Q&A: Testing a microbicide ring for HIV prevention

Dr. Zeda Rosenberg (below) has been CEO of International Partnerships for Microbicides (IPM) since its founding in 2002. IPM's mission is to prevent HIV transmission by accelerating the development and availability of safe and effective microbicides for use by women in developing countries. In June, IPM announced that an efficacy and safety study of a new vaginal ring containing the ARV dapivirine was underway in Africa. Dr. Rosenberg talks to GlobalPost about the ring, the theory behind it, and why it could be an important tool to empowering women and stemming the HIV epidemic in Africa.

Q: How long will this trial last?

A: The trial will last likely a total of three years. All of the women in our studies will receive product for a total of two years with a follow-up visit after that and it will likely take up to a year to enroll.

Q: Can you explain why it is so revolutionary for women in Africa?

A: We know that women are still at very high risk of HIV infection. Historically women have borne the brunt of the HIV/AIDS epidemic. They are more susceptible to infection than men during sex. And if you combine that with all of the issues surrounding women’s lives that may make them unable to negotiate condom use or other well-established HIV prevention tools, it means that women really need something that they have under their control. So the notion of a microbicide was that women can decide that they want to protect themselves and use a product themselves, rather than trying to get their male partner to use a condom or to accept the use of a female condom.

Q: Women ages 15-24 are at least twice as likely to be infected with HIV than men. Why is this?

A: Yes, it is very true and it’s because if you look at the infection rates, even in younger women and younger men, that same ratio occurs. It’s likely because younger women partner with older men, and older men are more likely to be HIV-infected because they have been sexually active for longer periods of time, and then they have relationships with younger women, either because many older men partner with younger women, or because older men are more likely to have money, and often younger women need financial support.

Q: How do you expect the ring study to be a game changer in southern Africa?

A: Well, it will be an additional tool that can be added to the HIV prevention mix. It is something that women can use for a month at a time so they don’t have to necessarily be prepared to have HIV prevention when they’re having sex. With a condom, you need to have a condom with you, you need to negotiate it at the time of sex, and with some other strategies you may need to have it available with you daily. In many instances, there are women who can’t predict when or even if they are going to have sex, and so a ring that can be worn a month at a time would allow women the option of protection without necessarily having to figure out how to do it at the time of sex.

Q: The ring doesn’t protect against other STDs. So other STDs and pregnancy would have to be avoided in another way?

A: That’s correct currently, but I should let you know that we are also developing a combination dapivirine contraceptive ring. So the goal will be that once the dapivirine ring is had been proven safe and effective and it’s licensed for use, there will be a product coming right behind it that combines dapivirine with a hormonal contraceptive.

Q: What motivated you to get involved in this work in the first place?

A: [HIV/AIDS] is something that, from a scientific perspective, is incredibly important. Obviously it has become one of the most important pandemics of human history, but also from the perspective of being a woman, a woman scientist, and a feminist from nearly birth, it was clear that woman were going to bare the brunt of this epidemic just from knowing the biology of transmission of HIV. And it really was many women activists around the world who, in the late 1980’s, very early 1990’s, put out a call to action to scientists to please do something. Think about ways that we can start helping women, because it was predictable that women would be at a greater risk of infection. A number of us out there were thinking a lot about this, and so it was just something that I gravitated to naturally.

Timeline: Women Fight Against AIDS