PxPulse: The Advocacy Chronicles with APHA’s Yvette Raphael 

Our debut episode of the Advocacy Chronicles features Yvette Raphael, the Executive Director of Advocacy for Prevention of HIV and AIDS (APHA) in South Africa, and a leader in the development of The Choice Manifesto, supported from start to finish by CASPR.

As co-chair of the African Women Prevention Community Accountability Board (AWPCAB), Yvette and other board members launched the manifesto in Kampala, in September 2023, calling for choice in HIV prevention options for women — such as oral and injectable cabotegravir for PrEP, the dapivirine vaginal ring and the Dual Prevention Pill — and a commitment to expanding access to them. A call heard by UNAIDS Executive Director Winnie Byanyima, who was on hand at the launch to endorse the manifesto.  

Yvette, who is also a 2014 AVAC Advocacy Fellow and celebrated as one of South Africa’s leading human rights activists, lays out why The Choice Manifesto matters and how advocates are leveraging it. 

Resources

Decolonizing Global Health: Dr. Madhukar Pai and COMPASS Africa Tell Us Why and How

Produced and hosted by Jeanne Baron.

Investing in the long-term success of African leadership is essential to breaking cycles that perpetuate inequity and that stall progress in the HIV response. In January, The Coalition to build Momentum, Power, Activism, Strategy and Solidarity (COMPASS Africa) announced a major transition, with Pangaea Zimbabwe assuming the role of secretariat and the launch of a decentralized approach to governance across the coalition. These changes come as other efforts, such as negotiations on the Pandemic Accord, are struggling to advance, uphold or safeguard equity.

In this episode of PxPulse, we talk about why and how the decisions that shape global health must be made by those facing the greatest risks. As the world evaluates the pandemic response and debates on decolonizing global health gain momentum, equity in global health has never been more urgent. 

This conversation features global health leader and critic, Dr. Madhukar Pai. And two members of the transnational coalition COMPASS Africa, Francis Luwole and Barbra Ncube, offer an up-close look at the coalition’s pioneering new model for power-sharing.

Tune in to Hear

Links

Advocacy Resources

Inclusion of Pregnant and Lactating People in HIV Research

What you need to know 

Produced and hosted by Jeanne Baron

People who are pregnant or lactating (PLP) have historically been excluded from research because of concerns for the developing fetus. But this has led to a dearth of data on new interventions against health threats for this population. In the case of HIV, pregnancy raises the risk of acquiring HIV by up to three times, but providers often do not have the data to know whether a new intervention is safe or how it will work for pregnant patients. As a result, PLP and their physicians are left to make difficult decisions around the use of proven HIV prevention products as they await more data specific to pregnancy and lactation. 

But change is in the air. Champions for the inclusion of PLP in research are paving the way for a paradigm shift—one that will redefine this population from needing protection from research to being better protected through research. In this episode of Px Pulse, AVAC’s Manju Chatani-Gada takes us through conversations with a trial participant who became pregnant, researchers, policymakers and donors to understand why this population gets excluded, the impact it has and what to do about it.   

Tune it to hear:

  • Dr. Anne Drapkin Lyerly, Principal Investigator of the PHASES Project to advance equitable inclusion of pregnant women in HIV research and its follow-on project, PREPARE, focused on ethical HIV research in adolescents who are pregnant. 
  • Elisia Madende, trial participant in the HPTN 084 trial in Zimbabwe 
  • Dr. Ashley Lima, Health Science Specialist and Lead Technical Advisor for Socio-behavioral Research — USAID Office of HIV/AIDS Research Division 
  • Dr. Takunda Sola, HIV Prevention and Key Populations Medical Officer — Zimbabwe MoH AIDS/TB Unit 

Links:

Advocacy Resources:

PEPFAR at 20: Keeping the promise

2023 is a big year for PEPFAR. Considered one of the greatest US foreign policy and global development achievements of the century, the program has saved upwards of 25 million lives since it launched in 2003. But PEPFAR is marking its 20th anniversary while fighting for its future.  

Its authorization expires September 30. Until a couple of months ago, most expected smooth sailing in the US Congress for a five-year reauthorization of the program. PEPFAR has enjoyed deep and broad bipartisan support since its founding. Evangelical Christians, staunch conservatives, DC Democrats, progressive HIV activists, and public health leaders have championed PEPFAR, year in and year out. But a handful of Republicans, including past PEPFAR allies, are pulling reauthorization into high-stakes partisan politics. 

In this episode, Px Pulse talks to some of the people who put PEPFAR dollars into action and to global health leaders who explain why PEPFAR’s approach has been so effective, and what’s at stake in this debate. 

Tune in to hear:

  • Ilda Kuleba from Mothers 2 Mothers talks about the impact of their work across 10 countries, training and employing HIV positive mothers as peer healthcare workers.
  • Dr. James Mukabi of World Vision’s Kenya program talks about how this Christian relief organization has changed the lives of thousands of orphans and other populations who are vulnerable to HIV. 
  • Tom Hart, President of the One Campaign, which was founded by the rock star Bono, to be an early champion of PEPFAR and other poverty fighting efforts talks about PEPFAR’s accomplishments at the global level and what’s next as congress debates reauthorizing the program.

Links:

Advocacy Resources:

Media:

Evolving Strategies for an HIV Vaccine: One researcher explains where the field is going and why?

Produced and hosted by Jeanne Baron

With several large HIV vaccine trials in the last few years finding no efficacy, the field is in transition. There are diverse ideas in vaccine research, but there’s no clear concept that’s ready to test in a late-phase trial or move towards product development currently. Researchers are back to testing new ideas in early phase research.

