This week the 69th United Nations General Assembly (UNGA) met under the theme Delivering on and Implementing a Transformative Post-2015 Development Agenda. There have been many conversations throughout the week – from climate change, global security, to Ebola and of course HIV/AIDS at these deliberations in New York City.

The governments of Ghana and Switzerland in collaboration with UNAIDS led a high-level panel on September 25 focused on fast tracking the end of AIDS by 2030. The packed session included presidents and other global leaders, leading scientists and advocates, donors and technocrats. This meeting was designed to build momentum and political support for the still-lofty goal of ending the epidemic—and to raise awareness of the new UNAIDS “90-90-90” targets which call for 90 percent of people with HIV to know their status, get initiated on ART and achieve virologic suppression.

The current goals have heavy emphasis on treatment, and an emphasis on the biomedical. So it was both necessary and energizing to hear remarks from Kenyan advocate, Teresia Otieno, an HIV positive mother of two, chairperson of the International Community of Women Living HIV/AIDS and a 2014 AVAC Advocacy Fellow, about what it will take to achieve these goals. Otieno spoke from the heart – challenging the UN Secretary General, represented by his deputy Jan Eliasson, to ensure that commitments made by governments, development partners and other key players are fulfilled. She emphasized the need for prevention targets alongside treatment goals.

“I do not want to come back here in 2030 and talk about the same thing,” said Ms. Otieno. “In 2030, I’ll be 56. It is my dream that I will still be alive. I dream of a world where I’ll have access to cheaper and better treatment; where my husband, who is seated in this room, will still be HIV negative; where my 22-year old daughter will have the prevention she needs and also not have to face gender based violence; and a world in which if she does not want to have children, she would have tools for that,” said Ms. Otieno. She urged leaders to put women and girls at the center of the response, if this dream of ending AIDS by 2030 is to be realized.

Ms. Otieno was one of the panelists at this high-level panel, along with President John Dramani Mahama (Ghana), President Didier Burkhalter (Switzerland), President Jacob Zuma (South Africa), Secretary John Kerry (US), UN Deputy Secretary General Jan Eliasson, Clinton Health Access Initiative (CHAI) CEO, Ira Magaziner, Chad First Lady Hinda Deby and UNAIDS Executive Director Michel Sidibe.

At the same session, South African President Jacob Zuma announced a new Global Access Program launched by Roche Diagnostics that will bring the cost of viral load testing using Roche’s program, down to less than USD$ 10 per test. South Africa is the largest purchaser of viral load tests in the world, and the country’s National Health Laboratory Service has the largest viral load program on the continent.

The program reflects work and partnership between the South African government, the Clinton Health Access Initiative (CHAI), UNAIDS, PEPFAR and the Global Fund. According to CHAI CEO, Ira Magaziner, who also gave remarks at the meeting, South Africa won’t be the only country to benefit from this price reduction. Magaziner said that 83 countries would benefit from this price reduction—which is key to tracking progress towards the goal of having 90 percent of individuals on ART achieving virologic suppression.

Dropping diagnostic prices is key—but the best and most affordable technologies and medicines won’t end the epidemic if people cannot access them. For some people, the access challenge may be the distance to the clinic; for others it may be the fear of judgmental care and/or violations of confidentiality that could happen in the clinic. Ensuring access means addressing the environments of stigma, discrimination and criminalization that hinder many people from seeking or staying on care. This is particularly true for LGBT individuals, sex workers, injection drug users—and for many women.

In another critical step in the right direction, on September 26, the UN Human Rights Council adopted a resolution against LGBT discrimination and violence. The resolution, which passed by a 25-14 vote, expresses “grave concern at acts of violence and discrimination, in all regions of the world, committed against individuals because of their sexual orientation and gender identity”. The resolution affirms one of the United Nations’ key principles—that everyone is equal in dignity and rights.

