New HIV infections are still a major driver of the epidemic. According to UNAIDS adolescent girls and young women are disproportionately affected. Around the world, this population group accounts for about 4000 new infections every week. 

In South Africa, where the highest number of people with HIV live, new infections among women and girls aged 15-24 is estimated at 43,300 a year. But the country is adding new tools to its HIV-prevention arsenal. 

In August the country started a pilot roll-out study of the PrEP ring or Dapi-Ring in Maria Rantho Clinic in Soshanguve, north of Pretoria. The aim of the study is to collect information on how to integrate the ring within existing services. The study will also provide better understanding of people’s choices when it comes to the various HIV prevention methods. 

PrEP or pre-exposure prophylaxis is when medicine – in this case antiretroviral drugs (ARVs) – are used to prevent infection in people. Oral PrEP has been available in South Africa since 2016. 

In 2022 South Africa approved the use of the PrEP ring.The silicone ring which is inserted into the vagina slowly releases the ARV, dapivirine, over a 28 day period. Adherence to the ring is much more promising than oral PrEP which requires people to take a pill at the same time every day. 

Professor Saiqa Mullick, director of implementation science at the Reproductive Health and HIV Institute at the University of Witwatersrand (Wits RHI), explains why it’s important to have many HIV prevention options.

“This is so that people can use a method that best suits their lifestyle and their situation. The PrEP methods are very different. Some people do not like to take a pill everyday and may forget, or they may want a method that they can use discreetly,” says Mullick.

The current roll-out of the dapivirine ring is on a pilot basis only. The Department of Health will expand the roll-out once there’s concrete feedback about the safety of the PrEP rings from the pilot implementation sites.

Rings, pills and injections   

Mullick says that there are clinical trials currently underway to establish safety of PrEP rings in pregnant and breastfeeding women. 

“Since the drug in the ring acts locally in the vagina, it is not absorbed systemically. Therefore the likelihood of side effects is much lower. In the clinical trials some side effects were noted but these were not common,” explains Mullick.

Another HIV prevention method on the cards for South Africans is the HIV prevention injection which was registered in December 2022. Mullick says that the roll-out of HIV prevention injection is only likely to start in the first half of next year, subject to its availability.

None of the PrEP methods offer protection against other sexually transmitted infections (STIs) and it is recommended they be used along with either male or female condoms.

Decline in condom use

Nelson Dlamini from the South African National AIDS Council (SANAC) is concerned about what seems to be a lack of awareness of the various HIV prevention tools available. 

“We need to work harder to improve knowledge and access through awareness intervention. Condoms remain the most effective barrier against both HIV and STIs, however the use of condoms has been declining over the years in South Africa,” says Dlamini.

The total number of people initiated on oral PrEP in South Africa has exceeded the one million mark. South Africa has the largest number of PrEP initiation in Africa.

“Access to more prevention options against HIV gives women more power. Women and girls need more control through discreet prevention tools and this is what PrEP ring offers them. Unlike in the case of condoms where men have more control,” says Dlamini.-Health-e News.