“We need to use modeling to communicate what the possibilities are and what’s been gained from investments to date.” This was the consensus of a small group of advocates, activists, public health leaders and modelers gathered on September 9 by AVAC and amfAR to take a closer look at the state of epidemiological modeling as it relates to the goal of ending the AIDS epidemic. There is scientific evidence for a range of potent prevention strategies including treatment as prevention, male circumcision in the immediate term and, in the future, microbicides, PrEP and vaccines. But decision makers face real challenges about determining priorities and budgets. Models can’t provide the answers, but they can give a sense of the benefits and trade-offs for different scenarios. On October 3, Tim Hallett, a modeler and epidemiologist from Imperial College London, met in Nairobi with AVAC and a small group of East African advocates including several of our Fellows, to discuss how advocates can be what Hallett calls “informed consumers” of HIV models. In the coming weeks and months, AVAC and its allies will be working to help frame the questions and modeling the needs critical to ending AIDS. Watch this space.
Leader Kanyiki, an AVAC Fellow, has been working with allies in South Africa since the beginning of this year to ensure civil society input into the National Implementation Guidelines for Medical Male Circumcision. This document, to be released on December 1, will guide South African policy and strategy for this powerful prevention tool. Kanyiki held meetings with policy makers, the Department of Health (DOH), the South African National AIDS Council (SANAC) and civil society as part of contributing to the drafting process, with a particular focus on gender sensitivity. Through the work of Kanyiki and allies, the final document states, “The involvement of women, both as sexual partners and mothers, will be promoted to the greatest extent possible. Men who wish to be circumcised will be encouraged to discuss the decision with their sexual partner.” While the inclusion of gender sensitivity language in significant, monitoring its implementation as South Africa’s medical male circumcision rollout moves forward is critical.
AVAC Fellow, Sylvia Nakasi, recently published a letter, “Uganda must move fast on HIV”, in The New Vision, a leading newspaper in Uganda. Her letter reflected on the recent announcement that Rwanda would consider implementing immediate antiretroviral treatment for all serodiscordant couples on the basis of effective data on treatment as prevention from the HPTN 052 trial. Nakasi called on Uganda to take similar steps, citing modeling data that suggests putting more resources into prevention now decreases how much will be needed to spend for treatment in the future. “As a country we need to move faster and also learn from our neighbors next door and speed up the process from research results to policy.” Given that Uganda sees 350 new HIV infections every day, prevention is a clear priority.