In this episode of our Px Pulse podcast, Evolving Strategies for an HIV Vaccine: One researcher explains where the field is going and why?, Dr. Katy Stephenson explores the implications of recent trial results, the big questions driving next generation vaccine development, and new strategies underway in early phase research. Katy is a doctor, a researcher, a professor of medicine at Harvard Medical School, affiliated with Beth Israel Deaconess Medical Center, and part of the Center for Virology and Vaccine Research.

Listen:

Resources:

The Shape of Pandemic Preparedness is Being Decided. Now is the Time for Collective Action.

Health leaders around the world are in the midst of creating a new architecture to deal with pandemics. In this episode of Px Pulse, Chris Collins, the CEO and President at Friends of the Global Fight Against AIDS, Tuberculosis and Malaria, talks about what’s at stake, which policy-makers get it already, why this year matters so much, and what advocates can do about it.

PPPR Advocacy 101: Find out what it means to you

Over the coming months, global leaders will make key decisions about several initiatives to prepare for the next pandemic. What they commit to and how much they will spend, and how well these plans incorporate equity as a principle across all of these agreements, is in question.

Deadlines for civil society to influence these decisions are coming up. There’s a Pandemic Fund. There’s a Pandemic Accord. There are UN High-Level Meetings. There’s also something called the Medical Countermeasures, or MCM, platform. The MCM platform would coordinate drugs, vaccines and other equipment for health emergencies.

In our last podcast, we spoke with Chris Collins, President of Friends of the Global Fight Against AIDS, TB and Malaria about all these efforts. Ultimately, these decisions will build a new architecture for Pandemic Prevention, Preparedness, and Response, or PPPR.

Chris and the HIV community have been calling for stronger health systems and expanded domestic funding for health, and have been pushing for a rights-based approach to pandemic prevention, preparedness and response—one that builds on the decades of advocacy that has shaped the response to HIV.

But it’s not clear whether planning for the next pandemic is heeding these lessons.

Karrar Karrar, who heads up Health Policy at Save the Children, and Samantha Rick, who leads AVAC’s PPPR policy advocacy, have been tracking these efforts closely. They are joining us today to explain exactly what commitments for equity are needed and who needs to hear this advocacy and when.

Listen

Transcript

Resources

New Products Are Needed But a New Paradigm is Essential

With all the talk about new HIV prevention products such as the dapivirine vaginal ring or injectable cabotegravir for PrEP (CAB for PrEP), what’s little understood is how to match proven products with the programs, policies and political will needed to get them to the people who need them. This episode explores the shifting landscape in HIV prevention and how this moment gives the world a chance to finally reimagine how to DELIVER prevention.

We go from big picture to grass roots, and dig into what it’s going to take to reach global targets. There’s a new road map out from the Global HIV Prevention Coalition with a big vision and a new target of less than 370,000 new infections by 2025. And PEPFAR’s new Strategic Direction talks about a target for ending the epidemic as a public health threat by 2030, but how are we going to get there?

This episode brings three perspectives together:

PEPFAR Ambassador Dr. John Nkengasong describes a model to scale up prevention in 5 countries and show impact in 1-2 years.

Executive Director of HEPS-Uganda, and former AVAC Advocacy Fellow, Kenneth Mwehonge talks about the commitments needed from a range of stakeholders to bring the Coalition’s new roadmap to life, and hit 2030 targets.

Lilian Benjamin Mwakyosi, the Executive Director of DARE and former AVAC Advocacy Fellow, talks about the day-to-day obstacles faced by young women who need prevention, what’s working now and what needs to change in HIV prevention programs.

Highlights

  • Listen to the ambassador’s appeal for an aggressive strategy to scale up combination prevention, including injectable cabotegravir for PrEP.

Resources

Research Fundamentals: An HIV Vaccine — What’s the challenge and what’s the science?

Some vaccines are easier to develop than others. COVID-19 vaccines were developed with unprecedented speed, taking a matter of months to become available. A measles vaccine took about 10 years to develop. But the field’s been working on an HIV vaccine for 40 years.

In this episode, AVAC’s Jeanne Baron and co-host immunologist Katharine Kripke of AVENIR Health explore why HIV is different with two experts on vaccine research: Caltech’s Pamela Bjorkman and IAVI’s Vincent Kioi.

Learn how HIV has evolved like no other virus today to escape detection by the immune system. Learn why the right target on HIV is so hard to reach and how scientists are tackling it all.

Previous Research Fundamentals

More Vaccine Resources

What Matters Right Now for Rolling Out the Ring and Injectable PrEP?

The HIV field has two new approved prevention options waiting in the wings, the dapivirine vaginal ring and injectable cabotegravir as PrEP. Until now, daily oral PrEP, first approved in 2012, has been the only drug-based strategy for HIV prevention.

So here we are: research has shown safety and efficacy for both the ring and injectable cabotegravir. Now it’s time to take the next steps to deliver these options and translate advances in science into real impact on the epidemic.

At AVAC, we’ve been calling for coordinated planning to introduce and rollout new products, while expanding access to existing options. These efforts must learn from the mistakes of the past, especially lessons from rolling out oral PrEP.

In this episode of PxPulse, Linda-Gail Bekker from South Africa’s Desmond Tutu Health Foundation and Lillian Mworeko from the International Community of Women Living with HIV East Africa (ICWEA) join host Jeanne Baron and AVAC’s Executive Director Mitchell Warren to discuss innovative models for scale-up and delivery. Taking the right steps now could mean HIV prevention options fulfill their life-saving, epidemic-ending potential, and to do so requires working faster and more efficiently than ever before.

We dive into what lessons the field has learned, what’s still off-track, and the steps advocates, policy makers, drug makers and funders should each take right now to turn efficacious options into effective choices.

Resources

Dapivirine Vaginal Ring
Cabotegravir
Ring and CAB