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Eswatini (27 August 2024) - IPPF’s Member Association in Eswatini, the Family Life Association of Eswatini (FLAS), is soon to roll out the first women-controlled HIV prevention product, the dapivirine vaginal ring (DVR). FLAS will be among the first organisations to offer the DVR outside implementation or pilot studies anywhere in the world. Made of flexible silicone, the ring is inserted into the vagina by a woman and slowly releases the antiretroviral drug dapivirine in the vagina over a one-month period, helping to reduce a woman’s risk of acquiring HIV. In 2023, in sub-Saharan Africa, women and girls accounted for 62% of all new HIV infections and every week, 3,100 adolescent girls and young women aged 15–24 years became infected with HIV. Therefore, there continues to be an urgent need for HIV prevention methods that females can use to protect themselves. The DVR is a product women can control themselves and use without the knowledge or consent of their partners, unlike condoms, which men often refuse to use. The DVR is inserted into the vagina and left for a one-month period, where it can then be replaced each month for continued protection. Unlike daily oral PrEP, the DVR does not rely on remembering to take a pill each day and is also discreet as it stays inside the vagina throughout the month. The DVR does not prevent pregnancy or other sexually transmitted infections (STIs), so women choosing to use the ring may want to consider combining it with condoms and methods of contraception. The availability of the DVR is an exciting step in supporting women’s autonomy and choice in HIV prevention. This need for women-controlled HIV prevention products has long been advocated for, with the African Women Prevention Community Accountability Board launching the HIV Prevention Choice Manifesto in early 2023. The Choice Manifesto prioritises the principle of choice to ensure that women and girls have the right to choose which HIV prevention methods work for them. Currently the ring is available at selected facilities through implementation studies across six countries in East and Southern Africa; South Africa, Kenya, Zimbabwe, Lesotho, Eswatini, and Uganda.  Diantha Pillay, Associate Director for Product Access for IPM South Africa NPC (an affiliate of the Population Council), said:  “It is encouraging to see the efforts made by FLAS and IPPF to support the choice agenda for HIV prevention for women and make effective HIV prevention methods, like the DVR, more widely accessible in a real-world setting. We hope this can pave the way for introduction of future pipeline products that speak to the needs of women.” The Population Council is currently developing a longer duration DVR that women would use for three months versus one month to significantly lower annual product costs and offer women a more convenient option to protect themselves. Thabo Lizwe Masuku, Programs Manager for FLAS, said: “Women have been telling us for a long time that  there is a need for a variety of methods for HIV prevention, since they are highly exposed. For women and girls to truly have choice about what works for them as they navigate different stages and circumstances of their lives, policy makers, donors, governments and implementers must ensure the mix of HIV prevention methods are available, accessible, and affordable. Access to the ring through our clinics in Eswatini now gives women choice and options to protect themselves against HIV.” IPPF is committed to ensuring that choice in HIV prevention is a reality for women and girls and aims to roll out the dapivirine vaginal rings at as many Member Associations as possible, as well as offer other HIV-prevention choices, as we work alongside our partners towards a future free of HIV in Africa and beyond. For more information and to speak to staff in Eswatini, please email [email protected]   Notes: The dapivirine vaginal ring has been recommended by the WHO since January 2021. (25) In clinical trials, the  ring was shown to reduce HIV infection by 35% in The Ring Study (26,27) and 27% in the ASPIRE Study. (28,29) Recent open-label studies show greater adherence to the ring, and modelling data suggest that HIV risk could be reduced by about 50%. (30) The dapivirine ring has received regulatory approval from the European Medicines Agency (EMA), as well as from local medicines regulators in Namibia, South Africa, Kenya, Zimbabwe, Uganda, Zambia, Malawi, Rwanda, Eswatini, Lesotho, Botswana and is currently under regulatory review in a number of other countries Our Member Associations (MAs) that provide clinical services are required to provide comprehensive SRH services through our Integrated Package of Essential Services (IPES) which include services for sexual health and well-being, contraception, abortion care, sexually transmitted infections (STIs)/reproductive tract infections (RTIs), HIV, obstetrics and gynaecology, fertility support, and sexual and gender-based violence. IPPF’s new five-year strategy, Come Together, focuses on expanding choice. In support of this, we recently launched a special programme to expand our HIV prevention options, which aims to integrate the newest HIV prevention methods – the vaginal ring and injectable PrEP - into our comprehensive sexual and reproductive health services.  