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.
Why is the Dapivirine ring such a game-changer for women?
It’s a way of protecting yourself without having to rely on someone else. It gives power and it gives comfort. We don’t know what the other person is doing but I can protect myself. We can’t deny that to a young woman.
I acknowledge that not everything works for everyone. I would love to use the Dapivirine Ring but I can’t because I am HIV positive. Even if it serves only 1 person it makes a difference.
How about adolescent girls?
We need to make sure we don’t leave the adolescents behind. I keep telling, we don’t give them prevention tools because they are adolescents and then they drop out of school and get pregnant, so the cycle just keeps on continuing. We don’t accept safe abortion, we don’t accept them to assess contraceptives, and then they don’t assess HIV prevention tools. We leave them in a very unsafe environment and expect them to be safe.
One thing we have learned from COVID that even at home, girls are not safe. We need to give them the tools to navigate the environment. We need to fight as hard as possible to include adolescent girls and young women even in initial stages.
As an activist for girls and women, what keeps you going?
My biggest motivators are my four teenage sisters. I know they are growing and I won’t always be there to save them. So I want them to be empowered with tools that can help them navigate. I wouldn’t want them to experience even half of the things I experience on a daily basis. I am a speaker for positive living, but I also acknowledge that positive living isn’t as easy as it sounds. It isn’t easy to wake up and take medication every day. It’s not easy to feel rejected and stigmatized.
So for me to see that my sisters and other young women out there are protected and safe is what keeps me waking up every day. Even on days that I feel I can’t do it anymore, I know that I am doing it for more people. To proof that young women living with HIV can become someone, can still live their dreams. That’s where I draw the strength from.
How do you see your role in adoption of the ring in Uganda?
With the International Community of Women living with HIV Eastern Africa (ICWEA) we partner to spread the message, on radio, on television. Any opportunity they have to talk about the ring, they invite me. For instance, I spoke with female sex workers as they had heard about it and wanted to know more.
I bring the Dapivirine researchers to the communities so they can ask questions directly to the intended users of the ring. I am the voice behind the women that participated in the research. They were part of the research so if they want to use the ring they should be able to. If they are advocating for it and sharing their experiences, that’s something we document and share.
One thing I know for sure is that I will be voicing what the ring does, how young women can benefit, educating the communities and rallying the young women to lead the advocacy and to be at the center for asking about this tool.
Even if it serves only one person, it makes a difference - Shakirah about the Dapivirine ring
What is needed to spearhead the introduction of the ring?
As civil society we need to move together with the government, be part of the programme design for roll out, monitor progress of commitments made, follow up and ask how as civil society we can work together. We need to sensitize communities of women and men to be involved in the push for the ring. That means giving true information, keep updating the information.
I don’t know how long it will take for the government to approve. But we are now starting our feet move. The government HIV prevention technical working group came up with a small task force to spearhead the ring introduction movement. They asked for a concept note to better understand how the Dapivirine ring works. The concept note will be shared for approval with the HIV prevention technical working group and the Ministry of Health respectively. From there we can start working on guidelines and necessary documentation. So hopefully by mid next year we should have at least the concept note approved.
How are PrEP implementation lessons in Uganda used for ring roll out?
We analysed what we have learned at that time so the ring roll out doesn’t take as long as it took for PrEP. One of the lessons is that in the beginning PrEP was seen as a key population tool. So now we try to share the information with as many people as possible.
Furthermore, the Dapivirine ring currently has a 35% effectiveness. When PrEP was introduced for the first time, it didn’t have the 95% it has now for efficacy. But through continuous research we are where we are now. That is something that we share with communities about the Dapivirine ring. We acknowledge the 35% and that ongoing research will allow the percentage to go up. With the open level studies, it’s is going up to 65%. It’s something that we use to encourage people.
What do you call upon your national authorities regarding Dapivirine?
We want to see regulatory approval for the Dapivirine ring roll out, and development and amendment of policies to support ring promotion and distribution within a comprehensive SRHR framework. This should include development of training modules for health workers on how to talk with women about the ring as a prevention tool.
We would like to see the Ministry of Health leaders educate themselves about the ring and be champions for introduction and adoption. They should be part of us.
We also would like to see the government increase budget allocations and also work together with development partners to implement the ring promotion and introduction. For young women, the ring should be for free.
Having it available in the pharmacy would be a very good idea, because more and more girls and young women are uncomfortable to access services from health centres. It would be very sad for us to push for the ring here in Uganda, and then it is approved and brought here but then young women can’t access it. It would be like washing and hanging in the dirt.
About Shakirah Namwanje
Shakirah Namwanje works as policy research and advocacy officer at the Uganda Network of AIDS Service Organisations (UNASO) and is a strong advocate for the Dapivirine ring. She is a young person living with HIV and a survivor of sexual abuse in childhood, that’s how she contracted HIV. Shakirah’s work is mainly centred around HIV prevention, as she would want to make sure that her HIV ends with her. She has never used the ring, but likes the idea that it gives young women protection. “It gives them the power to be in charge, which I never had.”