We Told You So—New UNAIDS report shows missing focus on rights and evidence-based responses hurting prevention

Earlier today UNAIDS released its Global AIDS Update ahead of next week’s UN High-Level Meeting on Ending AIDS in New York. The highlight of this year’s update was the news that across the globe 17 million people who are living with HIV are on antiretroviral treatment (ART), an increase of two million from 2014 to 2015. While there is clearly still work to do in closing the treatment gap (17 million is still a little less than half of the total number of people living with HIV all of whom are eligible for treatment per updated WHO guidelines), this recent accomplishment is ahead of the 15 million target set within the 2011 UN Political Declaration on HIV and AIDS.

This is welcome news, but unfortunately the news is not all good. The report also reveals that declines in rates of HIV acquisition have “slowed alarmingly” with the overall rates of new infections largely unchanged. These rates continue to be disproportionately high among young women, and key populations and their sexual partners.

While the annual number of new infections has changed little from the previous year, the data that make up that total have changed. Rates are on the decline in eastern and southern Africa—4 percent since 2010—while new infections in eastern Europe and central Asia are up 57 percent over the same period. Any decline, even a modest one, indicates progress, but prevention advocates are left to wonder what could have been had countries reached the 80 percent coverage of voluntary medical male circumcision (VMMC) targets. Some models predicted 10–15, even 25, percent declines if VMMC targets were reached. So yes, overall decline is good but this modest number represents a missed opportunity to do much much better.

And speaking of VMMC, the report didn’t speak to it much at all, or any of the prevention targets outlined in UNAIDS’ 2016 – 2021 Strategy, released last October. There is a section of the 12-page update on prevention, the title of which points to the need for a “reinvigoration of HIV prevention” but the update misses the mark, leaving out the targets completely and reporting only on successes in ART coverage.

And prevention was dealt another setback today with the National Health Service England confirming its decision not to fund PrEP—and somehow it’s still a surprise when reports like the one released today show that global HIV rates aren’t declining.

UNAIDS comments that “Fast-Track approach to HIV treatment is working. Global consensus and leadership have driven greater investment of financial and human capital, and mounting clinical experience and research, improved treatment regimens and diagnostics and reductions in the price of medicines have created gains in efficiency and effectiveness.” This is certainly true, but AVAC calls for—and looks forward to—future reporting where the “Fast-Track” approach to treatment AND prevention is the global success we all know it can—and has to—be.

Submit a Session for the AIDS 2016 Research Literacy Zone!

For the first time, the Global Village at AIDS 2016 will feature a Research Literacy Networking Zone, a space for advocates, local community members, conference presenters and researchers to engage with one another and discuss the science of HIV prevention, treatment and cure research.

The Zone’s organizing committee is seeking applications for programming during the week. Have a session idea that relates to HIV prevention research or implementation? We want to hear from you!

Click here to submit a brief session description—all applications are due no later than Monday, June 6.

And for more on the AIDS 2016, click here.

AVAC Marks International Day Against Homophobia, Transphobia and Biphobia with Advocacy at the UN and in Washington at Center Stage

The International Day Against Homophobia, Transphobia and Biphobia (fondly and widely known as IDAHOT) was last week—May 17. AVAC marked the day with action on the frontlines of the fight to secure dignity and justice for all people. Here are some of the steps we and our partners took during a full week of action.

One major focus for AVAC and for many advocates was the ongoing campaign to ensure that the voices of key populations are heard as part of the UN High-Level Meeting (HLM) on Ending AIDS which will take place June 8 – 10, and is described as a time where “world leaders, government representatives, HIV program implementers and civil society organizations from across the world will gather at the United Nations Headquarters in New York, United States of America, to chart the way forward to ending AIDS as a public health threat by 2030 as part of the Sustainable Development Goals.”

As many of our partners know, there has been an inexcusable move by some country delegations to block registration of NGOs representing key populations, including sexual minorities, from participation in the HLM. Since global health and justice depend on open, inclusive societies, this isn’t acceptable.

Last week, advocates working at the regional and national levels from HIV service organizations, networks of people living with HIV, women’s rights organizations, and advocates working with groups representing key populations, came together as a coalition to lobby member states and their missions. The “lobby week” brought together 38 advocates from 30 different civil society organizations in countries throughout North America, Africa, Latin America and the Caribbean, Eastern Europe, Asia and the Pacific, and the Middle East.

