The PrEP vaginal ring: a new way to prevent HIV

A number of African countries have approved the monthly dapivirine vaginal ring – one of a number of new PrEP products that are becoming available. Here’s what you need to know about this new HIV prevention method. 

What is the dapivirine vaginal ring? 

The dapivirine vaginal ring is made out of a flexible silicon that is easy to bend and insert. It looks a bit like a contraceptive ring. 

How does the dapivirine vaginal ring work? 

The ring is put into the vagina where it slowly releases the antiretroviral drug dapivirine to prevent HIV. After it has been inside the vagina for 28 days, it needs to be replaced by a new ring. That’s why it is often referred to as the monthly PrEP ring. 

How effective are dapivirine rings? 

A number of large-scale trials have tested the effectiveness of the dapivirine vaginal ring. Earlier studies (the Ring Study and ASPIRE) found around one-third fewer women got HIV when they used the ring (27-35%). These studies were then extended, and they found that women increased their use of the ring. This led to a risk reduction of more than 50%.  

Are they safe? 

None of the trials found any safety issues with the dapivirine vaginal ring. But some women in the trials had mild side effects like vaginal discharge or urinary tract issues (which can make it uncomfortable to pee). These symptoms usually went away in one to two weeks. 

Who are dapivirine vaginal rings for? 

PrEP rings are for women at high risk of HIV. This includes adolescent girls and young women, women who sell sex, or women whose partners have HIV (or an unknown HIV status) and are not on effective treatment.  

Because women can insert the ring themselves, they are more in control of using this form of protection than condoms, which male partners often control.  

Some women may prefer the ring to taking a daily PrEP pill for lots of reasons. It can be hard to remember to take a pill every day, and some women feel unable to do so due to HIV-related stigma or because their partners or family members don’t want them to. PrEP injections are also becoming available. But these have to be done at a clinic every other month, whereas women can get a supply of rings then use them at home. 

What does this mean for HIV prevention services where I am? 

In January 2021, the World Health Organization (WHO) conditionally recommended the dapivirine vaginal ring. WHO recommends that the ring should be offered to women at high risk of HIV, but it needs to be offered alongside other approaches to HIV prevention like condoms and reducing intimate partner violence. 

So far, Kenya, South Africa, Uganda, Zambia and Zimbabwe have approved the dapivirine vaginal ring. Other African countries have submitted applications. But in December 2021, the USA’s Food and Drug Administration (FDA) said it would be unlikely to approve the dapivirine vaginal ring.  

This decision might have an impact on low- and middle-income countries. And it might mean that the US donor PEPfAR will not fund other countries to provide the ring. All of this could affect wider roll-out and access.  

But in some African countries, advocacy is happening to convince governments to make the ring available. In a May 2022 statement, the International Community of Women Living with HIV in East Africa said: “The decision to withdraw the Ring for review by the FDA, cannot and should not affect plans to support its introduction and rollout in Africa by African Ministries of Health and funders …We need to give women more control over their health and bodies and access to a range of safe and effective options, including the Dapivirine ring, to choose from so they can decide to use what works best for them at different times of their lives.”