An ASPIRE study has revealed that wearing dapivirine vaginal ring for protection against HIV had little or no effect on sexual intercourse. The findings of the study were announced during the HIV Research for Prevention (HIVR4P) meeting in Chicago, held on 18th October.
The study was funded by the National Institute of Allergy and Infectious Disease (NIAID), the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute of Mental Health.
Collectively, the researchers observed that wearing dapivirine vaginal ring reduced the HIV risk by 27%. Interestingly, upon further investigation, they recorded the risk reduction by 56% in women who frequently wore the ring. Validating the effectiveness of this ring, it was found that women who used the ring consistently experienced the risk reduction by a significant 75% or even higher.
Conducted by the NIH funded Microbicide Trials Network, the study gathered data from 2,629 women native to South Africa, Uganda, Malawi and Zimbabwe, aging between 18 years to 45 years.
People suffering from HIV/AIDS experience a troubled sexual life as they fear transmitting the virus to their sex partners.
More than half of over 35 million HIV patients globally are women and African women have high disease prevalence for HIV. Contributing over 19 million HIV cases to the global statistics, east and southern Africa account for 46% new HIV cases per annum.
Antiretroviral medications, taken as pre-exposure prophylaxis such as vaginal ring, are in the run for being an effective treatment option in HIV eradication. While other competing treatments include taking pills before sex, the use of vaginal ring is found to be highly effective as it has to be continuously worn and problems like forgetting to take pills are avoided in this case.
Upon finding evidence for the use of antiretroviral drugs in pill form, the ASPIRE study showed that participants who were subjected to intimate partner violence and social harms found it hard to adhere to a routine of taking antiretroviral drugs, such as Truvada.
On the contrary, wearing of ring was associated with fewer than 5% reported incidents of partner violence or other social harm. However, amongst the women who reported such incidents during first month of study had a low adherence rate to wearing ring.
How Do Vaginal Ring Help Reduce HIV Transmission Risk?
The vaginal ring is made out of silicone polymer which is inserted into the vagina for a period of one month to give them a long-lasting preventive option. The ring contains an antiretroviral drug called dapivirine which is slowly released from the ring over a period of a month to give protection.
The high drug efficacy is due to ring insertion site also being the site for virus exposure which can cause a potential infection. Now that the findings of phase III clinical trial for the efficacy of vaginal ring look promising, further development and approval procedures also seem imminent.
The efficacy of the ring in ASPIRE study was monitored over a timeframe of 24 months and one vaginal ring carried 25 mg of dapivirine drug, which was studied against a control group of participants who received vaginal rings without containing the drug.
Does Wearing Vaginal Ring Disrupt Sexual Life Of Women?
The convenience of wearing this ring is a salient feature of this ring which poses no hindrance to the sexual pleasure for the partners, while the HIV negative partner stays protected from contracting the virus.
In this context, the director of NIAID, Anthony S Fauci, MD, said, “Women need an HIV prevention modality that offers safe, effective protection and is practical for use in their daily lives.” He added that during the investigation, the women reported that wearing the ring did not interfere with their sexual intercourse and which will encourage a larger target population of women to use this ring, who in turn are at a high risk of getting HIV infection.
In a detailed interview of 214 participants, important revelations were made by the women regard their use of the ring and the effect of wearing the ring on their relationship with primary sex partners.
Although, majority agreed that using the ring had no negative effect on their sexual activity, some participants were psychologically exhausted by worrying about their partner’s reaction on discovering that they are wearing a ring.
As these women were occupied with this stressful concern, some decided to remove the ring before sex while others tried to limit their sexual activity to postures where the ring is not discovered by their partner. In the latter case, to avoid partner’s awareness about the ring, they restricted their sexual activity to digital sex or oral sex.
Other group of participants also reported that their satisfaction during sex was improved because they did not have to worry about getting infected. In younger women, many refrained from disclosing to their partners about wearing the ring due to the involved fear of social harm.
The investigators believe that further research is warranted to increase their knowledge about the trends of intimate partner violence and social harms in the region which influence adhering to female-controlled HIV prevention methods.
On the brighter side, additional data revealed that 64% women disclosed the use of ring to their sex partners, while only 13% decided to never disclose it to their partner. Furthermore, the women’s decision of disclosing this preventive measure detail was found to have no effect on their adherence to wearing the ring.
Similarly, the apprehensions regarding the use of ring, initially recorded at 29%, was significantly reduced to only 4% by the time of final study follow up which is a positive sign of increasing acceptability of vaginal ring amongst women.