Vaginal insertion and partial efficacy are two challenges that could affect the uptake and continued use of the dapivirine ring. Analyses of the introductions of other products that share similar characteristics provide useful lessons to inform planning for rollout of the dapivirine ring. This paper provides information for planners, implementers, funders, researchers, trainers, providers of technical assistance and others to build an agenda for introducing the dapivirine ring that addresses these two challenges.
HIV prevention interventions
The Priorities for Local AIDS Control Efforts (PLACE) method aims to improve our understanding of the drivers of local HIV epidemics, identify gaps in services available to those most likely to acquire and transmit HIV, and provide evidence to support tailored interventions to reduce transmission. Achieving this goal is a challenge because many people don’t know they have the virus, making the local pattern of new infections almost impossible to detect.
Young women who have sexual relationships with older men often are dealing with inequitable power dynamics, little capacity to negotiate safe sex or to refuse sex, and—therefore —a greater risk of acquiring HIV. In sub-Saharan Africa, adolescent girls and young women are disproportionately affected by HIV, which has led to a heightened emphasis on understanding the characteristics of their male sexual partners. It also points attention to the fact that men are less often reached with HIV testing, care, and continued treatment—the 90-90-90 HIV care cascade.
Several meta-analyses and systematic reviews of the literature examining factors associated with care entry, engagement and retention show that optimal lifelong engagement in HIV care can be threatened by a range of factors at the individual, social, and structural levels. Mobility affects many of the factors found to contribute to delayed entry or lapses in care, including psychological factors (e.g. seeking care away from home because of stigma), clinic characteristics (e.g.
HIV is not the only risk – using condoms or getting tested can pose risks to trust and relationships
In many settings with high HIV prevalence, fertility rates are also high and women spend a significant proportion of their reproductive years pregnant, postpartum, or breastfeeding. Some, but not all, studies have demonstrated significantly higher HIV incidence during pregnancy. Per sex act analyses contribute an understanding of the absolute and relative risks of HIV transmission, and can provide insight into whether increased risk during pregnancy and postpartum is attributable to biological or sexual behavior changes.
High risk exposure to HIV among sexually active individuals who tested negative on rapid HIV Tests in the Tshwane District of South Africa—The importance of behavioural prevention measures
This study sought to assess the prevalence of HIV risk behaviour among sexually active HIV sero-negative individuals in the Tshwane district of South Africa. The study found that a large segment of sexually active people in the Tshwane district of SA have high risk exposure to HIV. The detection of newly diagnosed HIV infections in all study clinics reflects a wide distribution of individuals who are capable of sustaining HIV transmission in the setting where HIV risk behaviour is highly prevalent.