Despite round the clock work by scientist’s the world over, decades later a cure for HIV/AIDS is still but a dream. Zimbabwe like many other African countries, has been left with trails of broken families.
In Southern Africa alone, women constitute the 60% of those infected with HIV,and are in greater need of multiple HIV prevention options since they are also mostly affected. This time news of a possible HIV infection prevention tool designed specifically for women has surfaced with possibilities of reduced infection levels. Research is currently underway to come up with a prevention method for women which is expected to lower their risk of contracting the virus.
Two large scale clinical trials were done in Africa to come up with a vaginal ring known as the Dapirivine Ring. The ring was developed by a non-profit organisation called International Partnership for Microbicides (IPM) which works to fight against HIV transmission.
The two studies known as the Ring study and ‘A Study to Prevent Infection with a Ring for Extended Use’ (ASPIRE) intended to come up with a verified HIV prevention tool for women. A Dapirivine ring is inserted into the vagina for at least 28 days where it slowly releases the Anti-Retro Viral drug (ARV) minimising the chances of HIV infection.
These studies were done to prove if indeed the vaginal ring developed by IPM could prevent HIV. In both studies, women in separate groups inserted a dummy ring known as the placebo into the vagina. This particular ring had no active ingredient being released into the vagina to allow comparison of results.
Research on the ASPIRE study was conducted in the country between 2012 and 2015 amongst HIV negative women between the ages of 18-45 and results were released in February 2016. The results confirmed that the ring was safe but more research is needed to ensure efficacy in all ages.
The ASPIRE study led by the United States National Institute of Health (NIH), funded Microbicide Trials Network (MTN) showed that the ring safely reduced the rate of infection by 27%. Results for the ring study were almost similar as they showed a 31% efficacy.
One can insert the ring on their own at home, or it can be done at the clinic. For it to be effective, it should be removed after a month once it is worn.
In both the ASIPRE and ring studies, older women (above 21) recorded higher efficacy levels as much as 61% while younger women showed little or no protection. This was attributed to low adherence levels with fears that some of them might have removed the ring during the 28-day period reducing its effectiveness (during sex, menstruation or to clean it).
A total of 1 959 women participated in the Ring Study at seven sites in South Africa and Uganda, while Zimbabwe, Malawi, Uganda enrolled 2,629 women at 15 sites in the ASPIRE study leading to a total of 4588 women participating in both studies.
The Dapirivine monthly ring works as the first protection mechanism, adapting a medical technology normally used to deliver hormones in women, to instead deliver an ARV drug for HIV prevention.
The advantages of this ring are that one can hardly feel it inside their body, which reduces the risk of discomfort. The same goes for the partner during intercourse, making it a discreet prevention tool.
And because it is easy to use, it could prove to be a product women can consistently use for their protection at any given time. This increases the acceptability chances of this product as the idea of inserting a foreign object into one’s body would require much engagement.
However, there are disadvantages associated with using the ring. Unlike other protection methods, it only protects against HIV but not unwanted pregnancy and therefore this means women have to combine contraceptives together with the ring. Studies on this ring seem to only point to the protection of HIV negative women against infection leaving the question of whether it does not protect reinfection amongst those who are HIV positive.
Dr Nyaradzayi Mgodi of the University of Zimbabwe, who was one of the lead researchers in the trials, confirmed to Voice of America Zimbabwe that indeed the ring does work as an HIV prevention method
Dr Mgodi highlighted that there was a lot of commitment during both studies on the part of the participants as well as the researchers.
While this product may have recorded positive results its success would be mainly registered through its uptake, if it is released. A lot of awareness campaigns around the country would be needed to ensure that women get the knowledge on the use of the ring. Adequate information on how it is used is critical to ensure adherence.
On the plus side, since the ring is a discreet HIV prevention method it might prove to be a better option as compared to the female condom which is still shunned by most women. Married women for instance last year recorded a 0.2 % usage of the female condom compared to the 3.3 % use of the male condom among married men in a survey carried out by the Zimbabwe National Statistics Agency. This could be attributed to the fact that women are disadvantaged when it comes to negotiating for safer sex and the choice of wearing a condom is left to men.
The female condom currently the only HIV prevention method available to sexually active women in Zimbabwe yet it is still unpopular. The idea of carrying a condom around is somewhat embarrassing for most women and attracts labelling and stereotypes. If approved, the vaginal ring however will likely put an end to that as only the woman will know she is wearing one, if there is need for her to be discreet.
Despite Zimbabwe being one of the countries with the highest usage of condoms in the world, HIV prevalence in the country is still ranked amongst the highest globally. If the ring is adopted, there will be hopes to reduce the number of HIV infections.
The Dapirivine vaginal ring is still undergoing development; research has now gone into another phase known as an open ‘label extension phase’. Hopes are high that if and when it is approved it will be affordable and available for all. This ring, if successful could greatly expedite the UNAIDS 90 -90- 90 ambitious target to end AIDS by 2030.
Main image: Vaginal ring, image taken from www.health24.com