Vaginal ring will help women take control of their sexual health

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By Lahja Nashuuta

The fact that over half of the 35 million people living with HIV in sub-Saharan Africa are women is a sign that effective prevention tools for adolescent girls and young women in particular is critical.

Yes, efforts have been made at local, regional and global level to ensure that women are protected from sexually transmitted diseases such as HIV/AIDS and unplanned pregnancies. Among these efforts is the introduction of the female condom – Femidom.

With the introduction of Femidom, there were high hopes that it would empower women to have more control in their sexual relationships and offer better protection against sexually transmitted infections (STIs) and unwanted pregnancies but usage has remained relatively low.

Most women have openly shunned the Femidom, claiming that it is not user-friendly. They have stressed that it is difficult, especially for illiterate women to follow and understand the user instructions manual.

Some women opt not to use it because they fear it can easily burst and cause irreparable health problems in the womb. They have also alluded to the fact that female condoms are not available in rural areas.

However, the good news is that there is something good on the pipeline with potential to protect women from HIV and AIDS and that is the vaginal ring, containing an antiretroviral (ARV) drug called dapivirine.

Two clinical studies developed by the non-profit International Partnership for Microbicides (IPM) and ASPIRE point out that the monthly ring is the first long-acting HIV prevention method designed for women, who bear the greatest burden of the global HIV/AIDS epidemic.

Zeda Rosenberg, CEO of International Partnership for Microbicides, and her colleagues announced results of the clinical study on 2 600 women at the International AIDS Conference recently in Durban, South Africa. The ring was up to 70 percent effective at stopping HIV when women wore it regularly.

The ring, a silicon band that releases an experimental antiretroviral called dapivirine, was tested in South Africa, Malawi, Uganda, and Zimbabwe among 18- to 45-year-olds. The ASPIRE trial found 27 percent efficacy overall, while the second trial called ‘The Ring Study’ found a 31 percent efficacy.

She said a ring that continuously releases an experimental antiretroviral drug in the vagina safely provided a modest level of protection against HIV infection in women, the clinical trial in four sub-Saharan African countries has found. The ring reduced the risk of HIV infection by 27 percent in the study population overall and by 61 percent among women aged 25 years and older, who used the ring most consistently.

“It’s soft and flexible, about the diameter of a lime. The ring sits inside the vagina and releases anti-HIV drugs into the reproductive tract and most important it’s secretive,” Rosenberg says.

“No one knows you have it. And it doesn’t interfere with the sexual experience,” Rosenberg says. “It can help a woman control her body and her health without necessarily challenging the man.”

Rosenberg has been working on the ring for more than a decade. She finally has evidence that it works.

Rosenberg says she is now trying to get the World Health Organization to approve the ring. She hopes to have it available for all women by 2018.

In conclusion, of course I am aware of criticism that the vaginal ring is facing but ending the epidemic will require multiple prevention options that meet women’s needs and fit within the context of their lives.

Let us hope the monthly dapivirine ring will join other new innovations such as oral pre-exposure prophylaxis (PrEP), as part of a comprehensive HIV prevention package, alongside continuing development of next-generation vaginal and rectal microbicides, long-acting injectable, vaccines and other strategies.

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