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Drug-infused vaginal ring shows promising signs in battle against HIV rates

Silicone ring containing antiretroviral dapivirine drug could play an important role in preventing HIV infections.

A medicated anti-viral vaginal ring has been found to reduce the rate of HIV infection in women through trials conducted in Africa, where HIV is prevalent.

Two separate studies used this experimental form of prevention, which sees women insert the ring containing dapivirine, an antiretroviral drug that hinders HIV, which is slowly released over time. Each silicone ring lasts 30 days and can be replaced with a new one.

The first study, funded by NGO International Partnership for Microbicides, found that the risk of HIV infection dropped by 31 per cent among the 1,959 South African and Ugandan participants.

The second study included 2,629 women in Sub-Saharan Africa, and found the rate of infection for those using the dapivirine rings decreased by 27 per cent compared with those given placebo rings. However, the prevention rate was higher among women aged over 21, at 61 per cent, as they were more inclined to use the ring more often and return every month to have it replaced. In both studies, the ring offered no significant protection to those under 21.

HIV remains one of the great global health challenges. According to WHO, almost 37m are living with the disease, over half of whom are women. Previous trials haven't been as successful, as they involved antiviral pills and vaginal gels, which weren't used as frequently by the women. The silicone ring doesn't require any additional medication or procedures apart from the initial insertion and monthly replacements.

As the New York Times notes, a reason why the ring was popular is because it doesn't require the women to have their partner's permission or cooperation to use it. Men can refuse to wear condoms, prevent their partners from taking antiretroviral pills or using vaginal gels, all of which would also reduce rates of HIV infection when used properly.

During the trials, dapivirine levels were measured both in the women's blood and silicone ring to see if they had been used as instructed. This is incredibly important as dapivirine was only effective when the ring was used at all times.

The researchers said they will investigate why the ring wasn't effective for those under 21, while also looking into potential uses of the ring to carry other forms of treatment, such as contraception.

Emad Ahmed writes about science and gaming. He tweets @ThisIsEmad.

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Why Angela Merkel's comments about the UK and US shouldn't be given too much weight

The Chancellor's comments are aimed at a domestic and European audience, and she won't be abandoning Anglo-German relationships just yet.

Angela Merkel’s latest remarks do not seem well-judged but should not be given undue significance. Speaking as part of a rally in Munich for her sister party, the CSU, the German Chancellor claimed “we Europeans must really take our own fate into our hands”.

The comments should be read in the context of September's German elections and Merkel’s determination to restrain the fortune of her main political rival, Martin Schulz – obviously a strong Europhile and a committed Trump critic. Sigmar Gabriel - previously seen as a candidate to lead the left-wing SPD - has for some time been pressing for Germany and Europe to have “enough self-confidence” to stand up to Trump. He called for a “self-confident position, not just on behalf of us Germans but all Europeans”. Merkel is in part responding to this pressure.

Her words were well received by her audience. The beer hall crowd erupted into sustained applause. But taking an implicit pop at Donald Trump is hardly likely to be a divisive tactic at such a gathering. Criticising the UK post-Brexit and the US under Trump is the sort of virtue signalling guaranteed to ensure a good clap.

It’s not clear that the comments represent that much of a new departure, as she herself has since claimed. She said something similar earlier this year. In January, after the publication of Donald Trump’s interview with The Times and Bild, she said that “we Europeans have our fate in our own hands”.

At one level what Merkel said is something of a truism: in two year’s time Britain will no longer be directly deciding the fate of the EU. In future no British Prime Minister will attend the European Council, and British MEPs will leave the Parliament at the next round of European elections in 2019. Yet Merkel’s words “we Europeans”, conflate Europe and the EU, something she has previously rejected. Back in July last year, at a joint press conference with Theresa May, she said: “the UK after all remains part of Europe, if not of the Union”.

At the same press conference, Merkel also confirmed that the EU and the UK would need to continue to work together. At that time she even used the first person plural to include Britain, saying “we have certain missions also to fulfil with the rest of the world” – there the ‘we’ meant Britain and the EU, now the 'we' excludes Britain.

Her comments surely also mark a frustration born of difficulties at the G7 summit over climate change, but Britain and Germany agreed at the meeting in Sicily on the Paris Accord. More broadly, the next few months will be crucial for determining the future relationship between Britain and the EU. There will be many difficult negotiations ahead.

Merkel is widely expected to remain the German Chancellor after this autumn’s election. As the single most powerful individual in the EU27, she is the most crucial person in determining future relations between the UK and the EU. Indeed, to some extent, it was her intransigence during Cameron’s ‘renegotiation’ which precipitated Brexit itself. She also needs to watch with care growing irritation across the EU at the (perceived) extent of German influence and control over the institutions and direction of the European project. Recent reports in the Frankfurter Allgemeine Zeitung which suggested a Merkel plan for Jens Weidmann of the Bundesbank to succeed Mario Draghi at the ECB have not gone down well across southern Europe. For those critics, the hands controlling the fate of Europe are Merkel’s.

Brexit remains a crucial challenge for the EU. How the issue is handled will shape the future of the Union. Many across Europe’s capitals are worried that Brussels risks driving Britain further away than Brexit will require; they are worried lest the Channel becomes metaphorically wider and Britain turns its back on the continent. On the UK side, Theresa May has accepted the EU, and particularly Merkel’s, insistence, that there can be no cherry picking, and therefore she has committed to leaving the single market as well as the EU. May has offered a “deep and special” partnership and a comprehensive free trading arrangement. Merkel should welcome Britain’s clarity. She must work with new French President Emmanuel Macron and others to lead the EU towards a new relationship with Britain – a close partnership which protects free trade, security and the other forms of cooperation which benefit all Europeans.

Henry Newman is the director of Open Europe. He tweets @henrynewman.

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