Kenya approves roll out of vaginal ring to protect women against HIV infections

In the run-up to World AIDS Day on 1 December, here in Kenya, the battle against HIV/AIDS remains a pressing public health challenge, particularly for women.

According to the Ministry of Health, there are approximately 1,377,784 Kenyans living with HIV, with women making up the majority with 880,000 cases.

For this sex worker from Dandora, Nairobi, HIV infection is a real concern.

The 50-year-old single mother of four turned to sex work out of financial desperation and is doing all she can to minimize the risks.

Until recently, the woman was taking daily oral Pre-Exposure Prophylaxis (PrEP) tablets to protect herself from HIV infection, but she's now switching to the Dapivirine Vaginal Ring (DPV-VR), after Kenya’s ministry of health approved its use.

The Dapivirine Vaginal Ring works by releasing the anti-HIV drug dapivirine over a period of one month.

On a visit to her local health facility, she's given all the information she needs to effectively use the ring, which is still in the pilot study phase.

"I have had partners who I did not trust and they provided my daily bread for my children to get something to eat. I met a friend who told me about vaginal rings and told me where I could get them,” says the woman, who wishes to remain anonymous. While sex-work is not criminalised in Kenya, there is social stigma around it.

“I have used oral PrEP but they lack privacy and cause side effects but when my friend told me about vaginal rings, I chose it to be a method I could use to protect myself from infections," she adds.

The dapivirine vaginal ring was endorsed by the World Health Organization (WHO) as an additional prevention choice for women at substantial risk of HIV infection in January 2021.

Following this endorsement, the Kenyan government approved the ring for use in 2022, and a pilot study began in June 2023 to assess its implementation and effectiveness among women in the country.

The dapivirine vaginal ring will be rolled out in Kenya in 2025, and women will be able to access it at no cost.

The women involved in the pilot praise the ring's discreetness and ease of use.

"I have used daily PrEP pills before and they do not sustain your privacy because for example, you can get a visitor coming for sleepover, and it is not everyone who knows about PrEP pills, they might think it's ARVs (antiretroviral drugs) and they can judge you," says another Nairobi sex worker who wishes to remain anonymous due to the social stigma of her work.

"Now I prefer the ring because it is hidden, I am the only person that knows I have it and I can't forget to use the ring like how I used to forget to take the pills," she continues.

Jennifer Gacheru is a clinical officer at the Bar Hostess Empowerment and Support Programme (BHESP), an organization that supports sex workers and has been involved in the pilot study.

"Most of them prefer vaginal rings depending on the side effects that come with oral PrEP and also they will have to remember on a daily basis to swallow,” Gacheru says.

However, the vaginal ring works locally within the vagina and is only effective in preventing HIV/AIDS during vaginal intercourse.

“So if a client has oral sex or anal sex, it's not suitable," Gacheru adds.

The vaginal ring also can’t offer protection against other Sexually Transmitted Infections (STIs).

Jonah Onentiah, leader of the HIV Prevention Team at the National AIDs and STIs Control Programme (NASCOP) stresses that other measures need to be taken.

“The ring is one of the options for prevention of HIV and we highly recommend the use of the condom alongside the ring to prevent STIs and pregnancy,” he says.

"Other benefits of the ring include its discreetness, in that for the women who are not able to negotiate for safer sex or the use of condoms, they can now be able to use it to prevent HIV infection. With effective use we have seen that the effectiveness has increased from 27 percent to 75 percent," Onentiah explains.

Users are advised to avoid sexual intercourse during the first 24 hours after insertion to allow the medication to be properly released.

The ring has been approved for use in several African countries, including Botswana, South Africa, Lesotho, Rwanda, Uganda, Zimbabwe and Eswatini.

For women in Kenya, its roll out in 2025 can't come soon enough.

In 2023, 9,100 women were newly infected with HIV/AIDS compared to 4,100 men in Kenya.

Globally, 44% of all new HIV infections were among women and girls, according to UNAIDS.