Low Adherence to Dapivirine Vaginal Ring Linked With Social Harms by Male Partners

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Social harms from male partners can represent an important barrier to HIV prevention product use.
Social harms from male partners can represent an important barrier to HIV prevention product use.

Low adherence by females to use of the dapivirine vaginal ring may be the result of social harms by male partners, according to a study published in the Journal of Acquired Immune Deficiency Syndrome.1

The dapivirine vaginal ring provides long-acting protection against human immunodeficiency virus (HIV)-1 acquisition when used consistently.2-4 To maximize the potential public health effect of this device, researchers sought to identify whether partner-related social harms (defined as nonmedical adverse consequences of study participation or dapivirine ring use) may impede women's uptake and consistent use of the product.1 They found that in 2629 women, 85 (3.2%) reported partner-related social harms over a median follow-up of 1.6 years. 

The majority of partner-related social harms were reported to have minimal impact on quality of life; however; 26 cases resulted in physical harm to the study participant. Common triggers of social harms included discovery of the ring during sex or foreplay (n=23), partner notification of a sexually transmitted infection (n=4), and partner suspicion that the ring was associated with witchcraft, promiscuity, or ill health (n=16). The most common consequences were removal or destruction of the ring by the partner, physical and verbal violence, and/or relationship dissolution. While women were significantly more likely to have low adherence at visits with a social harm in the past month, there was no association for social harms reported 1 month or more prior, suggesting an acute short-term effect. In addition, women were significantly more likely to not return a ring at visits where social harms were reported.

“Social harms from male partners can represent an important barrier to HIV prevention product use” concluded the study authors.1 They also noted that “HIV prevention interventions that engage women, men, and couples with concomitant behavioural (eg, counselling, support services) and biomedical (eg, ring, oral [pre-exposure prophylaxis]) components may be efficient public health investments.”

References

  1. Palanee-Phillips T, Roberts ST, Reddy K, et al. Impact of partner-related social harms on women's adherence to the dapivirine vaginal ring during a phase III trial [published online September 18, 2018]. J Acquir Immune Defic Syndr. doi: 10.1097/QAI.0000000000001866
  2. Baeten JM, Palanee-Phillips T, Brown ER, et al. Use of a vaginal ring containing dapivirine for HIV-1 prevention in women. N Engl J Med. 2016;375(22):2121-2132.
  3. Nel A, van Niekerk N, Kapiga S, et al. Safety and efficacy of a dapivirine vaginal ring for HIV prevention in women. N Engl J Med. 2016;375(22):2133-2143.
  4. Brown E, Palanee-Philips T, Marzinke M, et al. Residual dapivirine ring levels indicate higher adherence to vaginal ring is associated with HIV-1 protection. Presented at: 21st International AIDS Conference (AIDS 2016); July 18-22, 2016; Durban, South Africa. Abstract TUAC0105LB 2016.
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