If we can put a man on the moon...

By Georgina Caswell

I’ve been an advocate for the sexual and reproductive health and rights of women for ten years. And in those ten years, we have seen exciting developments.

GeorginaWe have more shapes, sizes, colours, flavours and types of both male and female condoms. We’ve learnt that when used consistently and in the absence of sexually transmitted infections, anti-retrovirals can keep people living with HIV healthy and prevent the transmission of HIV to sexual partners who are HIV-negative (‘treatment as prevention’). We’ve also learnt that anti-retrovirals can be used by people who are HIV-negative to prevent them from getting HIV (‘pre-exposure prophylaxis’/‘PreP’).

At the same time, we’ve become increasingly aware how diverse women’s lives and contexts are and that effective HIV prevention is complicated. I work on a project called Link Up with young people who are living with and most affected by HIV. In Link Up, Nadia, a young woman living with HIV in Burundi, can tell us from her work around female condoms about unequal power in sexual decision-making, with men dominating and women needing to please their partners, women find it difficult to negotiate condom use, which is often perceived as reducing sexual pleasure or perceived as a lack of ‘real’ love and trust. Azalech, a young sex worker and peer educator in Ethiopia can tell us how young women regularly feel they must make decisions to have sexual relationships, often with older men for money or to access material goods such as clothes and cell phones, and often without knowing their HIV-status, their sexual partner’s status and without the use of condoms. Cindy, a young transgender woman in Uganda, can tell us about sexual minorities who are afraid and uncomfortable openly accessing HIV prevention information and services for fear of stigma and discrimination in health facilities and in their broader communities.

condoms
In Africa young women ages 15-24 are most affected by HIV than any other population. In some parts of the continent, young women are more than four times as likely to contract HIV as young men. Yet the prevention methods currently available aren’t doing enough to stop the alarming rates of infection amongst women in sub-Saharan Africa.

Within this context it is so exciting to hear today that two large studies —The Ring Study and ASPIRE — have shown that, for the first time, a monthly vaginal ring can safely help protect women from contracting HIV. The Ring Study, led by the International Partnership for Microbicides, found that a vaginal ring containing the ARV drug dapivirine reduced HIV infections in women by 31%. Its sister study, ASPIRE, led by the Microbicide Trials Network, showed a similar reduction by 27%. Higher efficacy was achieved among women who were able to use the ring most consistently. Both studies also found the ring to be safe.

In 1990, a woman in Uganda asked the question, ‘if they can put a man on the moon, why can’t they make something we can use to protect ourselves from HIV?’. 25 years later, we are working to extend our package of HIV prevention options for women. We have female and male condoms, anti-retrovirals for the health of people living with HIV and for prevention and now we may have a monthly vaginal ring that women will be able to use to help protect themselves.

We want and need more HIV prevention tools for women. It’s vital that African governments facilitate the necessary regulatory approvals to ensure that the ring makes it into our hands. They must continue to push for and support ongoing research so that we can build on today’s results, work on different versions of the ring and address the multiple prevention needs of women at different times in our lives.