IPPF’s IMAP Statement on Biomedical HIV Prevention can be found here. About the Family Life Association of Eswatini (FLAS)  For over 30 years, the Family Life Association of Eswatini (FLAS) has provided sexual and reproductive health (SRH) services to the people of Eswatini (formally Swaziland). While family planning, antenatal, post-natal and post-abortion care form a key part of FLAS services, there’s a significant focus on HIV and AIDS programmes. Eswatini has some of the highest HIV and AIDS prevalence rates in the world. As a result, the prevention and management of HIV and AIDS, the provision of voluntary counselling and testing (VCT), and the prevention of mother to child transmission (PMTCT) are central to FLAS’s work. FLAS has 15 service points, including three permanent clinics and three mobile facilities, staffed by a permanent team of 40 staff backed by 230 volunteers, 180 Youth Action Movement members and 29 peer educators. About the International Planned Parenthood Federation (IPPF) IPPF is a global healthcare provider and a leading advocate of sexual and reproductive health and rights (SRHR) for all. Led by a courageous and determined group of women, IPPF was founded in 1952 at the Third International Planned Parenthood Conference. Today, we are a movement of 150 Member Associations and Collaborative Partners with a presence in over 146 countries.Our work is wide-ranging, including comprehensive sex education, provision of contraceptives, safe abortion, and maternal care and responding to humanitarian crises.  We pride ourselves on being local through our members and global through our network. At the heart of our mission is the provision of – and advocacy in support of – integrated healthcare to anyone who needs it regardless of race, gender, sex, income, and crucially no matter how remote. Our services are available to all, and reach the most marginalised groups in societies, including key and priority populations, youth, and people with disabilities. Most of our MAs have special programs to engage youth (10-24) inside and outside of school settings. Because our clinics offer comprehensive services, attending our clinics is non-stigmatizing and does not label people as having a particular disease or membership to a particular group. This model of services that are integrated and open to all, embedded in indigenous, locally owned organisations, is ideal for ensuring that the most vulnerable and marginalised groups can access the HIV prevention services they need. About the Population Council The Population Council is a leading research organization dedicated to building an equitable and sustainable world that enhances the health and well-being of current and future generations. The Council transforms global thinking on critical health and development issues through social science, public health, and biomedical research. We generate ideas, produce evidence, and design solutions to improve the lives of underserved populations around the world.  

Haz click aquí para leer este posicionamiento en español. Khartoum, 2 July 2024: Another horrendous attack on one of our healthcare clinics in Sudan has occurred this week. Several staff and volunteers from our Member Association in Sudan, the Sudan Family Planning Association (SFPA), have now been injured or killed by the Rapid Support Forces (RSF). Our clinic in El Fasher has been destroyed, meaning there is one less option for women and girls to receive lifesaving sexual and reproductive healthcare in the region.   For over a month, ongoing battles around El Fasher, the capital city of North Darfur, have been taking place.The RSF, who have stationed themselves 10 kilometres from the city, have been indiscriminately shelling military and civilian targets.   One of our SFPA volunteers, Mahasen Abdul Jabbar, was killed after being hit by gunshot at the clinic. This morning, Dr Daifallah Mohammed, a volunteer family medicine specialist in our El Fasher clinic, also died as a result of the warfare.  The RSF bombardments have also severely injured several of our staff: Dr Marwa, a doctor at the Integrated Centre in El Fasher, was hit by shrapnel in her leg. A midwife at Abu Shouk centre, Halima Abdullah Adam, was hit and four of her children were injured and evacuated. The house of the guard of Abu Shouk centre was hit, killing his daughter and wounding four of his other children.  One of our nurses has been hit with shrapnel and has been transferred to hospital and is in critical condition and all contact with her has been lost. The RSF has also been kidnapping our patients, their whereabouts unknown.   This latest attack is on top of previous attacks on our clinics in Sudan, which destroyed our facilities in Khartoum and El Fashir and health centres run by SFPA between 7-9 September 2023.  Women and girls in Sudan are facing an upsurge in sexual and conflict-related violence. Our staff have witnessed firsthand the impact of this heinous crime on the most vulnerable people, including women, girls and other marginalized groups. We previously reported that rape victims and survivors are struggling to obtain contraception, abortion medication and post-exposure anti-viral medications. They face severe and life-threatening consequences, including loss of family support and homes and shelters and increased risk of suicide. Survivors are afraid to seek medical treatment because of the stigma and fear of reprisals from rape.  Fadoua Bakhadda, Regional Director, Arab World Region, said:   “We unequivocally condemn all violence against civilians, especially against health centers that are attacked while providing essential services to those in need. Such acts are an affront to humanity and the sanctity of care.  The murders, displacement and destruction in Sudan must stop. It is vital that warring parties remember their obligations under International Humanitarian Law, which include ensuring the protection of civilians and the protection of health structures and health personnel.”  Dr Alvaro Bermejo, Director-General of IPPF, said:   “We are devastated to learn of another attack on one of our clinics in Sudan, and the injuries and loss of lives to our staff and volunteers. Healthcare facilities, and most importantly, healthcare workers, must never be the target of war. The sexual and reproductive health and lives of 800,000 people in North Darfur – including women, children, and people with disabilities – are hanging in the balance as bombing and shelling cause widespread harm to civilians and severely disrupt the essential health services they very much depend on.  