By Sharon Atieno

An expert has called on young girls and women to take up the wide range of protections that fit their diverse lifestyles to check on the increase of HIV cases.

While addressing the media at a science café organized by the Media for Environment, Science, Health and Agriculture (MESHA), Prof Kenneth Ngure stressed.

Prof. Kenneth Ngure giving a presentation at the MESHA cafe

Adolescent girls and young women (AGYW) are at a higher risk of acquiring human immunodeficiency virus (HIV) than their male counterparts hence the need for them to pick on a wide range of protection methods that fit their diverse lifestyles.

According to United Nations Children Emergency Fund (UNICEF), young women are more than twice as likely to acquire HIV as young men; every year since 2010 they have made up 67 percent of new infections among adolescents.

Young women between the age of 15-24 years account for 30 percent of new adult infections in sub-Saharan Africa. While young women are twice as likely to acquire HIV infection than young men, women who experience intimate partner violence and sexual assault are 1.5 times more at risk of HIV infection.

Though the oral pre-exposure prophylaxis (PrEP) has been found to be more than 90 percent effective in preventing HIV, it has not had a significant impact on the HIV incidence among AGYW as adherence is still a problem for some.

Studies carried out on PrEP among African women ages 16-24 years in Kenya and South Africa, disclose that about half do not return after the first month and 20 percent restart within 3 months.  They also revealed that discontinuation due to adverse effects such as diarrhoea and nausea as well as challenges with adhering to a daily pill regimen was common during first month of use.

In his remarks at the thirteenth MESHA café held in Nairobi recently, Prof. Ngure, a HIV researcher, noted that sometimes, women do not perceive themselves at risk of HIV hence fail to adhere.

In order to increase adherence among women, the vaginal ring which will be the first biomedical prevention method exclusively for women has been developed. The vaginal ring contains an antiretroviral (ARV) drug called dapivirine, and is meant to be used on a monthly basis, upon approval by the European Medical Authority.

In 2016, two major clinical trials- The Ring Study and ASPIRE- revealed that the monthly vaginal ring reduces women’s risk of HIV-1 by approximately 30 percent overall and was well tolerated with long-term use. Moreover, HIV risk was decreased by 45 percent among participants who used the ring at least some of the time.

Further analysis of the ASPIRE data reported at AIDS 2016 found the level of HIV protection to be no less than 56 percent with regular use and as high as 75 percent or more with almost perfect use.

“With PrEP being made available in many countries and the possibility that the ring will be approved, we want to see that these products can work for and be made available to women and girls of all ages at risk of HIV acquisition, who both need and deserve methods of protection that are in their control,” noted Lulu Nair, protocol chair of the REACH study and clinical research site leader at the Desmond Tutu HIV Centre, South Africa.

In 2017, a study seeking to find out how safe and acceptable the ring is for teen girls was carried out in the United States of America on girls aged 15-17 years. The results indicated that the ring was safe and adherence was high and that majority of the participants (93 percent) liked the ring.

A related study is underway in Africa for approximately 300 adolescent girls and young women ages 16-21 years at five Microbicide Trials Network (MTN) – affiliated sites in Kenya, South Africa, Uganda and Zimbabwe.

According to Prof Ngure, the Reversing the Epidemic in Africa with Choices in HIV Prevention (REACH) study is designed to fill important gaps in information about the safety and acceptability of the dapivirine ring and oral PrEP, including in girls as young as 16.

The REACH study set to run for 18 months, will also evaluate how AGYW use the ring and PrEP and their preferences for either or both approaches.

“No product can protect against HIV if it is not used, women need prevention strategies that meet their individual needs and fit their lifestyle. Choice is important for effective use: uptake, persistence and adherence,” Prof.Ngure said.

For the number of HIV infection to reduce among the youths, the preferences of adolescent girls and young women to prevention strategies have to be taken in to consideration.

“By making different prevention options available, it increases the chances of adherence thus reducing the rate of infections,” added Prof Ngure.