Misconceptions hindering uptake of dipivefrine vaginal ring — experts

_________________

Uganda’s goal is that by 2030, there should be no HIV transmission from one person to another. This ambition has driven the introduction of several innovations in HIV prevention, including female condoms, oral PrEP, injectable options, and the Dipivefrine Vaginal Ring (DVR).

However, despite its promise as a convenient and discreet prevention method, experts warn that the ring’s uptake is being slowed by persistent misconceptions among potential users.

Across communities, misinformation continues to shape perceptions about the vaginal ring. Experts who met on April 7, 2026, at Fairway Hotel in Kampala to discuss new HIV preventive technologies observed that many women rely more on information from peers than from trained health workers.

These informal sources often spread fear and confusion. Some women believe that the ring can move from the vagina into the uterus during sexual activity, especially during forceful intercourse, while others worry that their partners will feel it or even remove it unintentionally during sex.

Dr Herbart Kadama, the national PrEP coordinator at the Ministry of Health, said deeper concerns are linked to long-standing myths about reproductive health products. According to him, some women associate the ring with cancer risks, drawing comparisons to misconceptions previously linked to contraceptive methods such as intrauterine devices.

For others, hesitation begins with the ring’s physical appearance, as its size alone creates anxiety and uncertainty about how it can be inserted or used comfortably.

“Many of the challenges we are seeing are not about the product itself but about myths and misconceptions. These fears are not based on scientific evidence, but they continue to influence decisions and slow uptake,” he said.

While presenting virtually, Dr Kadama explained that the vaginal ring is designed to sit securely in the vagina, where it is held in place by natural muscles. It does not travel to other parts of the body, nor does it enlarge the vagina, and in most cases, it is not felt during sexual intercourse.

“When used correctly and consistently, the ring is safe, stays in place, and is effective in reducing the risk of HIV infection,” he said.

Awareness improves acceptance

Despite these barriers, evidence from implementation studies shows that the ring can gain acceptance when communities are properly informed. One such study is the CATALYST trial, which introduced the ring alongside other HIV prevention options, highlighting the importance of awareness and access to accurate information.

Dr Carolina Akello, a technical advisor with Root to Rise and one of the principal investigators in the study, said awareness played a key role in uptake. She explained that when communities are properly sensitised and given accurate information, more people are willing to use the ring.

“When communities are properly informed and supported with the right information, we see more people coming forward to use the ring. In our study, about one-third of participants chose it, which shows that acceptance improves with awareness,” she said.

The study demonstrated that when individuals are given a range of prevention options along with clear information, they are more likely to select a method that fits their lifestyle. For some women, the ring’s appeal lies in its convenience, as it is inserted once a month compared to oral PrEP, which requires daily pill-taking. It is also discreet, allowing women to use it without necessarily disclosing to partners or others.

“HIV prevention methods are not meant to compete with one another but to complement each other. The goal is to provide a variety of choices so that individuals can select what works best for them, and consistent use is what determines effectiveness,” Dr Akello said.

However, even with these advantages, the vaginal ring remains largely unknown in many parts of Uganda. Awareness levels are still low, and access is limited to a small number of health facilities, creating a gap between availability and actual use.

Dorothy Namutamba, deputy executive director of the International Community of Women Living with HIV Eastern Africa, said increasing awareness must be a priority if uptake is to improve. She pointed out that very few people know about the ring, and even fewer are using it.

“We must create community awareness just like we did with condoms, so that women and girls can access, understand, and confidently use this option without fear,” she said.

Currently, the ring is only available in a limited number of sites across the country, which further restricts its reach. Namutamba noted that even in facilities where it is available, uptake remains low if clients are not adequately informed about it.

She also observed that many healthcare providers are not yet fully trained on the ring, making it difficult for them to confidently educate clients and address their concerns.

“Without proper guidance from trusted sources, myths and misconceptions will continue to persist because people will rely on rumours and incomplete information,” Namutamba warned.



How to improve uptake

To address these challenges, she recommended a comprehensive approach that goes beyond simply making the product available. Community education must be strengthened through culturally appropriate messaging that directly addresses fears and misinformation.

“Peer educators can play a key role in bridging the information gap because they are trusted within communities, and multi-channel communication such as dialogues, radio programmes, and health talks can ensure accurate information reaches more people,” she added.

She stated that training for healthcare providers must also be scaled up so that they are equipped to offer clear, consistent, and supportive counselling to clients.

“This is essential for building trust, correcting misinformation, and ultimately improving uptake of the ring,” she emphasised.

Diantha Pillay, a director of global product access, said there is also a need to improve facility readiness by ensuring a consistent supply of the ring and expanding access to more districts.

“Collaboration between implementing partners will be key in improving service delivery, strengthening systems, and ensuring that more women can access the ring where they need it,” she said.