Vaginal ring for HIV prevention

African women are particularly vulnerable to contracting HIV, because they are often not in positions of power to negotiate the use of condoms while dating, within marriages, and as sex workers. This is reflected in the disproportionate rate of HIV infection amongst African women. Excuses that discourage condom use are male-centric. They include decreased pleasure, discomfort, and a perception that women who encourage condoms are unfaithful or are demonstrating a lack of trust towards their husbands.

Consequently, there is a focus by healthcare professionals on identifying alternative HIV preventative measures. Previous studies tried using the anti-retroviral tenofivir as a pre-exposure prophylaxis (PrEP) in pills and vaginal gels. Unfortunately, there was little commitment to consistent use, which is critical for preventative success. It is for this reason that the development of an anti-HIV vaginal ring should be met with excitement.

The anti-HIV vaginal ring is a flexible silicone ring, which contains the anti-retroviral dapivirine. Two clinical trials have shown that the ring reduces a woman’s chance of contracting HIV by approximately a third in women below 21; half in women between 21 and 25; and two-thirds in women above 25. The ring was prescribed for a month at a time during the trial, but the younger women were found to remove it during the course of the month. The increased protection amongst older women is due to their more responsible and consistent use.

The ring is easy to insert and it is discreet. This is important for the safety of women who may choose to use it without the knowledge of their partners. The dapivirine ring is recommended by the World Health Organization for the prevention of HIV in women. Zimbabwe was the first country to grant it regulatory approval in 2021, followed by South Africa.

Further reading: Baeten, J. M. et al. (22 February 2016) Use of a Vaginal Ring Containing Dapivirine for HIV-1 Prevention in Women, The New England Journal of Medicine. DOI: 10.1056/NEJMoa1506110