Residents of Khayelitsha worry about a neighbour’s daughter who is only 13 but does not go to school because she cannot afford transport. She was raped by an old man. Her mother does not care and drinks a lot, swears at her about the rape and hits her. The child wants to go to school, so she went to stay in a neighbour’s home. The neighbour is also struggling and cannot afford the transport and school fees. – Banake Initiative Field Worker Diary

In recent years, innovative contraceptive methods that are discreet and female-initiated have expanded contraceptive access to millions of women who wish to prevent, space, or limit pregnancies but must do so without their partners’ cooperation. The International Partnership for Microbicides (IPM), developers of a new microbicide ring currently undergoing clinical trial in South Africa, hope to apply this same principle to HIV prevention. If proven safe for long-term use, the monthly vaginal ring, which steadily releases the antiretroviral (ARV) drug dapivirine, will serve as a valuable HIV prevention option for women, particularly those who wish to become pregnant or who are unable to safely negotiate condom use or monogamy with their partners. Offering new HIV prevention options to women is particularly important in high-prevalence regions like sub-Saharan Africa, where 60 percent of HIV infections are among women and girls.

A woman holds a vaginal microbicidal ring, now undergoing clinical trials.

This research comes on the heels of a number of recent studies that have shown that ARV treatment can prevent the transmission of HIV between serodiscordant partners when used consistently and correctly. Researchers have found that adherence can pose a serious barrier to the effectiveness of ARV-as-prevention. The microbicide ring addresses this barrier by delivering ARV treatment locally over the course of a month; the only action required by the user is insertion of the vaginal ring at the beginning of the month and removal at the end. Another benefit of this approach might be lessened side effects due to the low systemic absorption of dapivirine. A number of safety and acceptability studies have found the ring to be highly acceptable to women and their partners.