Original Paper

AIDS and Behavior

, Volume 16, Issue 7, pp 1775-1786

First online:

High Acceptability of a Vaginal Ring Intended as a Microbicide Delivery Method for HIV Prevention in African Women

  • A. van der StratenAffiliated withWomen’s Global Health Imperative, RTI InternationalCenter for AIDS Prevention Studies, Department of Medicine, University of California San Francisco Email author 
  • , E. T. MontgomeryAffiliated withWomen’s Global Health Imperative, RTI International
  • , H. ChengAffiliated withWomen’s Global Health Imperative, RTI International
  • , L. WegnerAffiliated withWomen’s Global Health Imperative, RTI International
  • , G. MasengaAffiliated withKiliminjaro Christian Medical Center
  • , C. von MollendorfAffiliated withWits Reproductive Health and HIV Research Institute
  • , L. BekkerAffiliated withUniversity of Cape Town and Desmond Tutu HIV Foundation
  • , S. GaneshAffiliated withSouth African Medical Research Council
  • , K. YoungAffiliated withInternational Partnership for Microbicides
    • , J. RomanoAffiliated withNWJ Group, LLC
    • , A. NelAffiliated withInternational Partnership for Microbicides
    • , C. WoodsongAffiliated withInternational Partnership for Microbicides

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Vaginal rings (VRs) are new methods for continuous delivery of microbicides. This is the first study to quantitatively and qualitatively explore the acceptability of rings in Africa: 157 HIV-negative, sexually active women aged 18–35 used a placebo silicone elastomer ring for 12 weeks. They completed product acceptability questionnaires every 4 weeks. We conducted 6 exit focus group discussions with a subset of 48 women and 19 in-depth interviews with male partners. Retention in the study was high (97 %). Initial insertion at the clinic was successful on first attempt for 81 % of participants. Most women were comfortable using the ring, and very few (≤2 %) could feel it during daily activities or had ring-related physical or emotional problems. In the qualitative interviews many participants reported that they initially had concerns about using the ring. However, only a minority of women actually reported concerns with the ring during the study. The most frequent concern was that the ring would get lost inside the body (20 %), and this was significantly correlated with study site, frequently thinking about the ring and reporting that the ring was not very easy to remove. Qualitative data suggest that informants grew to like the ring because it felt securely placed, was unnoticeable during daily activities, and felt “normal” during sex. The ring appeared to be highly acceptable for women and men. Initial concerns with this novel method suggest a need for enhanced product counseling when VRs are introduced.


Vaginal ring Microbicide HIV/STI prevention Acceptability Africa