capital, is obsessed with spontaneous sexual adventures and over-drinking.
To arrest the cold from the chilly winds of Kigali night, Nzabahimana takes unlimited alcohol, many a time ending up in bed with a random woman.
One day, one of his encounters, whom he had kept contact with, developed a rare facial rush. She spent a week in doors and neighbors who knew she was a sex worker, speculated she was HIV positive.
Nzabahimana learnt about it and froze. His mind convinced him he was probably a dead man already. “I was enslaved in thoughts of how I could break the news to my family,” he says.
He then decided to go for the HIV test which turned out to be negative.
Nzabahimana’s close friends advised him get circumcised. That it would reduce his chances of getting infected. But Nzabahimana was not willing to face the pain from surgical circumcision.
He was told the Rwanda Military Hospital conducts non-surgical circumcision. On arrival at the Military Hospital. The operation had just been launched. Nzabahimana was going to be among the first males to undergo a non-surgical circumcision.
Rwanda was then testing a circumcision device called ‘Prepex‘, which was later approved by the World Health Organization.
“I was a little skeptical, but the doctor re-assured me it was not going to hurt,” Nzabahimana says.
After the operation, Nzabahimana spread the word. Today, Dr. Leon Ngeruka, a Prepex expert at the military hospital, says about 200 men get circumcised per day.
Where did the Prepex come from?
It has always been Rwanda’s dream to achieve an AIDS free generation and Prepex came in handy.
In collaboration with Rwanda, Circ MedTech, an Israel firm, developed the Prepex device which the two partners believed would help roll out male circumcision to minimize HIV spread in Rwanda and possibly in Sub-Saharan Africa.
In 2011, Rwanda successfully tested the device. The Ministry of Health chose to partner with the military hospital because of its expertise in surgical operations.
The Ministry of Health chose to partner with the military hospital because of its expertise in surgical operations.
“Because we offer advanced clinical services, that surpass general surgeries to internal medicine and emergencies, the ministry was convinced we would start off well with the Prepex adventure,” says Dr Leon Ngeruka, Prepex Master at the Rwanda Military Hospital.
“We started with only 5 people, who we admitted to the hospital for monitoring,” says Dr. Jean Paul Bitega, another Prepex expert at the hospital.
The number rose to 50, then to 500 and in twelve months, the number had hit 10,000.
In 2013, Rwanda launched a nationwide campaign, targeting to circumcise over 700,000 men by 2016.
How does the device work?
According to Doctor Leon Ngeruka, the Prepex is a device composed of elastic rings. During the operation, a doctor needs no injections or cutting. There is no need for anesthesia too.
The operations take three minutes compared to 30 minutes of the surgical method which also requires a complete theater and at least a doctor. Prepex operation requires only a clean room and a nurse.
After 7 days, the device is removed and doctors bloodlessly cut off the dry fore skin with scissors.
A study conducted by the Rwanda Military Hospital, which awaits WHO’s approval, says male babies can have the ring placed at birth. Out of 100 males only 7 may not be eligible to use the device.
Taking Prepex to the villages
Hundreds of medics in all health centers in Rwanda have been trained how to operate the device, says Dr. Placidie Mugwaneza, Director of HIV Prevention Unit/HIV Division at Rwanda Biomedical Centre.
Over 180 medics, including doctors and nurses at district hospitals have been trained how to operate a Prepex.
The trainings include practical sessions. This approach has seen hundreds of men in the villages circumcised.
The success of the device in Rwanda is attracting other countries. Several doctors have traveled to Rwanda to learn about the device and how it functions.
“International trainings range from 3 days to two weeks,” says Dr. Leon Ngeruka.
Uganda, Kenya, Tanzania, Malawi, Mozambique, Zambia, Zimbabwe, Swaziland, South Africa, Lesotho, Indonesia and Botswana have sent medics to Rwanda for training and have successfully initiated the program.
South Africa has discussed the use of the device after hundreds of young males reportedly died in botched initiation ceremonies where surgical circumcision is poorly done.
According to WHO, HIV/Aids has killed about 40 million people since 1981, with 2/3 of the deaths reported in Sub-Saharan Africa, where about 25 million live with the virus today.
Rwanda, which is among the countries in Sub-Saharan region, has about 3% of its population living with the virus.
Numerically, this is one of the lowest, but Rwanda says it wants to achieve an Aids-free generation. And the question has been, how?
In 2007 WHO said male circumcision could reduce the risk of catching HIV by approximately 60%. Eventually, Prepex was the best approach.
Despite the project being effective, Dr. Bitega says it is too costly considering Rwanda is a developing country and offering such a service at no cost is a huge task for the government to undertake.
The industrial cost for one ring is about $20. Rwanda is currently negotiating a lower price to at least $12. If successful, more men will be circumcised.
Meanwhile, Nzabahimana is happy to have been circumcised; however, this has not taken away the fear of catching the HIV virus.
By: Lilian Gahima