EmpoweRing: Prevention by Choice

Through the EmpoweRing: Prevention by Choice project we:

  • advocate for accelerated approval and uptake of the dapivirine vaginal ring as an HIV prevention tool for women and girls in Uganda, Kenya, Tanzania and Rwanda;
  • contribute to increased demand for, and uptake of , the dapivirine ring.

The dapivirine ring is the first discreet, women-controlled, long-acting HIV prevention product. It is approved for women aged 18 and above. Made of flexible silicone, the ring slowly releases the antiretroviral drug dapivirine in the vagina over a one-month period.

Choice in prevention products is key to ensure women and girls have control over their health and their bodies. The dapivirine ring was developed to provide a long-acting prevention method for women when higher-efficacy products like daily oral PrEP are not viable options. The REACH study (MTN-034, Reversing the Epidemic in Africa with Choices in HIV Prevention) found that, after using both PrEP and the ring for six months each, 67% of the participants chose the ring, 31% chose oral PrEP, and only 2% chose to use neither.

The EmpoweRing: Prevention by Choice project is implemented by the International Community of Women living with HIV Eastern Africa (ICWEA) and partners using the Youth Advocates model. This model seeks to empower and build resilience among adolescent girls and young women in addressing HIV needs.

Time frame

Oct 2021 – Apr 2024

Communities

Adolescent girls and young women

Budget

€ 300,000

Countries

Kenya, Rwanda, Tanzania, Uganda

We are not going to stop advocating for it to be available and accessible to all the young women

– Beryl Auma Abade


Background

Adolescent girls and young women in sub-Saharan Africa remain one of the most at-risk populations for HIV, with infections three times those of adolescent boys and young men in the region (World Health Organisation) There is therefore an urgent need to explore all possible ways of preventing new HIV infections. Since November 2020, the dapivirine ring has been recommended by WHO. This followed the positive scientific opinion from the European Medicines Agency on the use of the ring for HIV prevention, which was granted in July 2020.

East Africa was among the regions where the study on the dapivirine ring was conducted and countries such as Uganda and Kenya had demonstrated willingness to be among the “early adapters”.  In the past two years, Uganda, Kenya and Rwanda formally approved the dapivirine ring as a prevention tool. Women-led advocacy is needed to accelerate the roll-out and affordability of the Ring, and active community leadership is urgent to support increased awareness and demand creation for the Ring.

Objectives
  • To contribute to a reduction in new HIV infections among women and girls in Uganda, Kenya, Tanzania and Rwanda through advocacy for approval and rollout of the dapivirine ring
  • Awareness raising and demand creation among women and girls for this new HIV prevention tool.
Results
  • The national drug authorities of Uganda, Kenya and Rwanda have approved the dapivirine ring as an HIV prevention tool (not a direct result of Empowering project)
  • 4 EmpoweRing champions lead dapivirine ring work and host WhatsApp literacy sessions with 50+ young women in each country
  • 200 Adolescent girls and young women were trained in HIV prevention advocacy. They are instrumental in spiking dialogues on dapivirine ring and country/regional advocacy endeavors on the ring with the leadership of the dapivirine ring country champions
  • Supported CSOs in the 4 countries to participate in technical working groups, review of national guidelines, writing teams, planning meetings, (inter)national conferences and other advocacy platforms
  • Created awareness on the dapivirine ring and choice in prevention products through online events and community campaigns
  • Supported the development of The HIV Prevention Manifesto, launched in September 2023
About the dapivirine vaginal ring

The dapivirine ring is the first long-acting, women-controlled prevention tool. Women could use it discreetly at times in their lives when they may be unable to negotiate condom use or to consistently use daily oral PrEP. The monthly ring is an important new option for women, who bear the greatest burden of HIV and AIDS. Developed by IPM (now Population Council), the dapivirine ring is the first to adapt a medical technology commonly used to deliver hormones to women to instead deliver an ARV drug to prevent HIV. The dapivirine ring safely reduces HIV infection overall by half (modelling data). In the DREAM study, the HIV incidence rate was 62% lower than an imputed placebo incidence rate (Nel et al. 2021).

Population Council is developing a longer duration dapivirine ring that women would use for three months, to significantly lower annual costs and offer a woman a more convenient option to protect themselves. Development of this longer duration ring will be completed and submitted for regulatory approval in 2024-2025.

Header image of Shakirah
Story

For young women, the ring should be for free

For young women, the ring should be for free

"We don’t know what the other person is doing but I can protect myself, we can’t deny that to a young woman". Shakirah Namwanje from Uganda is an advocate on a mission: fast approval and roll out of the dapivirine vaginal ring for HIV prevention in Uganda. We spoke with her about what is needed for accelerated implementation, the role of the government and of civil society, how lessons from PrEP support the process, and her personal motivation to do what she does. “Positive living isn’t as easy as it sounds. Meet Shakirah!

Read more about For young women, the ring should be for free
Woman's hand holding dapivirine ring
News

EMA adopts first-ever vaginal ring for HIV prevention

EMA adopts first-ever vaginal ring for HIV prevention

The European Medicines Agency has given a positive scientific opinion on the monthly dapivirine ring. The ring adapts a medical technology commonly used to deliver hormones to women, a milestone for women's HIV prevention. The opinion paves way for WHO and National Regulatory reviews. It is developed by the nonprofit International Partnership for Microbicides (IPM).

Read more about EMA adopts first-ever vaginal ring for HIV prevention
Two girls together holding a Dapivirine ring
News

Launch of HIV Prevention Choice Manifesto for Women and Girls in Africa

Launch of HIV Prevention Choice Manifesto for Women and Girls in Africa

On 8th September 2023, Aidsfonds joined women-led- and community organisations, advocates, government officials and development partners to launch the HIV Prevention Choice Manifesto for Women and Girls in Africa. The manifesto calls for continued political and financial support for HIV prevention choice. The HIV Prevention Choice Manifesto is a collection of voices of African women and girls in all their diversity, feminists and HIV prevention advocates across Southern and Eastern Africa who are united in the mission of having a future free of HIV for all daughters and women in Africa.

Read more about Launch of HIV Prevention Choice Manifesto for Women and Girls in Africa

'Dapivirine ring gives back the power to women to be able to take full control of their prevention'

Partners

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Aidsfonds is interested in working together to further strengthen community leadership, increase HIV prevention choices, and improve treatment outcomes and quality of life of people living with or exposed to HIV. We want to talk to anyone who shares our dream and wants to join us on a journey toward a world free of AIDS.

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A young woman joyfully raises her arms in the air, expressing happiness and celebration.