UN meetings generate plenty of headlines and important precedents. The proof of the utility of this UNGA meeting will play out in countries around the world. AVAC looks forward to working with partners on implementation of ambitious prevention and treatment goals within a rights-based framework. Please join us to learn more and get involved.

While many contraceptive options are on offer for women in high-income countries, the choices are limited, or nonexistent, in low-income countries and communities around the world. Globally, 215 million women are in need of modern contraception. For millions of women worldwide, the existing method mix of contraceptives is not sufficient.¹ Challenges to access and use include the need to reduce or eliminate side effects and removing the need for a doctor’s visit, among others. Ensuring the range of contraceptives available meet the needs of women in a variety of geographic and socio-economic settings and stages of life is key.

On September 9, 2014 the SILCS Diaphragm (brand name Caya®) was approved by the US Food and Drug Administration (FDA) for marketing in the US. Available in fourteen European countries since 2013, and also approved this year in Canada, women in the US can expect to see it available in 2015. Improving on other diaphragms currently on the market, the SILCS diaphragm is a one-size-fits-(nearly)-all product—eliminating the need for a woman’s cervix to be measured by her doctor before use. It is also easier to insert (like a tampon), and in Europe and Canada it is available without a prescription.

The SILCS Diaphragm is a non-hormonal form of contraception, which is preferred by some women. This is also key in that it relates to some of the major research questions under consideration in HIV prevention for women: whether hormonal contraception increases a women’s risk of HIV infection, and the importance of developing a multipurpose prevention option that could prevent pregnancy and sexually transmitted infections (STIs), including HIV. The potential use of the SILCS diaphragm as a non-hormonal contraceptive device to deliver anti-HIV drugs poses some intriguing possibilities.

Approval of the SILCS diaphragm expands the non-hormonal options women can use that do not necessarily require regular healthcare visits. PATH, the developer of the SILCS Diaphragm, is currently working to get this new diaphragm to low-income countries as it was designed with the settings and health systems of resource-limited countries in mind. They have licensed the technology to Kessel (Kessel medintim GmbH), a German company that markets the device in 14 countries throughout Europe, Canada, and soon, in the US (although not without a prescription in the US).

The Expanding Effective Contraceptive Options (EECO) project—led by WomanCare Global and funded by the USAID’s Office of Population and Reproductive Health, in partnership with Population Services International, Every1Mobile , the International Center for Research on Women and Evofem—is conducting pilot introductions of the SILCS diaphragm, along with four other woman-initiated reproductive health technologies. These pilots are in India, Malawi and Zambia. The EECO project works on the registration, marketing and distribution of the products, aiming to get them to the women who would like to use them.

Getting additional pregnancy prevention options to women in all settings is an important step to providing all women in need with a range of contraceptive options. It is of particular importance in areas where the injectable hormonal contraceptive Depo-Provera is the primary contraceptive option available and accessible and HIV infection rates are high.

The SILCS diaphragm may also play a future role in HIV prevention as research groups are considering how it could be combined with other products to provide protection against both HIV and unintended pregnancy. Multipurpose prevention technologies are drugs or devices that provide contraception and protection from HIV and/or other STIs. PATH and other partners are exploring the use of the SILCS diaphragm as a reusable microbicide gel delivery system where the gel could be applied to the diaphragm before insertion.

Studies are underway looking at the effectiveness of SILCS as a contraceptive when used with tenofovir gel, currently under study as a microbicide to reduce risk of HIV. This delivery system may be more acceptable to some women than the current microbicide applicator being tested, and it could hold gel higher in the vagina, closer to the cervix, possibly reducing the potential for leaking gel. In addition, SILCS is now an approved contraceptive method so it might reduce the stigma associated with use of a new product for HIV prevention alone; and, it is reusable for two years, reducing the cost of a potential delivery system for tenofovir gel.

