Vaginal Ring Protects Women From HIV — When They Use It

An insertable ring that slowly releases an HIV-fighting drug can cut in half the risk a woman will get infected — if the woman uses it, researchers reported Monday.

The results are mixed news for efforts to provide women with a discreet way to protect themselves against the fatal and incurable virus. They show that a product can safely work, but they raise the question of whether people can or will use the product correctly.

"This is the first demonstration of a sustained-release approach for HIV prevention," Dr. Jared Baeten of the University of Washington, who led one of two studies on the ring, told reporters.

The vaginal ring reduced the risk of HIV infection by 27 percent on average in more than 2,600 women Baeten's team studied in four hard-hit African countries. But it lowered the risk of infection by 61 percent among women aged 25 and older, the team said in a report published in the New England Journal of Medicine and that will be presented at the Conference on Retroviruses and Opportunistic Infections in Boston.

While a 27 percent rate of protection may seem low, Annalene Nel of the International Partnership for Microbicides, which makes the rings and which ran a second, similar trial, says that can add up quickly in some African communities where 80 percent of adults end up infected.

"If we don't change the current prevention paradigm ... more than half the women in the communities where the study took place would likely become HIV infected over the next decade," Nel told a news conference.

More study showed that the youngest women in the study hardly used the ring at all. They had very little of the drug, dapirivine, in their systems and study of the rings themselves showed most of the drug remained in the plastic.

The older a woman was, the more likely she was to use the ring as intended.

The rings are meant to be inserted once a month and then left in place, essentially forgotten, and so the researchers are struggling to figure out why the younger women apparently took them out.In Nel's study, the ring only reduced the risk of catching HIV by 15 percent in the women aged 18 to 21. In Baeten's study, the protection rate was only 10 percent in women under 25.

"The advantage to a ring is it can just stay there and you don't have to think about it," said Bethany Young Holt, executive director for the Initiative for Multipurpose Prevention Technologies at the Public Health Institute, who was not involved in either study.

"For some women, their partners can feel it." Those women may have removed the rings, Holt said.

Experts agree that women desperately need something better than condoms to protect themselves from HIV. More than half the 35 million people infected with HIV globally are women, and many live in communities where they cannot refuse to have sex with men, even their husbands.