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The Acceptability and Safety of the Shang Ring for Adult Male Circumcision in Rakai, Uganda

Kigozi, Godfrey MB, ChB, MPH*; Musoke, Richard MHS*; Watya, Stephen MB, ChB, MMed*,†; Kighoma, Nehemiah BA*; Ssebbowa, Paschal MB, ChB*; Serwadda, David MB ChB, MMed, MPH*,‡; Nalugoda, Fred MHS*; Makumbi, Frederick MHS, PhD*,‡; Li, Philip MD§; Lee, Richard MD, MBA§; Goldstein, Marc MD§; Wawer, Maria MD, MSH*,‖; Sewankambo, Nelson MB, ChB, MMed, MSc*,¶; Gray, Ronald H. MD, MSc*,‖

JAIDS Journal of Acquired Immune Deficiency Syndromes: August 15th, 2013 - Volume 63 - Issue 5 - p 617–621
doi: 10.1097/QAI.0b013e3182968dda
Epidemiology and Prevention

Objectives: Medical male circumcision (MMC) is recommended for HIV prevention in men. We assessed the acceptability and safety of the Shang Ring device compared with those of the dorsal slit method.

Methods: HIV-negative, uncircumcised men aged 18 years or older who requested free MMC services in rural Rakai, Uganda, were informed about the Shang Ring and dorsal slit procedures and offered a free choice of procedure. Men were followed at 7 days postoperatively to assess adverse events related to surgery and to remove the Shang Ring. Wound healing was assessed at 4 weeks postoperatively.

Results: Six hundred twenty-one men were enrolled, of whom 508 (81.8%) chose the Shang Ring and 113 the dorsal slit. The Shang Ring was provided to 504 men, among whom there were 4 failures of Ring placement (0.8%) that required surgical hemostasis and wound closure. Five hundred men received the Shang Ring and postoperative surgery–related moderate adverse events were 1.0%, compared with 0.8% among dorsal slit recipients. Complete wound healing at 4 weeks was 84% with the Ring and 100% with the dorsal slit (P < 0001). Resumption of intercourse before 4 weeks was 7.0% with the Ring and 15.0% with the dorsal slit (P = 0.01.) The mean time for surgery was 6.1 minutes with the Ring and 17.7 minutes with the dorsal slit. The mean time for Ring removal was 2.2 minutes.

Conclusions: The Shang Ring is highly acceptable and safe in this setting, and could improve the efficiency of MMC services. However, back-up surgical services are needed in cases of Ring placement failures.

*Rakai Health Sciences Program, Entebbe, Uganda;

Department of Urology, Mulago Hospital, Kampala, Uganda;

School of Public Health, Makerere University, Kampala, Uganda;

§Department of Urology, Weill Cornell Medical College, Cornell University, New York, NY;

Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; and

College of Health Sciences, Makerere University, Kampala, Uganda.

Correspondence to: Ronald H. Gray, MD, MSc, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 627 N Washington Street, Baltimore, MD 21205 (e-mail:

Supported by grant UO1 AI075115-0451 from the Division of AIDS, National Institutes of Allergy and Infectious Diseases, National Institutes of Health.

The authors have no conflicts of interest to disclose.

Received October 25, 2012

Accepted February 18, 2013

© 2013 by Lippincott Williams & Wilkins