About the authors: The authors work in the Office of HIV/AIDS -- Ashley Vij is a Research Portfolio Advisor, Shannon Allen, PhD is a Senior Technical Advisor for Biomedical HIV Prevention, Jane Schueller is a Senior Advisor for Family Planning and HIV Integration, and Udita Persaud is a Research Program Assistant

Over the last 20 years, the world has made exceptional progress in offering comprehensive HIV prevention services. From innovative approaches to making condoms accessible, to increasing coverage of treatment regimens and increasing the provision of oral pre-exposure prophylaxis (PrEP) to those at substantial risk, the global health community has helped turn the tide on HIV. Such programming has resulted in reduced incidence and prevalence among vulnerable populations.

However, HIV incidence for women, especially adolescent girls and young women (AGYW) in sub Saharan Africa, remains especially high. Because of vulnerabilities created by unequal cultural, social, and economic status, lack of consistent access to health services, and needs that vary according to phases of life, many women at substantial risk of HIV find challenges in the limited number of HIV prevention options. Women and girls have raised concerns about the need to use products on a daily or event-driven basis, limited number of products to choose from, and either perceived or experienced stigma associated with lack of product discreteness. All of these concerns can prevent women and girls from receiving adequate protection from HIV infection.

Research has shown, especially within the family planning field, that when there are more contraceptive options available, and women are able to choose which option fits best into their particular circumstances, they are more likely to use contraception. We expect the same will hold true for HIV biomedical prevention products, and underscores the urgent need to expand the number of available options for HIV prevention from which women can choose.

AGYW DREAMS beneficiaries gathering outside for a meeting at a mobile Safe Space meeting in Kanyakwar village in Kisumu, Kenya, with universal masking and physical distancing observed during the meeting.

USAID is committed to listening and responding to the needs and preferences of women about what they want in an HIV prevention product. From a USAID-funded study of young African women’s product preferences and experiences, we learned that women do not think that one product is a perfect fit for all: “We are not the same. Some, they will like the ring. Some, they will like the tablet … People are not the same.” Listening to potential product users is a powerful tool in designing, developing, and introducing new options for women, giving them a powerful voice in choosing and developing products that best fit their lifestyles.

We are approaching a watershed moment in HIV prevention with a variety of new products on the horizon. In the near-term, we are strengthening our prevention toolbox with the addition of two new products which are close to introduction: the 30-day Dapivirine Vaginal Ring and the bimonthly Cabotegravir Injectable. Further down the road, there may be a monthly pill and/or six-month injectable for HIV prevention as well as a single daily oral pill that can protect against both HIV and unintended pregnancy. Other USAID-supported R&D investments include a multi-purpose prevention vaginal ring and an implant, each providing the added benefit of allowing women to combine their HIV prevention and contraceptive needs into a long-acting single product.

A dapivirine ring undergoes a quality check before it’s packaged.

USAID has a long history of investing in research initiatives, product development partnerships, and service delivery programs dedicated to helping women protect themselves from HIV infection. However, new products will only have an impact if the global health community collaborates to accelerate product introduction, improve roll-out, and invest in scale-up. USAID continues to provide global leadership in creating platforms that address common barriers known to delay getting prevention products into the hands of those that need them most. The USAID-funded Microbicide Prevention Introduction Initiative (MPii) is focused on optimizing service delivery channels, mitigating intimate partner violence, and preparing for and accelerating the introduction of biomedical products for women. Building on the findings from MPii, USAID aims to expedite the timeline between regulatory approval and program implementation to facilitate rapid uptake and achieve high coverage through the Collaboration for HIV Prevention Options to Control the Epidemic (CHOICE) and Preparing for Ring Opportunities through Market Introduction Support and Knowledge Exchange (PROMISE) programs.

Studies show that a combination approach -- in other words, options that best fit the needs of specific people and communities -- is essential to ending the HIV epidemic. Providing women the opportunity to choose a prevention method that works best for them is a critical piece of the puzzle for sustaining and enhancing the remarkable progress towards epidemic control.