By Starphel Sithole
The Malawi National Strategic Plan for HIV and AIDS 2020-2025 states that Gender norms influence access to HIV prevention. For instance, in Malawi many women have limited power over their own sexual health-a substantial barrier for access to care. While there has been a drastic increase in the percentage of married women who report participation in decision making about their own health care (68% in 2015/2016, up from 55% in 2010), there are still far too many women who do not have a say in their own health.
It further says if a woman’s husband has a sexually transmitted infection (STI); 12% of men disagree that she is justified in asking that they use a condom. Gender-based violence is both a cause and consequence of HIV and a critical barrier to service access.
Statistics also show that new infections are high in women than men. For instance, according to Malawi Population-based Health Impact Access (MPHIA)2020-2021; 63% of the 946 000 people living with HIV is made up of women. Hence there is need to advocate for HIV preventive tools specifically for women.
Speaking during a meeting held by Civil Society Advocacy Forum (CSAF); a grouping of over 60 local NGO’s working actively on HIV and related conditions, Sexual and Reproductive Health Rights (SRHR) Africa Trust Country Program Officer Novice Bamusi explained that the new Dapivirine Vaginal Ring (DVR) was designed specifically for women. “Dapivirine vaginal ring is the first discreet, women controlled, long-acting HIV prevention method designed for women. Made of flexible silicone; the ring slowly releases the Antiretroviral drug dapivirine in the vagina. Women insert the product and replace it every month”, he said.
Bamusi further explained that the vaginal ring starts working 72 hours after being inserted. He further stressed that when inserted it is not felt by men during sexual intercourse; giving women power to make a decision on their own in as far as HIV prevention is concerned.
One of the women participants during the meeting who is also CSAF Vice Chairperson, Ulanda Mtamba hailed the coming of Dapivirine ring as a convenient preventive measure for women because it was suggested by women and specifically made to be used by them.
“As CSAF members there is need to advocate for dapivirine vaginal ring for adoption by the Ministry of Health as one of the preventive methods for HIV preventive in Malawi because it empowers women to be in control of their sexual health. The ring is a unique, female-initiated product, the ring provides women and girls with choice, complementing daily oral PrEP and condoms, the ring would also expand the portfolio of self-care biomedical HIV prevention options as it does not require storage conditions such as refrigeration and women can insert the ring themselves without a health care provider.” She said.
Mtamba added that, DVR should be considered as a preventive measure in the country to provide diverse options for women and not it be compared with other measures in place.
During a meeting of CSO loose Network on new HIV prevention option updates including DVR held at Crossroads Hotel on 15 November 2022 by SRHR Africa Trust (SAT), Pharmacy Medicines Regulatory Authority (PMRA) medicines registration officer, Aggrey Phiri said the Authority already registered DVR for use in Malawi in 2021.
World Health Organization (WHO) recommended to offer the DVR as a safe and effective additional prevention choice for women at substantial risk of HIV infection as part of combination prevention approaches in January 2021. As of now, Zimbabwe and South Africa are the first African countries to adopt and introduce DVR as part of their prevention package.
However, speaking with Ministry of Health Programs Officer at the Department of HIV, STIS and Viral Hepatitis Brown Chiwandira said currently the Dapivirine vaginal ring is not on the list as a preventive measure in Malawi. Malawi has already adopted condoms, Prevention of Mother-To-Child Transmission (PMTCT), PrEP and Voluntary Male Medical Circumcision (VMMC) as HIV preventive methods.
