Women in the region will soon have access to free vaginal rings designed to prevent HIV infection. The dapivirine vaginal ring, commonly known as the DapiRing, is a long-acting HIV pre-exposure prophylaxis (PrEP) option for women that has received regulatory approval in 11 Eastern and Southern Africa countries.

Among these countries are East Africa’s Kenya, Uganda and Rwanda, where women and girls over the age of 15 account for 61 per cent, 61.4 per cent and 62.86 per cent, respectively, of those living with HIV.

Worn internally, the new HIV prevention tool is a groundbreaking solution for women, in the form of a small, flexible silicone ring, inserted into the vagina to provide discreet, continuous protection against HIV during vaginal sex.

It is infused with the antiretroviral drug dapivirine, which is released slowly over the course of a month, to prevent the virus from establishing an infection. The released drug protects women from HIV transmission without having to rely on the male partners’ cooperation. 

Read: Kenya approves use of dapivirine vaginal ring

It requires minimal upkeep—once in place, it only needs to be replaced once a month.

“The PrEP ring gives women and girls a discrete option that is entirely within their control,” said Miles Kemplay, Executive Director, Sexual and Reproductive Health and Rights, Children’s Investment Fund Foundation (CIFF). CIFF is working with the Global Fund in a $2 million initiative to avail 150,000 rings.

“For too long price points have made this option inaccessible, this partnership is the first step in making the market more sustainable and increasing access for those who need it,” he said.

The ring is produced by Sever Pharma Solutions in Sweden for the Population Council. A next-generation ring, offering protection for three months, is expected to undergo regulatory review soon.

The ring represents a significant advancement in HIV prevention, particularly in sub-Saharan Africa, where women account for nearly 60 per cent of new HIV infections.

So far, regulatory authorities in Kenya, Uganda, Rwanda, Zambia, Malawi, Botswana, Eswatini, Lesotho, Namibia, South Africa and Zimbabwe have approved the PrEP ring, with other countries currently reviewing submissions. 

Since 2021, the World Health Organization (WHO) has recommended the PrEP ring as an additional prevention option for women at substantial risk of HIV infection as part of a combination prevention approach.

And already, the Global Fund has facilitated the procurement of the PrEP ring in Uganda, South Africa, Ghana, Eswatini, Mozambique, Cambodia and Indonesia, with procurement in Mozambique and Uganda partially supported by CIFF’s PrEP Matching Fund.

Starting in October, the partnership between CIFF and the Global Fund aims to support the early introduction of the PrEP ring, laying the groundwork for broader market adoption. Working alongside other partners, including Unitaid, the collaboration also seeks to pave the way for the lower-cost, three-month PrEP ring and an African-manufactured version, ultimately driving down prices in the long-term.

Read: South Africa to roll out vaginal rings to fight HIV scourge

The one-month ring currently costs $12.8, but the initiative has announced it will create a bridge to the three-month PrEP ring, which will cost less than $16, excluding distribution, representing a nearly 60 per cent drop in price per month. Partners also announced that they have identified several opportunities for further price reductions, which are being explored.

HIV remains a major global health challenge, with an estimated 39.9 million people living with the virus worldwide, according to WHO. In 2022, 1.3 million people contracted HIV, highlighting the significant gap in efforts to meet the goal of ending HIV and Aids by 2030.

Among countries worldwide, those in sub-Saharan Africa, despite significant progress in reducing new infections and expanding access to treatment, certain populations, particularly women in low-income countries, have the highest infection rates of HIV. In many regions, cultural norms, gender inequalities and limited access to healthcare contribute to a heightened vulnerability.

“In many areas of the world, the rate of new HIV infections among adolescent girls and young women is more than three times the rate among adolescent boys and young men,” said Executive Director of the Global Fund, Peter Sands.

“This is unacceptable. We are convinced that this new PrEP ring can have a revolutionary impact. Girls and women have spoken up that they want the PrEP ring, and today’s announcement is one more steppingstone in a series of innovative approaches to give it to them.”

The up to $2 million commitment over the next year (2024-2025) will facilitate the procurement and distribution of these rings.

“The ring is a powerful tool that is revolutionary as the first approved, long-acting prevention tool, particularly for women and adolescent girls, who often cannot negotiate condom use and find the pill burden of oral PrEP not discrete enough,” said Executive Director of Advocacy for Prevention of HIV and AIDS in South Africa and Chair of the African Women Prevention Community Accountability Board, Yvette Raphael.

“It gives women and girls another option to choose from. HIV prevention choice is very important, and making the ring available for young women is our duty.”