Combating HIV/AIDS: South African Firm Churns Out Discreet Vaginal Ring to Contain Violent-Sex-Driven Infections

Kiara Health, a South African pharmaceutical company has signed a memorandum of understanding with the Population Council, a not-for-profit entity research and developer of sexual and reproductive health products to produce the dapivirine vaginal ring (DVR).

The Population Council is looking for ways to reduce the cost of production and distribution of the dapivirine vaginal ring (DVR) for Africa, where 11 countries in the Eastern and Southern part of the continent have approved use.

DVR, already in use in Uganda, E-swatini, Kenya, Lesotho, South Africa and Zimbabwe is one of several options being tested, to reduce high HIV/Aids infection rates among women.

In Uganda, like elsewhere on the globe, HIV/Aids disproportionately affects women, more than it does men. Information from the Uganda Aids Commission (UAC) shows that there are 52,000 new infections in Uganda every year. Of those infections, 58 per cent occur in women.

“Women bear the brunt of the HIV/AIDS epidemic,” says Jim Sailer, Executive Director of the Population Council’s Biomedical Research, the non-governmental organization spearheading the international rollout of DVR.

“The virus is one of the biggest threats to the health and well-being of women. In sub-Saharan Africa, one adolescent girl or young woman becomes infected with HIV every three minutes. We cannot achieve the Sustainable Development Goal (SDG) of ending HIV by 2030 unless we curtail this epidemic in women,” he says.

In Uganda, policy leaders at the ministry of health and education opposed to reproductive health education have framed high rates of HIV/Aids infection and the accompanying teenage pregnancies among adolescents as a failure in parenting, but experts in the global arena blame domestic and sexual violence as well as poverty.    

According to the joint United Nations Programme on HIV/Aids (UNAIDS), teenage and adolescent girls aged 15 to 24, make up 75 per cent of the new HIV/Aids new infections in Sub Saharan Africa. Sexual and domestic violence is one of the reasons that UNIADS says is to blame for the high infection rates among girls and young women.

“Studies from Rwanda, Tanzania, and South Africa show up to threefold increases in risk of HIV among women who have experienced violence compared to those who have not,” reads an excerpt from a UNAIDS bulletin on intimate partner violence and HIV/Aids.      

The violence and lack of autonomy for the most at risk women makes DVR an important option as it is discreet and long term.

Diantha Pillay the Population Council’s Associate Director for Product Access says the DVR will improve choices for women seeking to protect themselves against HIV/Aids infection.

Despite a low efficacy rate at 30 per cent, which Pillay partly attributes to inconsistent use, DVR is a long-term method that is also discreet, an important attribute for women in abusive relationships or those who depend on their partners for survival.  

“Because of economic disparities and uneven power dynamics within sexual partnerships, women and girls are often unable to negotiate safer sex or even choose when or with whom they have sex,” she says.

She adds that economic disparities and uneven power dynamics also drive gender-based violence, which further increases women’s risk of HIV infection.

For those whose ability to choose when and with whom to have sex is compromised, having a long-term HIV infection prevention is safer than more effective methods such the pre-exposure prophylaxis (PrEP) pills that are taken daily.  

The long-acting HIV prevention DVR is also a pre-exposure prophylaxis (PrEP) method that releases dapivirine, an HIV drug for as long as the woman is wearing it correctly. As its name suggests, women insert the ring in the vagina, where it releases dapivirine for a month, although the memorandum of understanding with Kiara Health includes working to extend its lifespan to three months. 

The ring was developed to provide a long-acting prevention method for women when higher-efficacy products like daily oral PrEP are not viable.

According to Pillay, Oral PrEP is most effective among men who have sex with men, with an efficacy rate of 90 per cent, but among the general population of women, it goes down to 70 per cent.

A study on reversing the epidemic in Africa with choices in HIV Prevention, recently published in Lancet HIV, emphasized the importance of choice. The research found that, after using both PrEP and the ring for six months each, 67 per cent of the participants chose the ring, 31 per cent chose oral PrEP, and only 2 per cent chose to use neither.

According to research newer formulations in DVR and injectable cabotegravir, can directly address barriers to PrEP use among adolescent girls and young women. Among other things, research has found that adolescent girls and young women, struggle with the daily pill taking of PrEP, yet across Africa this category is the most at risk.

With the move to produce DVR in Africa, Pillay says the Population Council hopes to increase access to DVR, by reducing the cost of production and distribution. Currently DVR is produced in Sweden and a move to South Africa promises a cheaper option.

“We look forward to commencing with the technology transfer and enabling access to the PrEP Ring for all women in South Africa and other African countries. We will deploy our experience and distribution network to grow Kiara Health’s women’s health portfolio and meet our purpose to provide affordable, accessible health solutions to all women who need them,” says Dr. Skhumbuzo Ngozwana, Chief Executive Officer of Kiara Health.

Dr. Ngozwana says the initiative would also help address Africa’s over-reliance on imports of medicines and medical technology products.