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Overcoming demand barriers through PrePex

It has been six years since the PrePex device for medical male circumcision came into the fore and joined the global effort of facing one of the biggest health challenges of our times: stopping the spread of HIV and AIDS.
With innovative thinking, meticulous planning and engineering PrePex was introduced and prequalified by WHO as the only Non-Surgical male circumcision device, specifically designed to accelerate the scale-up of Voluntary Medical Male Circumcision (VMMC) programmes in countries hardest hit by the AIDS epidemic, at least up to now.
PrePex’s unique features overcome the demand barriers, which existing male circumcision methods and devices are facing, especially in low resource settings. With PrePex, as the only non-surgical alternative available, addressing all of the demand barriers to male circumcision, it is clear why so many men across Sub-Saharan Africa are opting for circumcision with the PrePex device.
I bring you a snapshot of men’s experiences from a number of countries which have gone ahead to embrace male circumcision using the PrePex device.
In Uganda: “I felt nothing, not even a little discomfort,” said Justin Igalla, a father of two in Kampala, Uganda after his circumcision with PrePex. In Zimbabwe: Male Circumcision Gone Sexy - Singer JahPrayzah got circumcised with PrePex during the successful national VMMC campaign conducted by the Zimbabwe Ministry of Health and Child Care and PSI.   In South Africa: Male circumcision becomes the “in” thing thanks to the introduction of PrePex! “I did my circumcision four weeks back using PrePex – it was painless” said 21 years old, KaraboNhlapo. In Botswana: PrePex is a Promising Game Changer attracting working men for MC thanks to its quick recovery and convenient features!  
If one looks at the Swaziland VMMC programme, a few demand barriers for men immediately come into the fore.
Some of these were highlighted by research conducted among men in Kwaluseni whichtalked of fear of pain, fear of earnings lost through off days post circumcision. Having worked in the programme for a significant period now, I can tell you that if none of these barriers are addressed, we will continue to see older men shying away from coming forward to be circumcised, irrespective of whether the barriers are real or perceived.
Note that I say some of these barriers are perceived because we hear a lot of the time men warning that we should be careful with interpreting research finding correctly. Sometimes well-meaning researchers collect date within our communities and then fail to make sense of the data they themselves collected and end up making conclusions that are really not tallying with the raw data collected.
I have heard Swazi men pointing out that the research saying the fear of pain is a barrier for male circumcision should be taken with the pinch of salt it deserves, because it wrongly implies that Swazi men are genetically made different from a Xhosa or Sotho boy who can stand strong and allow a traditional circumciser use a blunt knife to cut off his foreskins without flinching as a rite to passage in the mountains. Are we saying with medical male circumcision, the pain can be worse than in the traditional circumcising sector when all care is taken by health care providers to ensure that anaesthesia is effectively used to eliminate pain?
The obvious answer is no. So there you are, we need researchers who will not rush to writing research findings that do not make sense but we need experienced researchers who will interrogate the subject to its fullest to arrive at the correct conclusion over these issues otherwise we will confuse this nation with all sorts of messages that we develop through scratching the surface andas a result we fail to find the real barriers to men. Come to think of it, it is a known fact that whenever you set up a site for male circumcision, adolescents and young boys will run to get the service.
Are we allowing flimsy researchers to tell us that the reason the fathers of those boys are not coming forward to be circumcised is because they are mere chickens compared to their sons. For me that is not the case, we have obviously missed the point.  Real or perceived, that is the point that I am making, before I digress.
Among the real barriers in my opinion are those such as loss of income due to off days post circumcision, especially among seasonal workers. I do not care who says what, but this is a real barrier. In my opinion, this barrier cannot be mentioned in the same line as another perceived barrier that men are not circumcising because they are threatened by the six weeks abstinence period post circumcision.
A first class researcher would first try to establish the coping mechanisms around sexual intercourse between couples when there is agreed need for abstinence before labelling abstinence as a barrier for older men to circumcise. Couples would tell you that when a joint decision is taken at home that the men should go ahead to circumcise, the six weeks waiting period is not a problem at all. People go into fasting and praying for longer periods that six weeks and it becomes an insult to couples and men especially that they are implying waiting for six weeks for a just course is beyond their comprehension.
However, that said, we are grateful for global partners to consider the list of barriers that are existing for males to undergo male circumcision and efforts to address these barriers. Enter PrePex, as one innovation that goes a long way in addressing most if not all of the barriers.  With the conversional surgical approach the list of barriers include, fear of blood and adverse events; fear if the injecting procedure; fear of pain; fear of financial loss due to post procedure recovery and worry about the end result. With the introduction of the PrePex device for circumcision the following attributes of PrePex circumcision are realise, No blades; no bleeding; no sutures; low rate of adverse events; no needles because anaesthesia is achieved through use of a topical cream; minimal discomfort; no recovery time required therefore no days off work or school time; and to crown it all, a high satisfaction of the cosmetic results from circumcising using the PrePex device.
Till next time, cheers!

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