By the end of 2024, an estimated 8 million people had initiated pre-exposure prophylaxis (PrEP),¹ including approximately 2 million people in sub-Saharan Africa since 2022.² Young African women are a high priority for HIV prevention because of their persistently high HIV incidence despite increased frequency of HIV testing of African men, linkages to antiretroviral therapy (ART) when positive, and viral suppression among their male partners. Although uptake of daily oral PrEP by young women, including in South Africa, has increased substantially in the past several years, adherence and persistence are suboptimal,³ in part due to challenges with daily pill-taking, societal attitudes about young women’s sexual activity, anticipated or experienced stigma from taking an antiretroviral for HIV prevention, and fear of rejection by partners and family if they learn about their PrEP use. HIV prevention research and development has focused on long-acting modalities to overcome barriers to PrEP adherence and persistence. The first proven long-acting PrEP option for young African women is the monthly dapivirine vaginal ring (ring PrEP), which in randomised controlled trials had high safety and acceptability, albeit modest efficacy.^4,5 The European Medicines Authority and WHO endorsed ring PrEP, ⁶ and many African countries now include it as an option in their clinical guidelines.