The dapivirine vaginal ring, an alternative HIV prevention method for women, will soon be available in nearly a dozen countries in Africa. This is welcome news, as adolescent girls and young women are among the groups most at risk in sub-Saharan Africa. But the ring is not available to women in the United States, who also need more prevention options.

The antiretroviral ring is now approved or authorized for use in 11 countries in East and Southern Africa, according to a November 30 announcement from the Population Council and the International Partnership for Microbicides (IPM) South Africa.

It is currently being offered through more than 30 implementation and pilot studies in Eswatini, Kenya, Lesotho, South Africa, Uganda and Zimbabwe, and it will soon be available in Botswana, Malawi, Namibia, Rwanda and Zambia. More than 113,000 rings, marketed as DapiRing, have been sold as of September 2023.

The ring is currently produced by a company in Sweden, but Kiara Health, a South African pharmaceutical company, aims to set up local manufacturing capability, which should improve access and lower costs.

The flexible silicone ring, which is worn in the vagina for a month at a time, slowly releases dapivirine, a non-nucleoside reverse transcriptase inhibitor. Research has shown that the ring is safe and moderately effective. Studies suggest that effectiveness can reach 75% with optimal adherence.

However, as oral and injectable pre-exposure prophylaxis (PrEP) have raised the bar, vaginal rings and other topical microbicide products don’t appear to be in the same league. For this reason, the IPM withdrew the dapivirine ring from Food and Drug Administration consideration in 2022, after receiving feedback that current data are unlikely to support U.S. approval. 

Researchers and advocates stress that women need multiple HIV prevention tools—especially discreet options they can control themselves—as they now have for contraception. Some women find it difficult to take a PrEP pill every day, or they may not want to have pill bottles that could reveal that they’re concerned about acquiring HIV, potentially subjecting them to stigma or even violence. Others, especially those in poor or rural areas, may not be able to attend a clinic for PrEP shots every two months.