Impact of the Dapivirine Vaginal Ring on Sexual Experiences and Intimate Partnerships of Women in an HIV Prevention Clinical Trial: Managing Ring Detection and Hot Sex

Abstract

Vaginally-inserted HIV prevention methods have been reported to impact the sexual experience for women and their partners, and hence impacts acceptability of and adherence to the method. We analyzed in-depth interviews and focus group discussions about participants’ sexual experiences while wearing the ring, collected during the MTN-020/ASPIRE phase 3 safety and effectiveness trial of a dapivirine vaginal ring for HIV prevention in Malawi, South Africa, Uganda, and Zimbabwe. Most women reported that partners did not feel the ring during sex, however, women felt they had to manage their partners’ interaction with or reaction to the ring. In maintaining positive relationships, women were concerned about partners’ discovering ring use and about ensuring that partners had a good sexual experience with them. Finally women were concerned about how they themselves experienced sex with the ring. Some found that the ring made the vaginal environment more desirable for their partners and themselves.

End‐user preference for and choice of four vaginally deliveredHIVprevention methods among young women in South Africa and Zimbabwe: the Quatro Clinical Crossover Study

“…Nevertheless, biomarkers of adherence and qualitative data indicate that some women do not consistently use the ring, in particular young women. Consistent with previous trials of candidate microbicide gels and cervical barriers, ring nonadherence may have been caused by various contextual reasons such as perceived interference with sex, menses, short-term periods of abstinence and nondisclosure to male partners [9][10][11][12][13][14]. As with oral PrEP, and other antiretroviral-based approaches in development, use of a licensed dapivirine ring would require regular clinic visits and monitoring.…”

The Tablets, Ring, Injections as Options (TRIO) study: what young African women chose and used for future HIV and pregnancy prevention

“…One possible interpretation is that a private room may be necessary to be able to insert or remove the ring, whereas swallowing a pill can be done anywhere. Greater disinterest for the ring among nulliparous women may be associated with a concern that the ring may impact fertility or stretch the vagina, worries expressed previously by young ring users in a clinical trial .…”

A Qualitative Systematic Review of Women's Experiences Using Contraceptive Vaginal Rings: Implications for New Technologies

“…This review of qualitative research contributes to our understanding of how women approach currently available contraceptive rings and offers lessons for investigational anti‐HIV and multipurpose prevention rings. Our work contributes to ongoing efforts to integrate in‐depth user feedback and to explore product acceptability earlier in the product development and clinical trial pipeline. Preclinical qualitative studies, and basic science studies comparing the characteristics of various ring prototypes, require time and interdisciplinary design efforts, but the richness of the data that emerge has the potential to alter the course of how we approach product design and promotion.…”