WHO recommends use of vaginal ring against HIV

Saturday January 30 2021
Tedros Adhanom Ghebreyesus.

WHO director-general Tedros Adhanom Ghebreyesus on January 21, 2021. AFP PHOTO | CHRIS BLACK | WORLD HEALTH ORGANIZATION

By Elizabeth Merab

The World Health Organization (WHO) has recommended the use a silicone vaginal ring containing the antiretroviral known as dapivirine as a new method for preventing HIV among women at substantial risk of contracting the virus.  

The product, which was added to the WHO's list of prequalified medicines last November, is a discreet, long-acting, HIV-prevention product designed specifically for women.

This followed the positive scientific opinion from the European Medicines Agency that was granted in July 2020.

The WHO recommended it on Tuesday.

Currently, people without HIV but who are at very high risk of contracting the disease take a pill called pre-exposure prophylaxis (PrEP) that contains two anti-HIV drugs every day to lower their chances of contracting HIV.

Taken daily


PrEP is only effective when taken daily as prescribed. However, studies have shown that the pill is much less effective if consistency is interrupted.

To create better adherence and provide people with a variety of acceptable, discreet, and convenient choices, researchers have been studying new long-lasting forms of HIV prevention methods that can be inserted, injected, infused, or implanted in a person's body from once a month to once a year to provide sustained protection from acquiring the virus.

According to the WHO’s guideline, the dapivirine vaginal ring (DPV-VR) will be offered as part of combination prevention approaches.

The United Nations agency, however, issued a conditional recommendation noting some variability in effectiveness of the ring in younger age groups and limited data regarding use among pregnant and breastfeeding women.

“The WHO Guideline Development Group assessed that the benefits of the DPV-VR outweigh the harms based on a systematic review and meta-analysis of the scientific evidence presented to them,” said the WHO.

This evidence included the cost-effectiveness of the ring, acceptability, demonstrated feasibility, and the potential to increase equity as an additional prevention choice.

Women vulnerable

In some parts of the world, particularly in sub-Saharan Africa, women are especially vulnerable to HIV exposure, because they cannot negotiate safer sex due cultural, social and gender barriers, among other reasons hence putting them at a heightened risk of unintended pregnancies, STIs and HIV.

According to the UNAids, nearly 870,000 new HIV infections occur globally among women and girls every year – three every four minutes.

In sub-Saharan Africa, three in four new infections among 15–19-year-olds are among girls.

In Kenya, about 970,000 girls and women are estimated to be living with HIV. 

The antiretroviral dapivirine in the ring is released slowly to reduce the woman’s risk of acquiring HIV infection locally in the vagina with few effects elsewhere in the body.

The ring is seen as a method for cisgender women (people whose gender identity matches their sex assigned at birth) in sub-Saharan Africa, who despite being the face of the epidemic, have few options for protecting themselves against getting infected.

Complementary approach

In addition to other safer sex practices, the use of DPV-VR is intended as a complementary prevention approach and can be offered alongside oral PrEP as a choice for women who do not want or are unable to take a daily oral tablet, said the WHO.

The ring is made of silicone, which gives it flexibility to bend and insert. It works by releasing dapivirine into the vagina slowly over a period of 28 days, after which it is replaced with a new one.

Over the last decade, a number of studies in different settings have tested the ring’s safety, effectiveness and acceptability.

These studies were first conducted in Belgium and the United States, followed by Kenya, Malawi, South Africa and Tanzania

The initial research included women aged 18 to 45, with additional safety studies among post-menopausal women and adolescent girls aged 15 to 17 in the US.

While contraceptive vaginal rings have been available for several years, the DPV-VR is the first vaginal HIV prevention product.