African Women Using Anti-HIV Vaginal Ring Say Sex Felt the Same

African women in a study of a vaginal ring used as pre-exposure prophylaxis (PrEP) for the most part said wearing the ring did not affect the physical act of sex. However, for some the worry that their partner would discover they were using the ring reduced the enjoyment of sex. Also, the few women who were burdened by intimate partner violence were much less likely to use the ring.

At the HIV Research for Prevention (HIVR4P) meeting in Chicago, researchers presented new findings from the MTN-020 study, also known as ASPIRE, of a dapivirine-containing vaginal ring studied as PrEP among 2,629 women 18 to 45 years old in Malawi, South Africa, Uganda and Zimbabwe.

Study results presented at the 21st International AIDS Conference in Durban, South Africa (AIDS 2016), in July showed that on the whole, giving the ring to women reduced their risk of HIV by 27 percent. Women who used the ring with greater frequency had a 56 percent reduced risk, and those who used it consistently had a 75 percent reduced risk of HIV.

To reach the new findings, the researchers interviewed 214 participants who used the ring about their qualitative experiences with it. Most said the ring did not affect the physical act of sex negatively.

However, some women said they fixated on how their male partners would react if they found out about the ring. Consequently, some of them removed the ring before sex, which is not recommended. Others curtailed certain sexual practices they thought would raise the risk of the man finding the ring, including particular sexual positions and receptive oral or digital sex.

Some women reported having greater sexual satisfaction because they believed the ring was protecting them against HIV. But others had the opposite experience because of their worries over their male partners discovering the ring.

Less than 5 percent of the women said they experienced intimate partner-related violence or other related social harms. Those who did were nearly two and a half times more likely to adhere poorly to the ring’s protocol for use (the women received instructions to leave each ring in for a month).

Sixty-four percent of the women told their male partners they were using the ring at the beginning of the study. Thirteen percent never disclosed their use of the ring to their partners.

To read a press release about the study, click here or HERE: Women Report Vaginal Ring for Preventing HIV Had Little Effect on Sexual Intercourse

ASPIRE evaluated whether the ring, which continuously releases the anti-HIV drug dapivirine, could safely reduce HIV infection among 2,629 women aged 18-45 years living in Malawi, South Africa, Uganda and Zimbabwe. Among participants randomized to receive the dapivirine ring, risk of HIV infection fell by 27 percent. A further analysis found that the ring reduced the risk of HIV infection by at least 56 percent among women who used it with greater frequency, and up to 75 percent or higher among those who used it consistently. Further exploration of the ring’s clinical potential began in July 2016 through the large-scale HOPE (HIV Open-Label Prevention Extension) study, also known as MTN-025 (link is external). ASPIRE, HOPE and their ancillary studies were primarily funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH). The nonprofit International Partnership for Microbicides developed the dapivirine ring and supplied it for the studies.

“Women need an HIV prevention modality that offers safe, effective protection and is practical for use in their daily lives,” said NIAID Director Anthony S. Fauci, M.D. “Women enrolled in the MTN-020/ASPIRE study reported that the experimental vaginal ring generally did not interfere with sexual intercourse, which is an encouraging sign that this product could appeal to a larger group of women at risk for HIV infection.”

The ASPIRE study staff interviewed 214 participants who used the ring to obtain qualitative data about their sexual experiences during the trial. A team led by Nicole Laborde, Ph.D., M.P.H., of RTI International in Research Triangle Park in North Carolina, analyzed the participant responses. While most of these women found that the ring did not negatively affect the physical act of sex, some women said they were continually preoccupied with how their partners would react if they felt or discovered the ring. To address this issue, some women removed the ring before sex, a practice not recommended by study investigators. Other women limited sexual activities that they believed might heighten their partners’ awareness of the ring, such as certain sexual positions and receptive oral or digital sex.

Some women reported greater sexual satisfaction partially due to perceived protection provided by the ring. Other women reported diminished sexual pleasure associated with the worry that their male partners would notice the ring during sex.

Additional analyses of the ASPIRE data revealed other patterns of experience among study participants. Because women who face intimate partner violence and other social harms more often find it difficult to adhere to the clinically proven once-daily antiretroviral drug Truvada as pre-exposure prophylaxis, or PrEP, researchers investigated the connection between consistent use of the ring and these issues. While fewer than 5 percent of all ASPIRE study participants reported incidents of intimate partner-related violence or other social harms, women who did report violence or social harm within a month of the interview were nearly 2.5 times more likely to have low adherence to the ring. Younger age at enrollment, having a new primary partner and not disclosing study participation or ring use to the primary partner were significantly associated with reporting social harms. These findings, reported by a team led by Thesla Palanee-Phillips, M.Med.Sci, Ph.D., M.Sc., at the Wits Reproductive Health and HIV Institute in Johannesburg, South Africa, indicate that more research is needed to determine strategies to mitigate low adherence in the context of intimate partner violence and other social harms in future studies of female-controlled prevention methods.