Ladies, Put a Ring on It

New England Journal of Medicine reports that a ring filled with the antiretroviral drug dapivirine and inserted within the vagina provided extended protection against HIV — at least for older women. Now the National Institute of Allergy and Infectious Diseases has announced it will fund follow-up research to determine why the ring wasn’t as effective for younger women. 

Two large studies — the Ring Study and ASPIRE (“A Study to Prevent Infection with a Ring for Extended Use”) — conducted in Africa among sexually active, but not pregnant, women 18-45 years old found the ring was only 27 percent effective. That success rate rose to 37 percent when scientists removed data from locations where “it was apparent early on that many women were not returning for study visits or using the ring consistently.” 

Results were remarkably different when it came to women 25 and older, for whom the ring lowered the rate of HIV infection by 61 percent. Based upon the amount of dapivirine in the younger women’s blood streams, the scientists determined that the disparity existed because the younger women weren’t using the ring consistently. “If you could get a 61 percent efficacy in the older group, that means there is something about this that works,” Dr. Anthony Fauci, NIAID director said in a statement. “The real question is, in the real world, why is it not working in the younger group?”

The research was conducted in Sub-Saharan Africa, home to 80 percent of the world’s women living with HIV. HIV transmitted through rape is also a major issue in the region, where a 2011 United Nations study found frequent conflicts serve as harbingers of sexual violence against women. 

The ring isn’t nearly as effective as PrEP, but many women in Sub-Saharan Africa have little chance of accessing that preventative protocol. The ring, which is still at least a year from market, would offer women a form of HIV prevention that is under their control and doesn’t rely on the use of condoms by sexual partners; which makes it a life saving device in a region wracked by sexual violence.