Now, more than ever, our healthcare facilities must be protected so they can continue to provide care to the populations enduring these needless attacks. Our clinic, which previously was able to provide lifesaving sexual and reproductive healthcare such as prenatal care and contraceptives, is gone. Where will women and girls seek these services now? There must finally be a critical mass of people of conscience saying enough is enough in this forgotten crisis.”   For more information and to speak to one of our staff in North Darfur, Sudan, please email [email protected]   About the Sudan Family Planning Association  The Sudan Family Planning Association (SFPA) was established in 1965 by pioneers in obstetrics and gynaecology in response to increases in maternal, neonatal and infant mortality and morbidity. As the statistics show, Sudan is a country in great need of frontline sexual and reproductive health (SRH) services. Advocacy, and undertaking information, education and communication (IEC) programs are critical. In 2023, SFPA provided 38 million services through 25 clinics, 272 associated clinics, 39 mobile clinics, 1494 CBD/CBS, and digital/Virtual channels. Since the start of the crisis on 15 April 2023, the association teams were successful in providing 8 million services through 25 SDPs and 10 million services through non damaged associated and mobile clinics. SFPA was able to assist 1,183 deliveries under bombardment and provided 170 943 treatments of HIV in its static clinics. About the International Planned Parenthood Federation The International Planned Parenthood Federation (IPPF) is a global healthcare provider and a leading advocate of sexual and reproductive health and rights (SRHR) for all. We are a movement of 150 Member Associations and Collaborative Partners with a presence in over 146 countries. Building on a proud history of 70 years of achievement, we commit to lead a locally owned, globally connected civil society movement that provides and enables services and champions sexual and reproductive health and rights for all, especially the under-served. We advocate for a world where people are provided with the information they need to make informed decisions about their sexual health and bodies. We stand up and fight for sexual and reproductive rights, and against those who seek to deny people their human right to bodily autonomy and freedom. We deliver care that is rooted in rights, respect, and dignity - no matter what.    

Since the influx of Ethiopian refugees into Sudan began in November 2020 following military unrest in the Tigray region, most humanitarian assistance has been focused on food, shelter, and primary health services. In response to this, the Sudan Family Planning Association (SFPA) established two clinics in Um Rakouba and Tunaydbah refugee camps to meet the needs of sexual and reproductive health (SRH) services. This includes comprehensive care of HIV/AIDS, allowing people living with HIV (PLHIV) to continue antiretroviral therapy (ARV) with privacy and confidentiality. Their services also involve the prevention and syndromic management of other sexually transmitted infections.   The current emergency situation in Sudan has led to an estimated displacement of 7.6 million people across Sudan's 18 states, with over 13,000 reported deaths. This crisis is causing serious challenges to the already stretched health system.  The increase of internally displaced people (IDPs) during the last nine months has also affected the provision of health services for the general population.    The Government of Sudan, with the assistance of national and international partners, is going to huge efforts to ensure health coverage for IDPs and refugees. However, among the current national plans and funding, healthcare for HIV positive refugees is not adequately addressed. SFPA is also facing challenges providing SRH care, especially in the refugee camps, as they struggle to keep up with the numbers of IDPs - which are increasing dramatically by the day.   SFPA provides SRH services in collaboration with the Sudan National AIDS Control Program (SNAP) and Al Gadarif SMOH. The total number of refugees living with HIV has now reached a tipping point, with 758 current cases recorded so far. So far, all clients have been able to regularly receive their ARV treatment. Many of them have reached zero viral load due to good adherence to treatment, meaning that the levels of HIV in the body are so low that the virus cannot be passed on.   However, due to a shortfall of funding and resources, the risk of the discontinuation or interruption of ARVs may result in viral rebound, immune decompensation, and the progression of the virus.  The higher percentage of newly discovered cases (10.4% of newly arrived refugees tested positive to HIV) also indicates that there is a new spread of HIV, not only amongst the youth population inside the camps, but also host communities.    Given the current condition of refugee camps in Al Gadarif State, failure to adequately provide for people living with HIV/AIDS and prevent further transmissions may lead to catastrophic outcomes - not only in the camps but nationwide.          About the Sudan Family Planning Association (SFPA)   SFPA is a key SRH service provider in Sudan through its 15 branches covering 14 states1with a solid track record of delivering services in humanitarian settings. SFPA continues to fulfil its mandate and commitment to provide essential SRH and non- SRH services to refugees through an Australia Aid-supported emergency response to Ethiopian refugee crisis from 2021-2022 and continued with support from the Women’s Refugee Commission (WRC) until 31 December 2023, providing health services including testing, counselling, prevention of mother to child transmission, care and treatment services and ensure the enrolment of PLHIV in the ARVs regimen.     Banner credits: IPPF/Hannah Maule-ffinch/Sudan