Skip to main content


Log in

Ring-ing in the Future: Participant and Male Partner Perspectives Regarding Future Use of the Dapivirine Vaginal Ring for HIV Prevention

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript


Women account for a disproportionate percentage of new HIV infections in sub-Saharan Africa indicating a need for female-initiated HIV prevention options congruent with their lifestyles. The dapivirine vaginal ring for HIV prevention is one such option. We explored the interest of women, who used this ring during the Microbicide Trials Network’s ASPIRE and HOPE studies, in using the ring post-licensure and what they perceived as important considerations for future use. We also explored perspectives of HOPE participants’ male partners on their involvement in their partners’ future ring use. Women appeared keen to use the ring in the future and expressed desires for easy access, support for both ongoing and new users and intense community engagement. In parallel, male partners indicated high levels of interest in supporting their partners’ ring use and being involved in ring use decision making. These data offer important insights for ring rollout planning and engagement activities.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

Data Availability

Data is available as required.

Code Availability

The Dedoose qualitative software programme (Version 8.1.8) used for coding of transcripts is available.


  1. Kharsany ABM, Karim QA. HIV infection and AIDS in Sub-Saharan Africa: Current status, Challenges and Opportunities. Open AIDS J. 2016;10:34–48.

    Article  CAS  Google Scholar 

  2. Ramjee G, Daniels B. Women and HIV in Sub-Saharan Africa. AIDS Res Ther. 2013;10(1):30.

    Article  Google Scholar 

  3. Miles to go—closing gaps, breaking barriers, righting injustices ON;one: UNAIDS; 2018 [Available from:

  4. UNAIDS Data 2020 Online2020 [Available from:

  5. Consortium. EfCOaHOET. HIV incidence among women using intramuscular depot medroxyprogesterone acetate, a copper intrauterine device, or a levonorgestrel implant for contraception: a randomised, multicentre, open-label trial. Lancet. 2019;394(10195):303–13.

    Article  Google Scholar 

  6. AVERT. HIV and AIDS in East and Southern Africa Regional Overview [Available from:

  7. International Partnership for Microbicides. The Monthly Dapivirine Ring: Frequently Asked Questions 2020 [Available from:

  8. 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):2121–32.

    Article  CAS  Google Scholar 

  9. Nel A, van Niekerk N, Kapiga S, Bekker L-G, 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.

    Article  CAS  Google Scholar 

  10. International Partnership for Microbicides. Final Results of Open-label Study of IPM’s Dapivirine Vaginal Ring Show Increased Use and Suggest Lower Infection Rates Compared to Earlier Phase III Study 2019 [updated 11–14 June 2019. Available from:

  11. Baeten JM, Palanee-Phillips T, Mgodi NM, Mayo AJ, Szydlo DW, Ramjee G, et al. Safety, uptake, and use of a dapivirine vaginal ring for HIV-1 prevention in African women (HOPE): an open-label, extension study. Lancet HIV. 2021;8(2):e87–95.

    Article  Google Scholar 

  12. Brown ER, Hendrix CW, van der Straten A, Kiweewa FM, Mgodi NM, Palanee-Philips T, et al. 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.

    Article  CAS  Google Scholar 

  13. International Partnership for Microbicides. Dapivirine Ring [Available from:

  14. European Medicines Agency (EMA) approval of the dapivirine ring for HIV prevention for women in high HIV burden settings Online [Available from:

  15. WHO recommends the dapivirine vaginal ring as a new choice for HIV prevention for women at substantial risk of HIV infection Online: World Health Organization; 2021 [Available from:,the%20risk%20of%20HIV%20infection.

  16. Giguere R, Lentz C, Kajura-Manyindo C, Kutner BA, Dolezal C, Buthelezi M, et al. Counselors’ acceptability of adherence counseling session recording, fidelity monitoring, and feedback in a multi-site HIV prevention study in four African countries. AIDS Care. 2020;32(sup1):19–28.

    Article  Google Scholar 

  17. Montgomery ET, Stadler J, Naidoo S, Katz AWK, Laborde N, Garcia M, et al. Reasons for nonadherence to the dapivirine vaginal ring: narrative explanations of objective drug-level results. AIDS. 2018;32(11):1517–25.

    Article  CAS  Google Scholar 

  18. Naidoo K, Mansoor LE, Katz AW, Garcia M, Kemigisha D, Morar NS, et al. Qualitative perceptions of dapivirine vaginal ring adherence and drug level feedback following an open-label extension trial. J Acquir Immune Defic Syndr. 2020.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Montgomery ET, Katz AWK, Duby Z, Mansoor LE, Morar NS, Naidoo K, et al. Men’s sexual experiences with the dapivirine vaginal ring in Malawi, South Africa, Uganda and Zimbabwe. AIDS Behav. 2021;25(6):1890–900.

    Article  Google Scholar 

  20. Leonard Solai ST, Nadia Sutton, Dennis Kembero, Fiona Mahiaini, editor Dapivirine Vaginal Ring: End-user Assessment | Segmentation | Messaging | Positioning Amongst Women End-Users and Male Influencers. International Conference on AIDS and STIs in Africa (ICASA); 2–7 Dec 2019; Kigali, Rwanda.

  21. Gomez A, Loar R, Kramer AE, Garnett GP. Reaching and targeting more effectively: the application of market segmentation to improve HIV prevention programmes. J Int AIDS Soc. 2019;4(4):e25318.

