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Rings, films or inserts? Researchers need to develop prevention products that make sense in women’s lives
Roger Pebody, 2016-10-21 10:00:00

“We need to think outside of the box,” Sharon Hillier of the Microbicide Trials Network told the HIV Research for Prevention (HIVR4P 2016) conference in Chicago on Wednesday. Researchers should not be aiming to develop the most scientifically elegant solution for HIV prevention, but should “figure out how to make products that can really fit into people’s lives”.

“We have to remember that making products that work is only half of the battle,” she said. “We also have to develop products that are less stigmatising, that are fun to use, and that don’t undermine the sexual experience.”

The conference heard several more details of the Microbicide Trials Network’s ASPIRE study of the dapivirine vaginal ring. Women and their sexual partners rarely felt the ring during sex, but concern that this could occur meant that most women disclosed ring use to their partners. Experience of intimate partner violence was rare (3% of participants) but resulted in women not using the ring consistently.

Moreover, the dapivirine ring did not confer drug resistance in women who acquired HIV during the trial. There were no differences in the frequency and patterns of drug resistance between the active and placebo arms of the study.

Sharon Hillier said that the need to develop prevention products that can protect receptive sexual partners remained. The receptive partners in vaginal or anal sex are highly vulnerable to HIV both because of biology and because they cannot control condom use.

Vaginal rings, modelled on products already used to deliver hormone replacement therapy and to provide contraception, have several potential advantages, she said. They are longer acting, only needing to be replaced once a month or potentially less often. It’s hoped that this will make adherence easier than for products which need to be taken every day or used at the time of sex.

Hillier said that women find them easy to use, “once they get the hang of it”. The flexible ring can be inserted and removed by the woman herself. Many users would like a product which they can start and stop as they wish. (A disadvantage of a long-acting injectable PrEP would be the impossibility of taking the drug out of the body.)

Vaginal rings are very safe. As they provide a “miniscule” quantity of antiretroviral drug to a localised part of the body, rather than throughout the bloodstream, there is less potential for side-effects than with some other products. This might mean that the product could be delivered in a less medicalised way, including in settings with weak health systems.

Being placed in the vagina, rings are private to all but the person using the ring and (potentially) her sexual partners. They don’t require applicators or other paraphernalia that could disclose use of the ring.