Startup Nation’s Low-Tech Circumcision Technique
10/15/2013 - 20:00
Staff Writer
Tzameret Fuerst returned to Israel from New York, where she was a founder of the Dor Chadash pro-Israel advocacy organization.
Tzameret Fuerst returned to Israel from New York, where she was a founder of the Dor Chadash pro-Israel advocacy organization.

Tel Aviv — Back in her native Israel in 2009 after 11 years working in business and pro-Israel activism in New York City, Tzameret Fuerst heard about a “very early stage” medical project being developed by four young Israelis.

The group, including a urologist and a biomedical engineer, was working on a low-tech circumcision technique designed to reduce the chances of contracting AIDS and the HIV virus, and other sexually transmitted diseases among adult males. The idea, Fuerst says, followed publication of evidence that proved “the connection between the world’s oldest surgical procedure and the pandemic of our generation.”

Fuerst learned the details about PrePex, the device that the Israeli researchers had designed. It features a few disposable plastic-and-elastic rings that cut off the blood supply to the foreskin of uncircumcised adult males; it is painless and bloodless and sutureless; it does not require a physician or sterile setting; it can be done in greater numbers than traditional surgery.

“Captivated” by the idea, Fuerst joined Circ MedTech, which manufactures the device, as CEO and co-founder.

A self-described social entrepreneur, Fuerst, 42, is responsible for sales and marketing PrePex in sub-Saharan Africa, the focus of worldwide anti-HIV efforts. Several times a year she travels to “hot and dusty rural Africa,” where she meets with government leaders and health officials.

Does she find any discomfort in traditional societies among men in discussing matters of intimate male anatomy with a female?

“There’s awkwardness in the first minute or two,” she says. Then it’s all business. “People don’t see me as a woman. They see a passionate professional who cares about making a difference on a grand scale.”

According to World Health Organization statistics, about 70 per cent of the 34 million people with AIDS/HIV in the world live in sub-Saharan Africa.

In 2011, WHO, in collaboration with UNAIDS and the U.S. government, set a goal of circumcising 20 African men by 2015. That, the organizations said, would save 3.4 million lives and $16.5 billion in long-term medical costs.

Medical studies have found that circumcision reduces AIDS/HIV among men who engage in unprotected heterosexual relations, and also reduces sexually transmitted disease among their partners.

WHO earlier this year “prequalified” patent-pending PrePex, following clinical trials in Rwanda and Zimbabwe that performed circumcisions on some 9,000 men. Its approval follows earlier certification by the U.S. Food and Drug Administration and the European Union. According to a press release issued by U.S. Global AIDS, PrePex, the only-such device endorsed by WHO, “will truly help save lives.”

About a dozen other African countries have expressed interest in PrePex, and the WHO certification is expected to bring a dramatic increase in production, Fuerst says. “We have the potential to save millions of lives.”

With the help of public relations campaigns conducted in many African countries by governments among local leaders and tribal chiefs, most men, she said, have come to realize the benefits of circumcision that many health officials have long stressed.

“Three studies have shown that circumcising adult heterosexual men is one of the most effective ‘vaccines’ against AIDS – reducing the chances of infection by 60 percent or more,” The New York Times reported last year in a story about PrePex and “its current rivals."

A circumcision is believed to be effective because the foreskin contains many Langerhans cells, which are susceptible to viruses.

“The day of the assembly-line circumcision is drawing closer,” the Times story stated.

A PrePex circumcision is not a bris, Fuerst points out. It is not comparable to a ritual removal of the foreskin performed by a mohel on an 8-day-old boy. In other words, it’s not kosher for Jewish babies; it was not intended for this age group. “This is not a religious procedure.”

PrePex can be applied by nurses who receive three days of training; they can do up to 400 a day, at least five times the number of traditional circumcisions that a medical teams can perform.

“This makes it more ideal for most impoverished African countries with limited facilities and personnel to perform the procedure.” The Standard in Zimbabwe reported recently.

The device can be applied in a few minutes, using a topical antiseptic and anesthetic; it compresses the foreskin against a plastic ring slipped inside it; without blood, the foreskin dies within hours; after a week, it falls off or can be clipped off.

The man wearing the device can return to work and urinate regularly; no sex for six weeks, until healing of the area is complete.

The clinical trials found virtually no subsequent infections or other complications, Fuerst said.

Agnes Biganwaho, Rwanda’s minister of health, called PrePex “an opportunity to lay the foundation for an AIDS-free generation” in a recent Washington Post op-ed essay. “This device aligns with out national policy change, allowing for task-shifting of circumcision away from surgeons and family physicians to nurses and possibly even community health workers. Such simple solutions can be game-changers in the fight against HIV/AIDS.”

“There’s absolutely no doubt that if one can perform adult male circumcision without anesthesia, you save time, money, and it requires less expertise,” Scientific American quoted Kim Eva Dickson, senior adviser in WHO’s HIV/AIDS department, as saying.

Critics of PrePex have put forth several reservations. They say the estimated $15-$20 per-unit cost of the device, while about 30 percent less expensive than standard surgery, may be prohibitive for governments with limited financial resources when needed for millions of men. The critics question the reliability of studies that show a correlation between circumcisions and a decrease in HIV, they say any form of circumcision can give a false sense of security and lead to a greater incidence of unprotected sex.

Both claims have been rebutted by WHO, Fuerst says. “Studies show that men are in fact more likely to wear condoms after they get circumcised [with] proper counseling.”

Critics also question the openness to PrePex in societies where adult circumcisions are not common or where they are a mandatory teen initiation rite performed by tribal leaders with an — often inadequately sterilized — knife or spear.

Promoting PrePex at home “is the role of the government,” Fuerst says.

Circ MedTech startup funding came from a variety of public and private investors, but Fuerst declines to give the size of its budget or its profit figures.

Circ MedTech (, based in Herzliya, produces the PrePex device in an industrial park in the western Galilee.

GBCHealth, an organization founded by the late Richard Holbrooke, an American diplomat who served as ambassador to the United Nations, gave Circ MedTech its Technology for Health Award earlier this year.

Fuerst calls PrePex “a prime example” of the high-tech Israeli ingenuity that has brought the land the reputation of the “’start-up nation,’ using the Israeli innovative spirit to save millions of lives.”

Fuerst, who was a founder in New York City of the Dor Chadash organization that promoted Israel image and fostered relations between Israelis and American Jews, says her work with Circ MedTech is motivated by the same altruism that inspired her to become involved with pro-Israel advocacy in the diaspora.

“I was an ambassador for Israel while I was living outside of Israel,” she says. “Now I’m continuing to be an ambassador for Israel.” Everyone she meets in Africa, Fuerst says, knows that PrePex is an Israeli — i.e., a Jewish — initiative. “This is a chance to show the beautiful side of Israel.”

AIDS, Circ Medtech, Dor Chadash, FDA, Low Tech Circumcision, Medical, PrePex