For long, Jacques Habimana had an itchy foreskin. A doctor advised that it could be solved by circumcision. 

But even with the message by the World Health Organisation that says male circumcision reduces the risk of heterosexually acquired HIV infection in men by about 60 per cent, Habimana was reluctant to face the surgery: he feared the knife.

However, after a year of debating, he made the ultimate decision.

According to Dr Eugene Rugira, the in-charge of HIV prevention at Rwanda Biomedical Centre (RBC), male circumcision refers to the removal of the foreskin of the penis. 

The mainstream method (surgical circumcision) involves opening up of the foreskin, which is separated from the glands. During this procedure, sedation is applied in the area around the foreskin to numb the skin.

The PrePex alternative

However, Habimana underwent the PrePex method, a nonsurgical medical male circumcision for adults as part of a comprehensive HIV prevention strategy in sub-Saharan Africa.

"The doctors used two rubber rings; one was inserted in the foreskin, and the other outside to cut off blood supply to the foreskin. The foreskin then moved off gradually and it took a week for the area to dry up,” Habimana said.

"After it dried, the rubber rings were removed. Fixing and removing the PrePex rings took less than five minutes. I only waited to heal.” 

"It is not the same now. Before I went for it, the inside of the  fore skin was itchy, and the smell a bit unpleasant. Now I am not bothered,” he adds.

Dr Rugira said this method is painless and sedation is not required. 

"You might not see a single drop of blood during fixing and removing of the rubber rings. The healing process takes seven days with the rings on, and after removing them, you will need another six weeks to heal completely,” he said.

Dr Rugira said PrePex is a single-use device, comprising of four elements: a placement, inner and elastic rings, and a verification threat.

"When placed on the penis, it stops the flow of blood and oxygen to the foreskin, killing the tissue,” he said, adding that the bloodless procedure can be done in non-sterile settings. 

Dr Leon Ngeruka, a PrePex specialist at Rwanda Military Hospital, Kanombe, said once the dead skin has been removed, one is given antibiotics for the first three days.

PrePex was pre-qualified by the World Health Organisation in May 2013, after a rigorous three-year clinical and regulatory evaluation process, which began in Rwanda.

Health experts say rapid roll-out of medical circumcision is crucial to reducing the spread of HIV/Aids.

Dr Rugira said with the PrePex, one is free to wear clothes, as it doesn’t hurt or delay the healing process.

PrePex is being viewed as an alternative for men who fear the surgical procedure because it is painless, much easier to perform, with fewer requirements needed. 

Many more people can benefit from it in a short period of time, compared to the traditional surgical method.

We carry out an average of 50 PrePex circumcisions, compared to 15 for surgical, daily,” says Dr Ngeruka.

However, PrePex is recommended for adults aged 18 and above and should not be self-performed.