RIPPLE EFFECT: The Basket of HIV Prevention Options Needs to Be Filled

 

By Yvette Raphael

MUNICH, Germany [SHIFTEMEDIA] We stand at a pivotal moment in the battle against HIV/AIDS. For the first time, the end of this devastating epidemic seems achievable, not just a hopeful dream but a tangible possibility. Thanks to revolutionary advancements in HIV prevention, our approach to tackling the virus is transforming rapidly.

Recent progress includes the development of oral pre-exposure prophylaxis (PrEP), which, when taken consistently, has proven highly effective. The emergence of long-acting injectable PrEP, such as cabotegravir, addresses some challenges associated with daily regimens by offering protection for months at a time. Additionally, promising research is underway for PrEP implants and antibody infusions that could provide even longer-lasting protection.

Today, I want to spotlight a groundbreaking advancement that is both discreet and empowers women directly: the dapivirine vaginal ring. This ring marks a significant shift towards truly empowering women in HIV prevention. It represents the first long-acting, non-systemic, women-controlled HIV prevention method. Currently, women in six African countries can access this innovative product through 30 pilot projects.

However, a critical obstacle persists: the women and girls who need the dapivirine ring the most often cannot access it. A young woman from Malawi shared her frustration: “I do not have access to the ring, but it would help me control my health by providing protection against HIV and giving me peace of mind.” Another from Tanzania said, “I have been trying to access the ring for over a year since I heard about it, but it’s not yet approved in my country.” A third woman from Zambia expressed similar concerns: “I have not tried the ring because it is not available here. But it would help me achieve my goals.”

Currently, the only way to access this product is through pilot research projects. Women hear about the ring and inquire with their healthcare providers, only to find that they cannot obtain it to protect their health. This is unacceptable, given the severity of the HIV/AIDS crisis for women in sub-Saharan Africa. According to the UN, 82% of adolescent girls and young women (ages 15-24) who acquired HIV in 2022 live in sub-Saharan Africa. Yet, in the 19 sub-Saharan African countries with high HIV infection rates, less than half of the locations with high HIV incidence have dedicated prevention programs for adolescent girls and young women.

The dapivirine ring could be a vital component of these prevention services. Made from flexible silicone, the ring slowly releases the antiretroviral drug dapivirine in the vagina over one month, offering long-acting prevention tailored to women’s lifestyles. Research is also nearing completion on a version that would last three months.

Recent studies underscore the importance of choice in prevention methods. After using both the ring and oral PrEP for six months each, 67% of participants preferred the ring, 31% chose oral PrEP, and only 2% opted for neither. This demonstrates the need for better access to the ring for women who want it.

In Eswatini, access will expand once the pilot projects conclude, and similar plans are expected for Kenya, Lesotho, South Africa, Uganda, and Zimbabwe. Encouragingly, Botswana, Malawi, Namibia, and Rwanda have provided regulatory approvals or import permits for the ring. Additionally, a South African pharmaceutical company is poised to manufacture the ring locally, which should reduce costs.

At the 25th International AIDS Conference, the Children Investment Fund Foundation (CIFF) and the Global Fund announced a $2 million initiative to purchase approximately 150,000 dapivirine vaginal rings for countries implementing the Global Fund’s grants. This funding is a step forward, but we need more commitments for rapid, widespread implementation. Policymakers, governments, and global health organizations must act decisively. The success of these pilot projects should trigger automatic scale-up plans in each country, especially with available funding.

Health ministries should collaborate closely with NGOs and community organizations to develop comprehensive rollout strategies that extend beyond urban centers to reach rural and underserved areas. While the dapivirine ring is a significant advancement, it is only one piece of the puzzle. We must ensure that a full range of prevention options is accessible to all women and girls.

Equity must be central to these efforts. It is unacceptable that African women and girls, who have contributed their bodies and time to research studies, face the greatest barriers in accessing the very interventions they helped develop. They deserve preferential access and pricing.

The time for half-measures is over. We need bold, comprehensive action to ensure every woman and girl has access to the HIV prevention options they need. Their lives and futures depend on the actions we take today.

Yvette Raphael is a co-founder and Executive Director of Advocacy for Prevention of HIV in Africa (APHA) in South Africa.