Web Exclusive: Fighting AIDS One Person at a Time

A Conversation with Tzameret Fuerst: Co-Founder & CEO of PrePex

Hi, Tzameret! It's great to meet you. Your company has developed an incredible medical device called PrePex that is potentially going to save millions of lives. Can you explain the background?

Sure. Extensive scientific and clinical studies have shown that circumcised men in sub-Saharan African can reduce their lifetime risk of HIV infection by about 70%. Accordingly, the World Health Organization (WHO), UNAIDS, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), The Bill & Melinda Gates Foundation and the World Bank launched a five-year action framework to circumcise 20 million men by 2015, to save roughly 3.4 million lives and $16.5 billion in long-term health care costs.

The inherent challenge is that Africa does not have enough skilled providers or proper infrastructure to meet such a formidable public heath goal. Five years since launching the landmark recommendation to scale up the intervention, only 5% of the target goal has been met, that is, roughly 1 million out of the 20 million required.

So, how does PrePex help achieve this daunting public health goal?

Clearly something radical needed to happen and this is where our innovation came in. Our goal was to create a safe, simple, scalable and cost-saving technique to scale up adult-male circumcision, and for this purpose we created PrePex, an FDA cleared device for non-surgical adult male circumcision.

PrePex can be administered by low cadre nurses, in less than 5 minutes, with no injected anesthesia, no blood, no sutures and no sterile settings. It can be done anywhere, by any trained & certified provider, wearing jeans and a t-shirt. So far, over 6,000 safe procedures were conducted in clinical studies and pilots in Rwanda, Uganda, and Zimbabwe.

This sounds incredible. How does it actually work?

The best analogy is the removal of the umbilical cord—essentially we stop the flow of blood using a very special band, the foreskin tissue dries up over the course of a week, and you remove the device very simply—so it's the same concept. The procedure is virtually painless. In fact the head of UNAIDS visited Rwanda, saw this with his own eyes and called this "a revolution in HIV prevention."

As life-changing as we know it is, how do you go about convincing these 20 million men to consider PrePex as a treatment?

The strongest emphasis is on the hygiene—this is an opportunity for cleaner, healthier and more widespread prevention. Many women are encouraging their partners to be proactive and have the procedure.

Even with circumcision, you still need to practice safe sex, and still need to wear condoms. But to date, this is the most preventative measure we can take. It's the closest thing we have to a vaccine.

How has the United States been helpful?

The United States plays a critical role in the battle against AIDS.

The Obama administration announced last November that for the first time in 30 years, the U.S. government is committed to achieving an "AIDS-free generation". In the President's landmark speech, he emphasized that access to treatment, preventing mother-to-child transmission and scaling up adult-male circumcision in sub-Saharan Africa are the three important strategies to achieving this goal. Accordingly:

  • In August 2012, the New York Times announced that the Bill & Melinda Gates Foundation and the U.S. government, through its multi-billion dollar foreign aid initiative PEPFAR, will be funding pilots in the target WHO countries characterized by high HIV prevalence and low male circumcision prevalence.

  • U.S. government funds will empower sub-Saharan Africa to create a solution that is self-sufficient and self-sustainable. Rather than flying in Western surgeons to conduct surgical procedures, which is an expensive proposition, PrePex empowers African governments to leverage their existing nurses and infrastructure to scale up this lifesaving intervention without burdening their already constrained health system. For example, Rwanda has only 582 physicians to service a population of over 11 million. They need these physicians to deal with life and death situations, not to be burdened by performing circumcisions.

PrePex is a COST saving, LIFE saving intervention. When you're looking at U.S. foreign aid, it's important for U.S. tax payers to see—PrePex is not only inherently cost saving, in that the technique itself is less expensive than surgery, but it is also the only way to reach 20 million men by 2015, thereby saving 3.4 million lives and $16.5 billion dollars in long term health care costs.

The U.S. government is by far the largest donor to this effort. This is a perfect example of AIPAC's motto: Shaping Tomorrow Together.

That's great. But, given these staggering numbers, do you expect to reach your goal?

With the unwavering support of the U.S. Government and the commitment of African governments, we will achieve an AIDS FREE GENERATION.

You're a very impressive business person. And you're a woman. How do you feel being a woman in a male dominated field, dealing primarily with the male anatomy?

Thank you. As a social entrepreneur, gender makes no difference. My interest and what motivates me is the broad influence that this venture has in saving millions of lives. I keep my eye on the ball, and here the target is to reach 20 million men by 2015 to help achieve the goal we share with the United States—an AIDS free generation.

Tzameret, thank you for everything you're doing. PrePex is an incredible innovation and we're so grateful to you for taking the time to be with AIPAC at the 2013 Policy Conference!

Thank you!

Check out this BBC video about PrePex!