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Roselyne Sachiti
Features, Health & Society Editor
In a marriage, a ring is a symbol of the unbreakable bond of lifelong love and commitment between two married people.
It is said a circle has no beginning or end and a ring is therefore a symbol eternity, just the way commitment should be.
In the world of medical research, a dapivirine vaginal ring has become a symbol of hope, protection and longer life to women, both married and single especially in Sub Saharan Africa, where the HIV epidemic has hit hardest.
In this part of the world, the sad reality is that young women aged 15-24 are more than twice as likely to acquire HIV as young men.
With HIV/AIDS remaining the leading cause of death for women ages 15-44 worldwide, the monthly vaginal ring puts the power of protection into women’s hands, especially at a time Covid-19 has sparked a wave of sexual gender based violence (SGBV).
Married and single women experiencing SGBV during Covid-19 induced lockdowns usually cannot negotiate condom use and safe sex, especially in cases when males have multiple sexual partners.
In some instances where they ask their husbands and partners to use condoms for prevention of HIV and sexually transmitted infections (STIs), where there is mistrust, some of the women also face physical, financial and emotional violence.
The unbreakable bond of lifelong love and commitment between two married people usually goes under extreme stress during such times.
In January this year, the World Health Organisation (WHO) delivered news that many women were waiting for.
When the world health body recommended that the dapivirine vaginal ring (DPV-VR) may be offered as an additional prevention choice for women at substantial risk of HIV infection as part of combination prevention approaches, there was hope and anxiety as women patiently waited for country approvals and licensing.
In March 2021, WHO also released new clinical recommendations on HIV prevention which included detailed guidance for the dapivirine ring as an additional prevention choice for women at substantial risk of HIV infection as part of a combination prevention package.
Since the January and March announcements, Zimbabwean women have been following the science and anxiously wanted to hear when they would finally access the life changing intervention.
The wait is finally over, Zimbabwe becomes the first country in the world to okay use of the vaginal ring.
The Medicines Control Authority of Zimbabwe (MCAZ) this week told online publication HealthTimes that they had approved the ring and would continue monitoring it for safety purposes.
“The authority will continue to monitor the product as it is being used in Zimbabwe and relies on the public to report to their healthcare providers if they have any issues with the ring. This would help the authority to continually ensure the public are protected and have access to safe effective and good quality products,” MCAZ Projects and Public Relations Officer, Mr Shigai Gwatidzo told the online publication.
The DPV-VR, a female-initiated option to reduce the risk of HIV infection must be worn inside the vagina for a period of 28 days, after which it should be replaced by a new ring. The ring is made of silicone and is easy to bend and insert. It works by releasing the antiretroviral drug dapivirine from the ring into the vagina slowly over 28 days.
Dr Nyaradzo Mgodi, a histopathologist with vast experience conducting HIV clinical trials in women of reproductive age says as a Zimbabwean female researcher, she is thrilled by the recent development.
“This registration means that Zimbabwean women will soon have access to the first ever female-controlled, safe and efficacious method for HIV prevention.
“Besides being safe and efficacious, the ring does not interfere with sexual intercourse; nor does it disrupt the vaginal microenvironment,” she reveals.
Dr Mgodi said the monthly dapivirine ring could help fill a gap by offering Zimbabwean women a long-acting HIV prevention product that they can control and use discreetly to reduce the risk of HIV transmission during vaginal sex.
“Approval by MCAZ paves the way for ring introduction in the neighbouring countries. Drug regulatory authorities usually work together to provide a robust review process. I am sure the lessons brought in by MCAZ will assist other African drug regulatory authorities,” she adds.
However, Dr Mgodi says a lot of work still needs to be done.
“We continue gathering more safety and acceptability data in adolescent girls and young women, as well as pregnant and breast feeding women. International Partnership for Microbicides (IPM) will support the Ministry of Health and Child Care (MOHCC) and other stakeholders to incorporate the dapivirine ring into our HIV prevention policies and programs,” explains Dr Mgodi.
Welcoming the news, Anna Sango, an HIV advocate, who has been following the advocacy and developments on the ring is excited.
She says the ring is a game changer in prevention of HIV among women and girls.
“We welcome the approval for use of the dapivirine ring. Zimbabwe has been exemplary in ushering in new and innovative tools for HIV prevention.
“We hope the responsible authorities ensure equitable access for all, including marginalised women and girls,” Sango says.
She adds: “There is also much need for sensitisation of communities on this amazing prevention tool for girls and women engaging in sexual activity.”
She explains the ring is a discreet tool that empowers women and girls, adding it will contribute to lowering HIV infections among young women and girls.
“We value that there will be continued monitoring of this tool and use to keep track of its efficacy. Once again we applaud Zimbabwe for this approval and that there will be careful monitoring of use,” Sango further explains.
Zimbabwean women and other African women were among those who participated in the trials.
One of the randomised trial participants Tariro Kutadza, a TB Champion for StopTB Partnership Zimbabwe points out the ring is an empowering gadget that puts an upper hand for and used by only a woman.
“It also reduces stigma a lot after insertion, no one knows about it. Finally, HIV cannot pass to my body because of the prevention initiative of the 21st century,” she explains.
Chairperson of the Zimbabwe Women Living with HIV National Forum, Catherine Murombedzi, says the power to protect lies in the woman now.
“This is a great HIV prevention tool kit, we must now demand the MoHCC to bring the prevention kit home, and ask parent Ministry cost, it has to be affordable. It infact must be subsidised,” she notes.
She says the ring has several advantages that benefit women.
“It is light and needs no refrigeration so rural centres can have it. No one knows, only the user does. It is intact for 28 days so no need to wash even when having a menstrual cycle. It’s the key to prevention safely paddocks virus on entry point,” she emphasises.
National Aids Council (NAC) board member representing persons living with HIV, Tendayi Westerhof said she is happy that the dapivirine ring, which was long waited for by women has received approval in Zimbabwe.
“As women living with HIV, we welcome the development and hope that more women will empowered to prevent HIV and also reduce cases of gender based violence. We hope the dapivirine ring will be readily accessible, affordable for all women to use it,” she points out.
“What we would like to see now is for community to ensure that they are sensitised on the ring and to involve particularly traditional leaders on the ground so that everyone buys into it and know the benefits at family, individual, and couple level.
“Let it be accessible to all women who need it.”
According to WHO, Two Phase III randomized controlled trials found that using the DPV-VR reduced the risk of HIV infection in women and long-term use was well-tolerated.
The Ring Study demonstrated an HIV reduction of 35 percent among women using DPV-VR, and the ASPIRE study a 27 percent reduction in risk.
Results from the open-label extension studies of the trials showed increases in ring use and modeling data suggest greater risk reduction — by over 50 percent across both studies — compared to the Phase III trials.
Secondary analyses of the trial data also suggest higher risk reduction among women who consistently used the DPV-VR.
As Zimbabwean women create a new bond with the vaginal ring, we should also applaud all the heroines who played a part in the trials as their efforts will save many women around the world from HIV infection and reduce the burden of HIV and AIDS at country level.
Taking into consideration what science says, the vaginal ring will create an unbreakable bond with women, give them security, power, protection and lifetime commitment.
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