Other than the female condom and Pre-Exposure Prophylaxis (PrEP)—a daily pill packed with AIDS medications that’s proven to prevent HIV— there aren’t that many prevention methods that HIV-negative women have total control over.
And still, many African-American women don’t use either one. While the female condom is popular in developing countries, it hasn’t really caught on in the States and PrEP has been mostly been marketed to gay and bisexual men, leaving the ladies out of the conversation. Now, looking at our disproportionate HIV rates, it’s obvious why this is a serious problem.
Yes, there’s the male condom, but not everyone uses them. That, and studies have shown that women don’t usually control condom use—men do. And while may be in relationships where their opinions about contraception matter (i.e. “No glove, no love”), not every Black woman in America has that luxury. For some, negotiating condoms means not having diapers for their baby, lights on in their house or a roof over their head. And in too many instances, just to utter the word “condom,” can be an extremely dangerous act if they are in an abusive relationship.
And while our HIV rates have gone down over the past few years—thanks to heightened awareness, testing initiatives and increased funding—they are still too high. So what else can help women gain more control?
Enter: The monthly vaginal dapivirine ring.
Ringing In a New Prevention Tool
It’s concept is pretty simple: Like the monthly hormonal birth control Nuvaring, women can insert the silicon vaginal dapivirine ring inside their vaginas and overtime, it will release the antiretroviral dapivirine into their bodies to help protect them against the HIV virus. And the two existing studies about this ring—conducted by the Microbicide Trials Network and the International Partnership for Microbicides—have been pretty promising.
According to Dr. Zeda Rosenberg, the CEO of International Partnership for Microbicides, her team found that after testing the ring on 4,500 women living in sub-Saharan Africa, it was highly effective in preventing HIV transmission.
“Overall, it reduced HIV infection by 30 percent, which isn’t high,” Rosenberg admitted to HelloBeautiful. “But when we looked at the women who used it correctly and consistently, they had much higher success,” Rosenberg told.
How much higher?
Well, the media has reported that the dapivirine ring can reduce a woman’s risk up to a whopping 70-80 percent, but Rosenberg explained that she’s not comfortable owning that number because it’s not “statistically robust.” However, she did stress that they “are confident that the ring works if used properly” and that they are “excited” about the future.
Beyond efficacy, the dapivirine ring can withstand an environment conducive for women living on the margins. It doesn’t need any fancy storage or refrigeration and it has a shelf life of well over four years at room temperature. Studies also found that women said the ring was comfortable, easy to reinsert, enjoyable during sex and they didn’t experience out of ordinary vaginal issues or infections. Plus, after wearing the ring for roughly two years, researchers cite that weren’t any serious safety issues or side effects.
But most important, the women felt in control and the ring was discrete, which helps those who are victims of gender violence.
So When Can The Sistas In The States Use It?
Unfortunately, this is where it gets complicated.
According to Rosenberg, currently they are conducting more research around it, but they plan on sending paperwork to the regulatory authorities in 2017 and will most likely get an answer in mid 2018. But even if they get approved, their funding and scope are only geared for women in the developing world. This unfortunately means that African-American women could lose out on this cutting edge prevention, which is infuriating given how wealthy and resourceful this country is—a ring like this should have already been in the works.
But Rosenberg assures that not all is lost. “I believe the best way to meet the needs of American women could be developing a ring that prevents pregnancy and HIV,” she says. And the good news is that the International Partnership for Microbicides is developing that type of ring as we speak. But it’s not even in the clinical trial phase yet and the project needs funding.
And while some may argue that African-American women could easily benefit from a ring solely geared for HIV prevention, Rosenberg could be on to something. Perhaps if the HIV/AIDS and women’s health sectors came together to flex their joint-power, a vaginal ring could be fast-tracked domestically. But as Marsha Jones, Executive Center of the Afiya Center, a reproductive justice organization in Dallas, Texas, points out; those collaborations have been few and far between.
“Too often, these groups work separately in their worlds, when in fact HIV, reproductive justice and reproductive health all go hand in hand,” Jones told HelloBeautiful.
“The same reason a woman walks into a clinic to have an abortion, is the same reason why she’s at risk for HIV. This ring could provide an exciting opportunity for us to finally come together and actually get some work done,” she added.
Now hypothetically if this “work” got done—it passes the clinical trial phase, gets approved by the proper channels in the U.S. and is massed produced —that would be great, but it’s just the beginning.
Realistically, there could be some serious barriers under a Trump presidency. His administration, which consists of many white supremacists and evangelicals, continues to dangerously view the AIDS epidemic as a moral issue instead of a public health crisis. Based on their campaign platform, Team Trump’s non-scientific and non-empathetic attitudes could translate into very little funding—if any—being allocated to help low-income women pay for the ring, which is especially frightening given that the state of Obamacare, Medicaid and CHIP is currently hanging in the balance.
In addition, where would Black women go to get the ring? Granted in the South, the epicenter of the AIDS epidemic, access to reproductive health services is already scarce, but under new GOP rule, that access will likely worsen, having widespread effects for women across the country that solely rely on these clinics for care.
But the looming new administration isn’t the only thing potentially standing in the way.
“Definitely the ring’s potential and the science around it is exciting, but its success rests on a lot of factors including making sure that the people doing the outreach and education look like the people its being marketed to, which doesn’t always happen,” Jones says.
“Our people don’t always trust the medical community, so it’s important that Black advocates are on the forefront providing information and answering [Black women’s] questions and affirming their concerns.”
Angela L. Green, MPH, an HIV public health consultant in Oakland, CA, agrees.
“We don’t practice health care, we practice sick care—a lot of Black folks don’t see a doctor until they end up in the ER. And a big part of that is due to historical mistrust, so we’re going to need a lot of transparency and education in order to get our community on board,” she said.
But for Kimberly Parker, an assistant professor and HIV/AIDS activist in Dallas, in order for Black women to even be in a room to be educated about this prevention tool, they first have to admit that they’re at risk.
“Studies have shown that [we] underestimate our risk for transmission. Given that heterosexual sex is our main mode of HIV transmission, some just don’t believe their man could have HIV and so they just don’t worry about or think it can happen to them,” Parker told HB.
She also blames misinformation, stigma and denial of contracting HIV from someone they love, for this disconnect.
“But either way,” she says, “Without this realization of risk, the women that would really benefit from the ring, won’t.”
And for some advocates including Dr. Rachael Ross, family physician, sexologist and former co-host of the talk show The Doctors, there are real concerns about ring’s long-term effects (data that we don’t have) and whether or not HIV advocates focus too much on bio-medical interventions to address prevention.
“I’m not mad at PrEP or the ring, I just hope that we can continue to grow as a community where more of our prevention techniques can include behavioral interventions and social [justice work] that address why we’re at risk in the first place.”
In the end, there’s one thing that everyone can agree on: In order to bring HIV rates down, Black women need and deserve more tools in their HIV prevention toolbox. And in order for that become a reality, it’s clear that there’s a lot more work to be done.
Learn more about HIV/AIDS in Black America and how to protect yourself at cdc.gov.