“Women need options when a man says no to a condom”: An interview with Kenyan HIV activist Jacque Wambui

In Kenya, as in most parts of Sub-Saharan Africa, few women are able to speak up when it comes to reproductive health. Family planning and prevention methods for sexually transmitted infections (STIs) are still taboo topics. Most women will tell you that once a man says that he doesn’t want to use a condom, that’s that and if you dare object, you risk physical abuse – sometimes to an inch of your life- or desertion.

This leaves women vulnerable to a myriad of sexually transmitted infections with resultant psychological, emotional and social trauma. High on the list is HIV. Mercifully, science, has come to the rescue. The advent of new HIV transmission prevention methods trials ranging from Oral Pre-Exposure Prophylaxis (PrEP) to Microbicides, means that women might have more options in the near future.

Microbicides, compounds that can be applied inside the vagina or rectum to prevent STIs, have been in the spotlight of late. Though no effective microbicide is available at present, the results of trials studying the effectiveness of vaginal rings to prevent HIV transmission seems to bring a message of hope.

When the results of two vaginal ring trials were released in February 2016, they showed modest efficacy in HIV protection. For women, a monthly ring that they could use discreetly is a more than welcome option. When I sat down for an interview with her, Kenyan HIV activist Jacqueline Wambui explained why it is important for women to have safe options they can turn to when a man says no to a condom.

Kindly give us a little background as to who you are and what you do.

I am a woman living with HIV since 2004 when I tested positive. I am in a discordant* relationship and have four sons. I am an HIV activist affiliated to The National Empowerment Network of People Living with HIV in Kenya (NEPHAK) and an alumnus of the AVAC (AIDS Vaccine Advocacy Coalition) Fellowship.

Why would you say that Microbicide trials are significant to women? Furthermore, considering that the existence and proven success of oral Pre-Exposure Prophylaxis* (PrEP) trials.

The challenge is that many women don’t know their partners are infected. And if you think its hard convincing a man to use a condom, try asking him to go for a HIV test. The idea of test-and-treat is great; but only if people are willing to be tested, and once they are aware of their status, they are willing to go on treatment. But there’s such a huge reservoir of people who are undiagnosed and it’s difficult for women to know that they’re being exposed to HIV.

Though no effective microbicide is available at present, the results of trials studying the effectiveness of vaginal rings to prevent HIV transmission seems to bring a message of hope

We currently have oral PrEP that is when people at very high risk of HIV infection take antiretrovirals as a once a day pill to lower their chances of getting infected. Though, this might work, many African women don’t have control over when they’re having sex and sometimes even who they’re having sex with.

Could you highlight reasons why women would prefer the vaginal ring formulation as opposed to an oral preparation?

The disparity between prevalence of HIV in Sub-Sahara Africa, clearly shows the vulnerability women face. When it comes to prevention methods, we are not moving fast enough for these women. In Kenya we welcome the recent launch of PrEP guidelines and PrEP, which is about to be available, while we wait to see if the vaginal ring will be approved for use.

Women across Africa are crying out: We are here and We need options.

An on-demand product is critical to increase the HIV prevention options and expand coverage of potential incidents that could promote HIV transmission. The key to this is that the product has to be discrete because women are aware of the need of safe sexual practices, but the societies we live in make it difficult for us to have control. We need options that give us control without endangering our lives and welfare.

What kind of difference do you think if approved the ring would make?

Efforts to promote abstinence, monogamy and the use of male condoms have not been enough to put a stop to the HIV epidemic nor are they realistic methods. Women need a range of practical and discreet tools they can use to protect themselves from HIV infection. The vaginal ring would be easy for women to insert and remove themselves and has the potential to offer women monthly protection from HIV during sex with a male partner.

This would be a lifesaver, as women would know they are protected and be able to live their lives without constant worry and fear. Of course, winning the war against HIV will require a variety of effective products that match the women’s individual needs and fit within the context of their lives.

The key to this is that the product has to be discrete because women are aware of the need of safe sexual practices, but the societies we live in make it difficult for us to have control

As for the research community, what would your parting message be?

I speak for myself and as a woman living with HIV, despite all the scientific research and if we are to leave behind the medical jargon, these prevention methods are to be used by women. They are to be used by human beings. We must remember the context; the existing prevention methods for HIV transmission work for some, but not all; the simplest might be condom use but it can be difficult for many women to negotiate. I doubt we shall find one method that suits all, but as women we do need options.

* Discordant couples are those where one partner is HIV-infected and the other is not.

* Pre-exposure prophylaxis, or PrEP, is a way for people who do not have HIV but who are at substantial risk of getting it to prevent HIV infection by taking a pill every day.

Dr. Diana Wangari is a medical doctor turned-health Journalist from Nairobi with a soft spot for dogs. Follow her on Twitter @diana1wangari.