AVAC Partners’ Forum 2012

What happens when 71 advocates from 10 countries gather to survey the state of HIV prevention for the year to come? At the annual AVAC Partners’ Forum (December 4-6), the answer was: a high-energy conversation that just wouldn’t stop.

For three days of plenary sessions and small group work, participants debated, strategized and prioritized—and energy was as high at the end of the final day as it was when the meeting kicked off with an overview presentation on the science of AIDS in Africa, by South African researcher Helen Rees.

The annual Partners’ Forum is a chance for advocates to share experiences, consider upcoming plans, strengthen existing collaborations and forge new connections. This meeting’s highlights were many and varied—and included a review of advocacy victories in Kenya, Uganda, Zimbabwe and many other countries; review and debate of the different definitions of “combination prevention” packages proposed by PEPFAR, UNAIDS and other groups; serious consideration of what non-surgical voluntary medical male circumcision devices will mean in 2013; deep concern over the open question as to whether specific long-acting injectable hormonal contraceptives increase women’s risk of acquiring HIV; and comprehensive updates on each biomedical prevention option and related advocacy priorities in 2013.

The conversation covered a lot of ground—with breaks for song, dance and socializing—but resulted in a focused, ambitious set of goals for 2013. These will take flight through many collaborations and projects in the coming year. Look for upcoming webinars to help advocates get up to speed on key topics—and, as always, contact us if you’d like to be more involved.

Ants Can Kill the Elephant

The following is excerpted from a longer piece by Mannasseh Phiri originally appearing in Zambia’s Sunday Post. Phiri is a long-time HIV prevention practitioner and advocate.

If you have ever heard me make a presentation on HIV and AIDS in Zambia in the last 10 years, you will know that I always start with a picture of a magnificent specimen of a bull elephant standing in its majesty on the banks of the mighty Zambezi. As I show the picture I tell the story of how the African elephant in many ways behaves like HIV—quietly consuming a huge amount of resources.

I was thinking about how I seriously need to rehash, freshen or renew my own presentations’ opening story about the similarity the African elephant to the virus HIV [when I was reminded of] a piece of African wisdom that I hadn’t heard since I was child. “When ants are well organised, they can kill an elephant”. HIV/AIDS is a giant elephant and if we the people organise ourselves well, like ants, we can conquer HIV!

I was recently holed up in hotel in Johannesburg with other ‘ants’—feeding off each other’s energy, enthusiasm, sense of purpose, conviction and determination that the end for this elephant is possible and can be achieved. For this meeting [the AVAC Partners’ Forum] the ants came from Kenya, Rwanda, South Africa, Uganda, Zambia and Zimbabwe—all of them researchers, advocates and activists—with the combined power to make a whole herd of elephants scamper in fear.

It was not just the energy and enthusiasm of the “ants” that floored me. Their technical knowledge and understanding of the detailed intricacies and nuances of the research work they are doing made me ashamed of coming from Zambia. While cutting edge research in HIV prevention with oral antiretrovirals, vaginal and rectal gels, and vaginal rings is going on and advancing HIV science in Kenya, Uganda, Rwanda, Malawi, Zimbabwe and South Africa, Zambia is dithering with approvals because of suspicion.

I feel like the day is not far when I shall no longer need to always wear the AIDS red ribbon and the Until There’s A Cure copper bangle on my left wrist. Thanks to the meeting of the ants, the elephant’s days are numbered.

The GLAM Toolkit: Advocacy to promote lube access in Africa

The GLAM Toolkit was launched at a side meeting of the AVAC Partners’ Forum. GLAM (Global Lube Access Mobilization) is project of IRMA’s Project ARM (Africa for Rectal Microbicides), and this new resource provides background on the status of lubricant access in Africa and strategies for civil society to secure sustainable supplies of safe, condom-compatible lube.

After introducing the Toolkit, advocates discussed needs, innovative strategies and next steps for the promotion of lubricant as an HIV prevention tool. One challenge faced by advocates for lubricant access is the lack of concrete answers about lube safety. The evidence shows that condom-compatible lube (water- and silicone-based as opposed to petroleum-based) keeps condoms from breaking and slipping, which is important for HIV prevention. It is still unclear, though, which lubes are safe in humans and which might cause inflammation, increased shedding of epithelial cells and rectal bleeding. Such effects could possibly make a person more vulnerable to HIV infection.

Laboratory tests show that particular kinds of lube (iso-osmolar: having the same concentration of dissolvable substances in its cells as normal human cells) have little effect on the structure of rectal cells and the integrity of the rectal membrane. Other lubricants with higher (hyperosmolar) or lower (hypo-osmolar) levels of dissolvable substances are shown to alter cell structure in test tubes. Scientists have found that some hyperosmolar lubricants disrupt rectal epithelial tissue in macaque monkeys. The US Centers for Disease Control and Prevention (CDC) is currently conducting a trial in non-human primates to determine whether an unnamed water-based hyperosmolar lubricant affects SHIV susceptibility and transmission. (SHIV is a non-human primate version of HIV.) The CDC has said that lubricants with different chemical properties will be evaluated at a later date using this model.

Advocates have put the need for more clarity around lube safety front and center. As a result, the PEPFAR Scientific Advisory Board recently formed a lubricant safety working group to produce PEPFAR programmatic recommendations on the use of lubricants.

At the advocates’ meeting, participants agreed that there is an urgent need to clearly articulate what is known and unknown about the science, while working to meet the demand for lube from many different constituencies: gay men, men who have sex with men, and others who have anal sex. Women who have vaginal and/or anal sex also need safe, condom-compatible lubricants as well.

Click here to download The GLAM Toolkit.