The second way SILCS could be developed as a multipurpose prevention option is as a slow-release microbicide delivery system. By loading an ARV-based drug for prevention into the SILCS “spring” during the production process, it could allow for controlled release of the ARV over time. Researchers at PATH and Queens University Belfast completed a proof-of-concept study testing the device loaded with dapivirine (another ARV-drug currently being tested as a vaginal microbicide ring) where the drug was released at a constant rate over a period of at least 12 months. The next phase of preclinical study is not underway due to funding constraints, and it remains to be seen if this approach will continue through the pipeline.

It is critical that additional contraceptive options like SILCS continue to move towards rollout in settings with high HIV incidence. AVAC is working in partnership with groups and advocates in East and Southern Africa and on the global stage to bring the voices of women as the end-users to the conversation around hormonal contraception and HIV risk, and to the importance of expanding the range and choices in contraceptive and disease prevention methods.
AVAC will continue to track SILCS and other multipurpose prevention options in the research and development pipeline on our Prevention Research Database (PxRD).

To get involved, email avac@avac.org.

¹Guttmacher Institute, 2011, 2012

A trial designed to evaluate how different methods of contraception (Depo, the copper IUD and the Jadelle implant) affect HIV risk is under-funded and in jeopardy—as explained in a new editorial published on RH Reality Check, authored by Lillian Mworeko of ICW-EA, AVAC Program Director Emily Bass, Tyler Crone, Johanna Kehler of the AIDS Legal Network South Africa, Sophie Dilmitis and Definate Nhamo of PGAT, Zimbabwe.

In it, the authors argue that this trial is “one of the best research investments that could be made in reproductive health and rights in the context of women and HIV today.” We look forward to widening discussion and amplifying voices on this issue. For background, please visit avac.org/hc-hiv. And please contact us to get involved in ongoing advocacy.

AVAC’s relaunched website, avac.org, includes a new blog, P-Values. It’s a place where AVAC, its partners and colleagues in the field of biomedical HIV prevention advocacy have their say about the latest findings, biggest challenges and most exciting successes in our collective work.

Posts include guest-authored pieces by leading scientists, AVAC’s “take” on emerging issues in real time and more.

We hope you’ll visit the page regularly and, to get you started, invite you to check out some recent highlights:

• The Big Picture of Small Molecules for Curing HIV Infection — Dr. David Margolis and Karine Dubé of The Martin Delaney Collaboratory of AIDS Researchers for Eradication explain one strategy being pursued by scientists as a possible way to cure HIV.

• What Does PrEP Mean for Condom Use? — Nicholas Feustel, a documentary filmmaker specializing in films on health and human rights and a member of AVAC’s PxROAR program in Europe—a program that connects advocates and builds advocacy skills. In a July interview with the German magazine Männer, he talked about PrEP and the implications of its use.

• No Turning Back in Fighting AIDS — The past decade of financial and political commitment has resulted in a major expansion of access to HIV prevention and treatment services around the world but these gains remain fragile. In this piece, originally appearing in PSI’s magazine Impact, Kevin Fisher and Catherine Connor—writing as co-chairs of the Global AIDS Policy Partnership—call for increased funding of PEPFAR and further investment in domestic HIV prevention and AIDS treatment programs globally.

• Corporate Leaders Must Stand Up for LGBT Rights in Africa — AVAC and partners worked in coalition with 26 organizations to develop a sign-on statement urging US corporations to raise the importance of human rights, including rights for LGBT individuals, for the recent US-African Leaders Summit.

• A Prevention Agenda for Women — There is extensive evidence that integrating family planning services and HIV prevention and treatment isn’t just a good idea, it is the only effective approach to women’s health. A report from a 2013 AVAC/CHANGE meeting on the topic includes recommendations on how to integrate HIV and family planning services along with ideas on how to best move forward in the context of uncertainty about whether some hormonal contraceptives (HC) increase HIV risk and how to advance “method mix”—a wider array of contraceptive choices for women everywhere.

Have a comment on one of our blogs? Want to write something yourself? Reach out to us at avac@avac.org.