Apr19

If you like it, put a ring in it! The intravaginal ring that may soon be a life changer in the sexual and reproductive health arena

Thursday, 19 April 2018

Yes! Yes! We soon may have a ring for our vaginas! I know what you are thinking; vaginal rings have been here since sliced bread. True, but what’s new about this one is that it will provide protection from HIV. Future rings will also include protection from unintended pregnancies and other sexually transmitted infections (STIs), too. And when that ring is available, I am putting it in! Because I like my vagina, and I want to stay healthy.

Although I was not in Boston for the 2018 Conference on Retroviruses and Opportunistic Infections (CROI), I am excited! Excited because as I closely followed the conference proceedings from my desk in Nairobi, I heard the good news: Interim results indicate that a ring developed by the nonprofit International Partnership for Microbicides (IPM), containing the antiretroviral Dapivirine, could reduce the risk of HIV infection among women. And an MPT vaginal ring that contains Dapivirine and a contraceptive is also in the works! There are other vaginal rings in development as well.

Can you imagine, that a little ring inserted in a woman’s vagina can save many of us from HIV infection, other STIs, and possibly unintended pregnancy too? What more can a girl ask for? Are you not sure why this is such a big deal? Well, let me bring you up to speed with what is happening in the arena of sexual and reproductive health (SRH) – more specifically, I am talking about HIV and unintended pregnancy rates among young women. I will use my country, Kenya, as an example.

In Kenya, like many other resource-limited countries, the HIV pandemic wears a female face. Results from the Kenya AIDS Response Report 2016 indicated a general prevalence of 5.9 percent – with 6.3 percent among women, and 5.5 percent among men. Country-level statistics from the Ministry of Health’s 2016 report indicate that in 2015, Kenya had nearly 78,000 new HIV infections, translating to just over 200 new infections every day. Of these, nearly half (46 percent) were among young people aged 15 to 24 years, with young women in this same age group accounting for a third of all new HIV infections in adults.

On the other hand, fertility rates remain high in Kenya, with an average total fertility rate of 3.9 children during a woman’s lifetime. Women in the rural areas are likely to have one more child than those women who live in the urban areas. Moreover, over 40 percent of pregnancies in Kenya are unintended; stemming largely from an unmet need for contraceptives – one in four married women. The national modern contraceptive prevalence rate is estimated at 53 percent, but still 18 percent of married women have an unmet need for contraceptives.

Many women face a simultaneous risk of both unintended pregnancy and STI infection, including HIV. Kenya is not only among the countries with the greatest burden of HIV, but also has high levels of unmet need for contraceptives.

In this context, young women face the greatest need for unmet SRH needs. In Kenya, 18 percent of young women aged 15 to 19 years are mothers. Those who live in the informal settlements are at an added disadvantage, as they face poor infrastructure, overcrowding, poor sanitation facilities, high disease and morbidity burden, low levels of education, and high levels of unemployment. All of these factors make it difficult to prioritize and achieve good SRH.

We need to invest in newer strategies like MPTs that offer combined protection against unintended pregnancy and STIs, including HIV. The only MPTs currently available that offer protection against unintended pregnancy and STIs, including HIV, are male and female condoms. Although condoms are extremely effective if used correctly and consistently, they are also dependent on one’s ability to negotiate for safe sex with one’s partner, and hence, they are not always a good option for all women who would want to use them. There are several MPT configurations in development that will combine a contraceptive and infection prevention, including intravaginal rings (IVRs), vaginal gels and a single sized diaphragm for delivery of a microbicide gel. These products will not only provide women with diverse options, but could also allow women unable to negotiate for safe sex to be able to use the product without requiring the permission or knowledge of their partners.

Simultaneously addressing unmet SRH needs through an MPT could have multiple benefits: improving the health of women through averting unintended pregnancy, and STIs; improving the health of their children by avoiding mother to child transmission of HIV; and improving the socioeconomic well-being of women and their families. Investing in SRH for women will contribute towards Kenya’s Vision 2030 and achieving the Sustainable Development Goals. Resource allocation to this important cause must be deliberate at both the international and county levels in order for Kenya to achieve significant improvements in SRH.

Now that you know what the source of my excitement is, if I break into a happy dance randomly and look like a mad woman, do not mind me. I dance for the 13-year-old Mary in Mukuru Kwa Reuben, somewhere in the slums of Nairobi, who got raped 10 months ago and now has 1-month old baby! I dance for 16-year-old Janet in Homabay who was in a loving relationship with her boyfriend, got pregnant, acquired HIV, and then had to drop out of school. I dance for myself. That soon we may all have this life saving product and not have to worry when a future boyfriend (imaginary for now, ha!) decides to have “mpango wa kando” (an affair). I dance for women the world over! I dance for us. Yes! Our vaginas will have a ring! Not just any ring, but a ring that will change our lives forever!  And for that ring, dancing like a mad woman, I will!

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Disclaimer: The views and opinions expressed in this article are my own and do not reflect the official policy or position of any government Institution.

About the Author

Everlyne Ombati

Everlyne holds BSc and Master’s Degrees in Medical Microbiology from the Jomo Kenyatta University of Agriculture and Technology. Her interests include HIV prevention, especially among women and adolescents; and research ethics. She currently serves as the Advocacy and Regulatory Affairs Coordinator at the Research Care and Training Program, Center for Microbiology Research KEMRI.

 

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