Partner Voices: What the Heck is PrEP?

PxROAR member Nichole Little talks about her recent work with PxROAR colleague Robert Newells.

For years here in Oakland, CA, community health advocates have tried everything to get ahead of the curve on HIV transmission. When presented with a new tool, pre-exposure prophylaxis (PrEP), my fellow PxROAR member Robert Newells and I were eager to take advantage. To better understand how our community could implement PrEP we planned a series of local meetings on the subject.

The first of three community meetings took place late last month. Speakers at What the Heck Is PrEP: Biomedical Interventions for an AIDS-Free Generation included Ruben Gamundi from Gilead Sciences, HVTN 2013 Ramp Scholar Angela Scott and Yamini Oseguera-Bhatnagar and Ifeoma Udoh of the Oakland Downtown Youth Center. The presentations were designed as an introduction to PrEP and the clinical trial results of PrEP safety and effectiveness data. Participants included a number of Oakland HIV/AIDS service organizations who discussed the potential benefits of PrEP but expressed concern over the issue of access in a community where many already struggle to receive basic medical care.

The next two meetings in the series will focus on coordinating a response among the larger Oakland HIV prevention community. Later this month we’ll meet with local AIDS service organizations to encourage collaboration in an effort to reach a greater number of people with uniform and accurate information. We’re working to ensure these organizations are familiar with HIV prevention intervention basics and know how to best give this information to their clients and patients.

Our goal is to be sure everyone thoroughly understands the subject matter. It will be at these local organizations that discussions about whether PrEP could work in their community or not. The hope is that the advocates and activists can have informed conversations with clients and other at-risk community members. Robert and I are excited to be able to share this very important and exciting information with our community partners. Oakland is alive and ready to mobilize!

2013 AVAC Advocacy Fellows Orientation

Last month, the AVAC Advocacy Fellowship 2012 Wrap-up & 2013 Orientation Workshop took place in Cape Town, South Africa. The three-day gathering provided an opportunity for the 2012 Fellows to present their projects, reflect on the program and discuss their future work as advocates. The 2013 Fellows and their host organization supervisors were oriented to the specifics of the program and discussed their proposed projects for their Fellowship year.

Four years in, AVAC’s Fellowship program continues to expand. New Fellows have joined the program from China and Nigeria — the first Asian and West African countries to be represented. The program has also evolved into a network with strong alumni participation. The alumni network of Fellows—now 23 strong—continues to be engaged and supportive of new Fellows.

A number of 2013 Fellowships directly build on the work of their predecessors. For example, Maureen Milanga’s 2013 Fellowship is building on Jacque Wambui and Lucy Ghati’s 2012 work in Kenya to follow-up on HIV-related commitments by political candidates. And Mickey Meji’s work around civil society engagement on treatment as prevention in South Africa will use some of the networks created by Bukelwa Sontshatsha last year.

Bringing together these plugged-in advocates also provided a window into what might be most needed and useful in local prevention advocacy. Their work — both Fellowship projects and continued advocacy by alumni — is focused on the latest research and figuring out how to quickly translate recent findings into policy and to use proven technologies to help their communities.

Following the Workshop, the South African Fellows past and present were also able to work with the AVAC team in coordinating a series of local civil society roundtable meetings on AIDS vaccine research and on the evolving and expanding women’s HIV prevention agenda.

Watch this space to follow the work of the 2013 Fellows and to learn more about the continued advocacy by our alumni.

PrEP Trial Design and Ethical Considerations

In January AVAC collaborated with the French AIDS organization Sidaction to host a meeting, Challenges of clinical trial design, degree of evidence and recommendations in the era of PrEP. The meeting provided a forum for local French researchers and advocates to discuss IPERGAY, the intermittent PrEP study currently underway with men who have sex with men in France. A number of international researchers, advocates and normative agencies were also on hand to broaden the discussion. Advocates on both sides of the Atlantic have questioned the use of a placebo arm in IPERGAY since the US FDA approved daily TDF/FTC (Truvada) for prevention last July. French and other European regulators, however, have yet to approve the use of Truvada as PrEP, therefore it is not currently available for prevention, only treatment.

The daylong gathering brought key stakeholders together to discuss the difficult questions of trial design and ethics—issues relevant not only to IPERGAY but to other current and future biomedical prevention trials. Presentations from the meeting are available at

While participants in the meeting highlighted the various perspectives on the actual IPERGAY trial design, there was general agreement on the important role of the trial in answering questions around intermittent PrEP, whether TDF/FTC could be taken “on demand”, meaning at the time of sex, and still reduce the risk of HIV transmission.

At the meeting the French organization AIDES called on the French regulatory agency (the National Security Agency of Medicines and Health Products, or MSNA) to approve Truvada via a compassionate use authorization for HIV prevention among most at-risk groups. For a copy of the press release, click here.

Continue following developments at

Supporting Lubricant Access in Africa

IRMA, amfAR and AVAC are delighted to announce that IRMA Nigeria, in partnership with the International Center for Advocacy on the Right to Health, Stop AIDS in Liberia (SAIL), and an organization in Zambia (which requested to remain anonymous), have been awarded Global Lube Access Mobilisation (GLAM) funding to campaign for access to safe, condom-compatible lubricants in their communities.

Throughout the world, and especially in Africa, safe, condom-compatible lubricant (water- and silicone-based) is inaccessible for most people who engage in anal intercourse. It is also inaccessible for women who engage in vaginal intercourse. A number of analyses in various settings indicate that the use of oil-based products is the most common form of lubrication and is known to significantly reduce condom effectiveness. Faced with the lack of condom-compatible lubricants, people often resort to such products as body lotion, soap, cooking oil, spit, pre-cum, antibiotic creams and even motor oil to provide lubrication during anal intercourse. This lack of appropriate lubricant products for people who practice anal and vaginal intercourse is unacceptable when we know that they can keep condoms from breaking and slipping.

In December 2012, IRMA, amfAR, and AVAC launched The GLAM Toolkit – Advocacy to improve access to safe, condom-compatible lubricant in Africa, Version 1.0. The Toolkit offers tools and ideas for civil society and government partners to secure affordable and sustainable condom-compatible lubricant. Tools include a fact sheet, case studies, the results of a review of African National and Strategic Plans on HIV/AIDS and a list of proposed advocacy activities.

After the Toolkit launch, the group released a request for proposals targeted to community advocates and organizations in Africa interested in improving lube access. Eighteen proposals were submitted from 11 African countries. IRMA Nigeria, SAIL and a Zambian organization received the highest scores in a thorough evaluation process and began their lube access advocacy projects this month. These include speaking with sex workers about lube’s importance, working to increase public awareness and reduce stigma, disseminating the GLAM Toolkit and much more.

To learn more about GLAM, click here, and download The GLAM Toolkit here.