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A Vaginal Ring to Prevent HIV: Could It Catch On in the US? - TheBody.com

A Vaginal Ring to Prevent HIV: Could It Catch On in the US? - TheBody.com

Nov 30, 2021 3 mins, 42 secs

“There’s a lot of excitement about the ring in Africa.” So says Dázon Dixon Diallo, founder and president of the longtime Atlanta-based women’s HIV and sexual health group SisterLove.

The ring’s prevention rates, as well as its safety, were enough for the World Health Organization, early this year, to recommend it as a new prevention choice for women at “substantial risk” of HIV infection—meaning in places like many African countries where at least three in 100 women get HIV.

“The current efficacy data on the ring isn’t high,” explained Diallo, “but nonetheless, for teen girls and young women in sub-Saharan Africa, there’s excitement, especially as folks anticipate that at some point it’ll be a two-in-one contraceptive and anti-HIV device.

Of those who contracted HIV via heterosexual contact, 3,758 were Black, compared to 1,030 Latinas, 956 whites, 98 Asians, 17 American Indian/Alaska Native women, and five Native Hawaiian/other Pacific Islander women—indicating that HIV hits Black Americans harder across sexual and gender categories?

Among experts, that question can’t be answered without first addressing another: If HIV rates remain high among Black women and must come down if the overall epidemic is to be ended in the U.S., then why have so few women—as few as 7% of those who could benefit, according to the CDC—gone on oral PrEP in the decade since it’s been FDA-approved.

“Women weren’t included with the messaging from the beginning,” said Diallo, “so by the time you have a message for women, no one believes it” because PrEP was by then seen as primarily for gay men.

“So then,” said Diallo, “you’re asking women to take a daily pill that’s associated with something highly stigmatized and discriminated against”—namely having, or being at risk for, HIV.

“Providers believe that if they talk to minority women about sexual risk, the women will think they’re judging them as promiscuous,” explained Charlene Flash, M.D., an infectious-disease specialist at Baylor College of Medicine and president and CEO of the Avenue 360 clinics in Houston.

Flash is not alone in saying these conversations need to happen—not in the narrow context of Black women being at higher risk for HIV, but the broader one of their choices about their entire reproductive and sexual health.

That’s partly, she said, because pickup of oral PrEP among women has been low—and may likely stay low unless broader and better efforts are made to message PrEP toward women.

“The ring will have a harder case with the FDA because of lower levels of efficacy [in the African trials],” said Diallo.

And even if the ring is approved alongside monthly injectable cabotegravir and already-approved oral PrEP, “people will learn that the ring is not as effective.”?

Flash agreed, pointing to focus groups she’s done showing that Black women feared side effects from PrEP.

Will it impact my bones, kidney, or liver?’ A ring would have only local impact.” (Related to this, branded or generic Truvada for PrEP has been proven safe for women, including those who are pregnant or breastfeeding, but Gilead’s slightly different PrEP pill, Descovy (emtricitabine/tenofovir alafenamide), has not been tested in cisgender women.).

And Diallo thinks that, at least with some women or transgender men, the ring’s vagina-specific nature might help decouple it from PrEP, which is associated so closely with gay men.

“Hearing about a vaginal ring might perk up my ears,” she said, “because if I have a vagina, that’s me.”.

But she also broadens the scope of the conversation, noting that ending HIV in women will not depend solely on their finding the right biomedical prevention tool, be it some form of PrEP or the vaginal ring, but on addressing disparities in Black women’s health that flow from systemic racism—everything from having sex within communities with higher baseline HIV rates due to things like mass incarceration, to lower access to health care and coverage.

“We need to tackle the inequities that drive Black, and then Brown, women’s sexual and reproductive health outcomes to the very bottom,” said Diallo.

“WHO Recommends the Dapivirine Vaginal Ring as a New Choice for HIV Prevention for Women at Substantial Risk of HIV Infection,” World Health Organization (WHO).

“IPM’s New Drug Application for Dapivirine Vaginal Ring to Reduce HIV Risk in Women Accepted for Filing by US Food and Drug Administration,” International Partnership for Microbicides (IPM).

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