Skip to main content

Men’s Sexual Experiences with the Dapivirine Vaginal Ring in Malawi, South Africa, Uganda and Zimbabwe


The dapivirine vaginal ring has been well-tolerated and shown to prevent HIV in clinical trials. The ring is female initiated, yet endorsement for use is sought from male partners in many relationships. In clinical studies, participants have expressed worries about men detecting rings during vaginal sex, which introduces concerns about product use disclosure, sexual pleasure, penile harm, inter-partner dynamics, and ring removals. This study reports African men’s firsthand sexual experiences with the ring. Qualitative data were captured through 11 focus group discussions and one in-depth interview with 54 male partners of ring-users at six research sites in Malawi, South Africa, Uganda and Zimbabwe. Following a semi-structured guide, and using demonstration rings, vulva and penis models, men were asked to discuss the ring’s impact on sex and views on male engagement and ring use. Interviews were facilitated by local male social scientists, audio-recorded, translated into English, and analyzed thematically. 22 (41%) of the male partners reported feeling the ring during sex, often attributed to perceived incorrect insertion. Many men described the ring as “scratching” the tip of their penises, and sensations of “prodding” something that “blocked” the vagina and prohibited “full entry”. In most cases, feelings dissipated with time or when sexual fluids increased. Less common descriptions included perceiving the vaginal texture, wetness and size as different, which increased pleasure for some, and decreased for others. Over half (59%) never noticed the ring; some attempting and failing to feel it during intercourse. A majority of men reported that the ring did not lead to changes in sexual positions, feelings, frequency or experience of sex, although some were initially afraid that the ring was a “magic snake” or “potion”. Male partners expressed strong opinions that ring use was a shared prevention responsibility that men should be engaged in, especially for maintaining trust and open communication in relationships. The ring was noticed by many male partners, particularly during women’s initial stages of ring use, although this led to few sexual problems or changes. Nevertheless, results suggest that risk of ring discovery should be discussed with women to mitigate any potential negative reactions or social harm. Strategies to increase male partner engagement will enhance support of this prevention method for women.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. Nel A, van Niekerk N, Kapiga S, Bekker LG, Gama C, Gill K, et al. Safety and efficacy of a dapivirine vaginal ring for HIV prevention in women. N Engl J Med. 2016;375(22):2133–43.

    CAS  Article  Google Scholar 

  2. Baeten JM, Palanee-Phillips T, Brown ER, Schwartz K, Soto-Torres LE, Govender V, et al. Use of a vaginal ring containing dapivirine for HIV-1 prevention in women. N Engl J Med. 2016;375(22):2121–31.

    CAS  Article  Google Scholar 

  3. Brown ER, Hendrix CW, van der Straten A, Kiweewa FM, Mgodi NM, Palanee-Philips T, Marzinke MA, Bekker LG, Soto-Torres L, Hillier SL, Baeten JM; MTN-020/ASPIRE Study Team. Greater dapivirine release from the dapivirine vaginal ring is correlated with lower risk of HIV-1 acquisition: a secondary analysis from a randomized, placebo-controlled trial. J Int AIDS Soc. 2020;23(11):e25634.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  4. Baeten TP-P J, Mgodi N, Ramjee G, Gati B, Mhlang F, Hunidzarira P, Mansoor L, Siva S, Govender V, Makanani B, Naidoo L, Singh N, Nair G, Chinula L, Mayo A, Szydlo D, Soto-Torres L, Nell A, Rosenberg Z, Hillier S, Brown E 2019 MTN-025/HOPE study team. High adherence and sustained impact on HIV-1 incidence: final results of an open-label extension trial of the dapivirine vaginal ring. IAS 2019; Mexico City, Mexico

  5. Nel A 2019 Safety, adherence and HIV-1 seroconversion in DREAM-an open-label dapivirine vaginal ring trial [Abstract]. 9th SAAIDS Conference, Durban, South Africa

  6. Montgomery ET, Stadler J, Naidoo S, Katz A, Laborde N, Garcia M, et al. Reasons for non-adherence to the dapivirine vaginal ring: results of the MTN-032/AHA study. Aids. 2018.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Montgomery ET, van der Straten A, Cheng H, Wegner L, Masenga G, von Mollendorf C, et al. Vaginal ring adherence in sub-Saharan Africa: expulsion, removal, and perfect use. AIDS Behav. 2012;7:1787–98.

