HIV Prevention Meets the Vaginal Ring

New data from two clinical trials confirm suspicions that vaginal ring HIV prevention works better than originally observed.

Since 2012 and the launch of the ASPIRE trial, researchers have been hopeful that monthly dapivirine-containing vaginal rings will be the next great tool in the HIV prevention toolbox. In the last few days, recent data out of UNAIDS and the 25th Conference on Retroviruses and Opportunistic Infections (CROI) suggest that vaginal ring HIV prevention is effective in a remarkable 54% of people enrolled (HOPE, DREAM trials). Not only that, but data also suggest that about 90% of participants used the ring at least some of the time throughout every month. In HIV/AIDS work, adherence has long been a vital measure of success.

From an LGBTQ+ perspective, however, these studies are imperfect. Transwomen with neo-vaginal tissue, who have historically been excluded from participation in these trials, are left with incomplete evidence. Additionally, it is unclear how dapivirine vaginal rings offer or do not offer protection from HIV in folks with vaginas who engage in anal intercourse. (Study investigators have commented that they believe systemic protection to be unlikely in this situation.)

The positive argument is this: talking about vaginas and HIV prevention engages people who have historically been left behind in a field directed mostly at gay, cisgender men. There is no doubt that these reports represent an expansion of the HIV prevention landscape. However, this research must be built, conducted and disseminated in a way that gives service providers the tools and language they need to empower decision-making in all consumers, regardless of gender expression or sexual preferences.