    Google Scholar 

  22. Lawton J, Blackburn M, Breckenridge JP, Hallowell N, Farrington C, Rankin D. Ambassadors of hope, research pioneers and agents of change-individuals’ expectations and experiences of taking part in a randomised trial of an innovative health technology: longitudinal qualitative study. Trials. 2019;20(1):289.

    Article  Google Scholar 

  23. Saethre E, Stadler J. Malicious whites, greedy women, and virtuous volunteers: negotiating social relations through clinical trial narratives in South Africa. Med Anthropol Q. 2013;27(1):103–20.

    Article  Google Scholar 

  24. Naidoo S, Morar N, Ramjee G. Participants as community-based peer educators: Impact on a clinical trial site in KwaZulu-Natal. S Afr J Sci. 2012;109:01–5.

    Google Scholar 

  25. Katz AWK, Naidoo K, Reddy K, Chitukuta M, Nabukeera J, Siva S, et al. The power of the shared experience: MTN-020/ASPIRE trial participants’ descriptions of peer influence on acceptability of and adherence to the dapivirine vaginal ring for HIV prevention. AIDS Behav. 2020;24(8):2387–99.

    Article  Google Scholar 

  26. Garcia M, Luecke E, Mayo A, Scheckter R, Ndase P, Kiweewa FM, et al. Impact and experience of participant engagement activities in supporting dapivirine ring use among participants enrolled in the Phase III MTN-020/ASPIRE study. BMC Public Health. 2021;21(1):2041.

    Article  Google Scholar 

  27. 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):1209–24.

    Article  Google Scholar 

  28. Sinead Delany-Moretlwe FS, Sheila Harvey. Evidence Brief: The EMPOWER study: An evaluation of a combination HIV prevention intervention including oral PrEP for adolescent girls and young women in South Africa and Tanzania 2018 [Available from:

  29. Delany-Moretlwe S, Lombard C, Baron D, Bekker L-G, Nkala B, Ahmed K, et al. Tenofovir 1% vaginal gel for prevention of HIV-1 infection in women in South Africa (FACTS-001): a phase 3, randomised, double-blind, placebo-controlled trial. Lancet Infect Dis. 2018;18:1241–50.

    Article  CAS  Google Scholar 

  30. Baron D, Scorgie F, Ramskin L, Khoza N, Schutzman J, Stangl A, et al. “You talk about problems until you feel free”: South African adolescent girls’ and young women’s narratives on the value of HIV prevention peer support clubs. BMC Public Health. 2020;20(1):1016.

    Article  Google Scholar 

  31. 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 

  32. 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.

    Article  CAS  Google Scholar 

  33. Hartmann M, Lanham M, Palanee-Phillips T, Mathebula F, Tolley EE, Peacock D, et al. Generating CHARISMA: Development of an intervention to help women build agency and safety in their relationships while using PrEP for HIV prevention. AIDS Educ Prev. 2019;31(5):433–51.

    Article  Google Scholar 

  34. Hartmann M, Palanee-Phillips T, O’Rourke S, Adewumi K, Tenza S, Mathebula F, et al. The relationship between vaginal ring use and intimate partner violence and social harms: formative research outcomes from the CHARISMA study in Johannesburg, South Africa. AIDS Care. 2018.

    Article  PubMed  Google Scholar 

  35. Wilson E, Wagner D, Palanee T, Mathebula F, Hartmann M, Tolley E, et al. Acceptability and Feasibility of CHARISMA: Results of a Pilot Study Addressing Relationship Dynamics, Intimate Partner Violence and Microbicide Use for HIV Prevention. HIV Research for Prevention (HIV R4P) 21–25 Oct 2018; Madrid, Spain.

Download references


The authors are grateful to the study participants for their participation and dedication. The authors thank the research site study team members, the MTN-032/AHA Protocol Management Team, the MTN Leadership Operations Center, Women’s Global Health Imperative (WGHI) RTI International and FHI360 for their contributions to data collection. The AHA trial was designed and implemented by the Microbicide Trials Network (MTN). The MTN is funded by the National Institute of Allergy and Infectious Diseases (UM1AI068633, UM1AI068615, and UM1AI106707), with cofunding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute of Mental Health, all components of the US National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The rings used as sample products were developed and supplied by the International Partnership for Microbicides (IPM).


This work was funded by the Division of AIDS, US National Institute of Allergy and Infectious Diseases, US Eunice Kennedy Shriver National Institute of Child Health and Human Development, US National Institute of Mental Health, US National Institutes of Health.

Author information

Authors and Affiliations




KR, AK and ETM designed the study. FM performed data analysis on code reports, EL provided quantitative data. KR wrote the first draft of the manuscript. AK and ETM reviewed and edited the first manuscript draft. TP-P, ST, MG, LEM, SN, NM, MC and MT provided additional review and edits to the manuscript.

Corresponding author

Correspondence to Krishnaveni Reddy.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare that are relevant to the content of this article.

Ethical Approval

The study was approved by the Institutional Review Boards (IRBs) at RTI International and local IRBs at each of the study sites and was overseen by the regulatory infrastructure of the U.S. National Institutes of Health and the Microbicide Trials Network (MTN). The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

Consent to Participate

Informed consent was obtained from all individual participants included in the study.

Consent for Publication

Not applicable.

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

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Reddy, K., Mathebula, F., Katz, A. et al. Ring-ing in the Future: Participant and Male Partner Perspectives Regarding Future Use of the Dapivirine Vaginal Ring for HIV Prevention. AIDS Behav 26, 1923–1932 (2022).

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: