Fill HIV prevention basket
For the first time in history, the end of the HIV and Aids epidemic is within our grasp—thanks to expanding options revolutionising HIV prevention.
In recent years, we have seen remarkable advancements such as oral pre-exposure prophylaxis (Prep), which has proven highly effective when taken consistently. Long-acting injectable Prep, like cabotegravir, offers protection for months and addresses some of the challenges daily regimens present.
Promising research is underway for Prep implants and antibody infusions, which could provide even longer-lasting protection.
But today, I want to highlight the dapivirine vaginal ring, a ground-breaking addition that is discreet and does not require women to ask permission from their partners to use it.
The ring symbolises a shift towards truly empowering women in HIV prevention. It is the first long-acting, non-systemic, women-controlled HIV prevention method. Women in six African countries, including Malawi, through 30 pilot projects, can now tap into this new product.
Unfortunately, a major obstacle remains: the women and girls in the region who urgently need the products, particularly the dapivirine ring, cannot actually access them.
A young woman from Malawi wrote to me: “I do not have access to the ring, but it would help me have control of my health by giving me protection against HIV and it would give me peace of mind.”
A young Tanzanian could not access it because it is not yet approved to be used in her country. The situation is similar in Zambia.
The only way to access this product is through the pilot research projects.
Women hear about the ring and ask their healthcare providers about it, but cannot obtain it to safeguard their health.
We need to do better because HIV and Aids is a serious problem for women in sub-Saharan Africa where 82 percent of all adolescent girls and young women (ages 15-24) who acquired HIV in 2022 live, according to the United Nations. Yet, in the 19 sub-Saharan African countries with a high burden of HIV infections, less than half of the locations with high HIV incidence have dedicated HIV prevention programmes for adolescent girls and young women.
The ring can be a critical component of these services. Made of flexible silicone, it slowly releases the antiretroviral drug dapivirine in the vagina over one month. It provides long-acting prevention for women so that they could choose a method that best suited their lifestyle.
A dapivirine ring that would work for three months is also undergoing the final stages of research.
Recent research has confirmed the importance of choice. After using both the ring and oral Prep for six months each, 67 percent of the participants chose the ring, 31 percent chose oral Prep and and only two percent chose to use neither.
Simply put, we need to make sure women have better access to the ring.
I am encouraged that Botswana, Malawi, Namibia and Rwanda have provided regulatory approvals for the ring or authorisation for its use through import permits.
A South African pharmaceutical company plans to manufacture the ring locally, which would lower the cost.
It is also exciting that, at the 25th International Aids Conference, the Children Investment Fund Foundation and the Global Fund announced a $2 million initiative to purchase approximately 150 000 rings for countries supported by the Global Fund’s grants.
We need more commitments to rapid and widespread implementation of the dapivirine ring beyond the pilot projects, from policymakers, governments and global health organisations.
The success of these pilots should trigger automatic scale-up plans in each country now, especially that there is available funding.
I urge health ministries to work closely with non-governmental organisations and community organisations to develop comprehensive rollout strategies that reach beyond urban centres into rural and underserved areas.