    Article  Google Scholar 

  8. Montgomery ET, van der Straten A, Chitukuta M, Reddy K, Woeber K, Atujuna M, et al. Acceptability and use of a dapivirine vaginal ring in a phase III trial. AIDS. 2017;31(8):1159–67.

    CAS  Article  Google Scholar 

  9. Laborde ND, Pleasants E, Reddy K, Atujuna M, Nakyanzi T, Chitukuta M, et al. Impact of the dapivirine vaginal ring on sexual experiences and intimate partnerships of women in an HIV prevention clinical trial: managing ring detection and hot sex. AIDS Behav. 2017;22(2):437–46.

    Article  Google Scholar 

  10. Drug database: Dapivirine - health professional version 2020. Available from:

  11. Chitukuta M, Duby Z, Katz A, Nakyanzi T, Reddy K, Palanee-Phillips T, et al. Negative rumours about a vaginal ring for HIV-1 prevention in sub-Saharan Africa. Cult Health Sex. 2019;21(11):1–16.

    Article  Google Scholar 

  12. Duby Z, Mensch B, Hartmann M, Montgomery E, Mahaka I, Bekker L-G, et al. Achieving the optimal vaginal state: using vaginal products and study gels in Uganda, Zimbabwe, and South Africa. Int J Sex Health. 2017;29(3):247–57.

    Article  Google Scholar 

  13. Montgomery ET, van der Straten A, Chidanyika A, Chipato T, Jaffar S, Padian N. The importance of male partner involvement for women’s acceptability and adherence to female-initiated HIV prevention methods in Zimbabwe. AIDS Behav. 2011;15(5):959–69.

    Article  Google Scholar 

  14. Montgomery ET, van der Straten A, Stadler J, Hartmann M, Magazi B, Mathebula F, et al. Male partner influence on women’s HIV prevention trial participation and use of pre-exposure prophylaxis: the importance of “Understanding.” AIDS Behav. 2015;19(5):784–93.

    Article  Google Scholar 

  15. Mngadi KT, Maarschalk S, Grobler AC, Mansoor LE, Frohlich JA, Madlala B, et al. Disclosure of microbicide gel use to sexual partners: influence on adherence in the CAPRISA 004 trial. AIDS Behav. 2014;18(5):849–54.

    Article  Google Scholar 

  16. Venables E, Stadler J. ‘The study has taught me to be supportive of her’: empowering women and involving men in microbicide research. Cult Health Sex. 2012;14(2):181–94.

    Article  Google Scholar 

  17. Montgomery CM, Lees S, Stadler J, Morar NS, Ssali A, Mwanza B, et al. The role of partnership dynamics in determining the acceptability of condoms and microbicides. AIDS Care. 2008;20(6):733–40.

    CAS  Article  Google Scholar 

  18. Montgomery ET, van der Straten A, Chidanyika A, Chipato T, Jaffar S, Padian N 2010 The importance of male partner involvement for women’s acceptability and adherence to female-initiated HIV prevention methods in Zimbabwe. AIDS Behav. 15:959–69. Available from:

  19. Roberts ST, Nair G, Baeten JM, Palanee Philips T, Schwartz K, Reddy K, et al. Impact of male partner involvement on women’s adherence to the dapivirine vaginal ring during a phase III HIV prevention trial. AIDS Behav. 2019;24(5):1432–42.

    Article  Google Scholar 

Download references


The study was designed and implemented by the Microbicide Trials Network (MTN) funded by the National Institute of Allergy and Infectious Diseases through individual grants (UM1AI068633, UM1AI068615 and UM1AI106707), with co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute of Mental Health, all components of the U.S. National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Elizabeth T. Montgomery.

Ethics declarations

Conflict of interest

There are no potential conflicts of interest (financial or non-financial) by any of the authors in regards to this manuscript. The research involved human subjects and no animal subjects. All researchers who collected data from humans were trained in the principles of Human Subjects. A written informed consent process, approved by local ethical review committees in all research settings, was undertaken with participants prior to any research procedures.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Montgomery, E.T., Katz, A.W.K., Duby, Z. et al. Men’s Sexual Experiences with the Dapivirine Vaginal Ring in Malawi, South Africa, Uganda and Zimbabwe. AIDS Behav 25, 1890–1900 (2021).

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Vaginal ring
  • Male partners
  • HIV prevention
  • Qualitative
  • Sexual experiences
  • Africa