January

The latest report from UNAIDS that gains made in the fight against new HIV infections may be reversed ten years back is worrying. Every week this year, Kenya is recording 275 new HIV infections from adolescents and young women aged between 18 and 25 years. Although no research has been done, it is believed that girls younger than 18 are also getting infected.

Loss of incomes, schools closure, sickness and even deaths due to COVID 19 which continues to ravage the country since March 2020 have been pointed to as some of the reasons why there has been a spike in the numbers of girls who are contracting HIV. This is because adolescents and young women have turned to transactional sex to buy essentials like sanitary towels and even food, are engaged in cross generational sex due to early marriages to escape poverty, and some have been sexually violated.

“Unless all stakeholders come together and re-direct their efforts by doing everything necessary, we risk reversing the milestones made in fighting new HIV infections. If we are to attain our target of zero infections by 2030, we must ensure we are on the path to recording fewer cases of new infections,” said Rosemary Mburu, WACI Health Care CEO during a one day workshop dubbed ‘a conversation with young women and policy makers in Kenya in view of women initiated HIV prevention options’.

News that adolescents and young women can take charge of their own health and protect themselves from possible HIV infection is exciting. With a Silicon Ring laced with anti-retroviral drug Dapivirine, every sexually active woman has been afforded an opportunity to remain protected. The Ring which has been under research for 16 years received a positive opinion form European Medicines Agency (EMA) in July 2020 with the World Health Organisation (WHO) approving it for prequalification. It has already undergone phase I, II and III studies, and has been found to protect women from HIV infection at an over 50 percent rate for those who adhered to it as instructed. The ring is now into phase IV clinical trials, to ascertain its efficacy in mass population.

Once approved, adolescents and young women at their own privacy and convenience will have access to the first woman initiated HIV prevention option available for use. The Ring is designed to protect one for 28 days upon insertion to the cervix by releasing a daily dose of the Dapivirine drug to the cervix, making it effective for cisgender women only.

“The fact that I can protect myself from a possible HIV infection by using something which my sexual partner does not have to know I am using is empowering,” said one young woman who participated in the conference. Indeed, may other young women who attended the conference were grateful that for the first time, there is a product that has been developed with them in mind, and are looking forward to when the Ring will be made available in the country.
Joyce Ouma, a young HIV advocate urged all HIV negative adolescents and young women to embrace the Ring when it is eventually available, stating that whereas other options that exist are excellent, the Ring affords one the power to self- protect without having to negotiate for the same from a sexual partner. “Besides, since nobody plans to have sex, it is better to have something which will protect you for any in eventuality,” she added.
Indeed, although the Ring does not offer 100 percent protection from HIV, the consensus from the participants was that they were better of protected at some degree than remain exposed to the virus.

Scientists and Researchers are one trial closer to launching a woman’s first initiated HIV prevention option, the Dapivirine Ring. Years of research and three clinical trials are delivering the exciting reality of a product that a woman is in control of. Already, the Dapivirine Ring has received approval from World Health Organisation (WHO).
The ring which is developed by the International Partnership for Microbicides (IPM) is made of a flexible silicone matrix polymer contains the ARV Dapivirine, an NNRTI, which is slowly released over the course of a month. The ring delivers Dapivirine directly at the site of potential infection, with low systemic absorption. Women insert the flexible, long-acting ring themselves into the vagina and replace it every month.

Dr Nelly Mugo, while addressing participants in an event where young women and stakeholders met to discuss the innovation praised the Ring. A researcher with Kenya Medical Research Institute (KEMRI), Dr Mugo endorsed the product as an effective one, and was happy that women have yet another option in the basket of HIV prevention initiatives. “Africa remains hard hit by HIV, with young people accounting for half of all Africa’s infections. Women continue to be more vulnerable because of many factors such as their anatomy, social, cultural and even economic setbacks. That there is something which adolescents and young women can use without having to negotiate with anybody in order to protect themselves is a game changer in the world of HIV prevention research,” said Dr Mugo.
Maryann Mburu, WACI Health CEO, told the participants that the Dapivirine Ring when approved would go long way in helping prevent potential infections.

“At the moment, we risk reversing gains made in combating new HIV infections, if the numbers from UNAIDS is anything to by,” she said, adding that 275 girls are getting infected every week in Kenya. “These numbers are alarming and if there is anything we can do to stop the spread, then we must,” she added. Calling on all stakeholders to join hands and ensure that the Ring gets approved in Kenya, Mburu said that as much as the Ring does not deliver 100 percent protect from HIV infection, our adolescents and young women were better off with the Ring option than with nothing.

Same was echoed by Lydia Tuitai from Pharmacy and Poisons Board, who broke down the process of having a drug registered in Kenya. Ephasising on the need to ensure due process at all stages to ensure safety and efficacy, Lydia said once the Ring meets the board requirement, they would be excited to approve the Dapivirine Ring.

Maureen Inimah, a program officer at National AIDS and STD Control Programme (Kenya) (NASCOP) said that they were excited and open to more options that will help women protect themselves against HIV infections. NASCOP, which operates as a unit within the Ministry of Health and is mainly involved with technical co-ordination of HIV and AIDS programmes in Kenya promised to scale up youth friendly facilities so that when products such as the Dapivirine Ring finally comes in the country, Kenya’s adolescents and young women will find sensitized work force in the clinics. “In 2010, only seven percent of Kenya’s health facilities were youth friendly. This has in a way hindered effective service delivery to the same demography. Towards this, we are doing all we can to improve these numbers and to empower the service providers on how to interact with the young women seeking services from the clinics,” said Maureen.