Vaginal ring: The next frontier in HIV prevention

A report from the Aspire study of 2 629 women in Malawi, South Africa, Uganda and Zimbabwe presented at the 21st International Aids conference in South Africa shows that consistent users of the vaginal ring experienced 65 percent fewer infections and that women liked the product, found it easy to use and preferred it to possible alternatives such as tablets or vaginal gels.

The Aspire study evaluated the effectiveness of a vaginal ring impregnated with the anti-HIV drug dapivirine. The ring, which is similar to devices used for contraception, is designed to be worn inside the vagina for a month at a time; women can insert and remove it themselves.vaginal-ring

Results released earlier in the year showed disappointing results, but on further analysis the researchers have found higher effectiveness in women who use the ring consistently.

As part of the qualitative component of the study, the researchers interviewed 214 study participants to provide insight into women’s experience using the vaginal rings and their appreciation of the product’s qualities.The average age of women was 26, 45 percent were married, and 73 percent had completed secondary school.

Most women said the ring was felt to be simple and discreet. While some women had initial concerns about the appearance of the ring and potential side-effects, these were generally overcome through group discussion, counseling and increasing familiarity with the product. Continuing to provide this kind of support may be important if vaginal rings are rolled out.

The researchers asked some women to compare vaginal rings with other ways in which prevention drugs could be delivered—oral tablets, injections, implants, vaginal suppositories, vaginal films and vaginal gels. Women often preferred methods that were familiar to them—the vaginal rings they had been using as part of Aspire or products similar to contraceptives they knew about.

They tended to appreciate long-acting products rather than those which needed to be remembered daily or applied at the time of sex. Nonetheless, there was some anxiety about the side-effects, invasiveness and lack of reversibility of long-acting products. Such concerns in relation to vaginal rings diminished with education and through experience.

The next step is to develop the study further based on the results to improve effectiveness and adherence. n

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