Members met with 26 different governments to inform governments on the coalition’s key priorities and to educate them further on how to address contentious issues throughout HLM negotiations. Among these key priorities are sex work, financing, TRIPS and access to medicine, gender-based violence, comprehensive sexuality education, and key populations including young key populations.

During the week, AVAC, with support from the Danish Mission in NY and the UN LGBT Core Group (a wide network of countries that aims to ensure a place for “SOGI” (sexual orientation and gender identity) at the UN), organized a ground-breaking event at the Danish Mission in New York. The event brought together over 10 country missions and over 22 activists from around the globe to dialogue on inclusion of issues related to gay men and other men who have sex with men (MSM) in the HLM declaration. The meeting also addressed the exclusion of MSM-led organizations. The US government representative in the meeting said the US Ambassador to the UN Samantha Power did write a letter to the UN Secretary General Ban Ki-moon about the exclusion, and AVAC and other organizations are working to ensure that MSM and LGBT voices are heard during the HLM—through direct participation and high-impact side events.

In other IDAHOT activities, on May 14th, the UN Free & Equal campaign launched a new video, Why We Fight” which celebrates the contributions that LGBTI people make to families and local communities around the world.

OutRight Action International organized, Celebration of Courage, the first LGBTI event to take place inside the exclusive Delegates Dining Room of the United Nations. This event honored individuals and organizations, including UN Free & Equal Campaign, Arus Pelangi (national federation of LGBTI communities in Indonesia), US special envoy for LGBTI rights Randy Berry and Microsoft’s Dan Bross. Omar Sharif Jr. of Logo TV presented the Global Ally Project, where Egyptian-born Sharif helps share stories of LGBT people around the world. The project also includes a survey of 100,000 people in 65 countries on attitudes toward LGBTI people. The event’s host, actor Alan Cumming, congratulated the efforts of the activists and the Global Ally Project for bringing to light the real stories of LGBT people.

“Homophobia is a form of fear,” he told us. “All fear, when you’re exposed to it or understand it, goes away. You open your heart a little bit. It would be easy to be complacent and forgot what’s happening in the world.”

The week ended on yet another high note at the US Capitol. The Institute of Current World Affairs hosted a conference on the Geopolitics of LGBT Rights with an overview of rights in Africa, Asia, Europe and America. The conference had high-level keynote speakers, including Denmark’s Ambassador to the UN and the US special envoy Randy Barry, who in his remarks said, ‘’Tolerance is not our goal but it is often better that what we have now,” adding that if people are accepted for who they are the world will be a better place.

Prevention Activism as PEPFAR Finalizes its Country Operational Plans

For the second year in a row, the US AIDS program PEPFAR has opened its annual planning process up to civil society engagement and input. Last week and this week, the country operational plans, or COPs, for a range of sub-Saharan African countries are being finalized at in-person meetings in Johannesburg, South Africa. Meeting participants included PEPFAR staff, government representatives, UNAIDS staff and international and in-country civil society.

The in-person COP review is the culmination of an engagement process that has included countries sharing voluminous quantities of data on the previous year’s performance and the next year’s targets, along with a narrative “Strategic Direction Summary” describing the plans for the years ahead.

AVAC and a range of partners, including strong in-country coalitions in Kenya, Malawi, Uganda, Zambia and Zimbabwe, have been working over the past year—since the last review—to access quarterly country data and to shape input into the next COP. We’re also delighted to work in strong coalition with international groups including Health GAP, MSMGF, amfAR and the International HIV/AIDS Alliance.

One COP review meeting is still underway, but the news from last week’s meeting is energizing and speaks volumes about the importance of engagement and activism in this space. As detailed in a blog from Health GAP, there was a range of ways that civil society had impact on treatment targets, service-delivery models and engagement with key populations (Click here to read a report from MSMGF on key populations advocacy). These weren’t easy victories, and they depended on sharing work, diving deep into data and standing ground on key demands.

In addition to the gains detailed by Health GAP, there were key strides in non-ART prevention. These included:

  • Increases in VMMC targets in Zambia and (as of press time—with the COP not yet signed) Zimbabwe.
  • Safeguarding of VMMC resources from PEPFAR, GFATM and World Bank in Malawi—when one possibility was reallocating a portion of GFATM away from VMMC. (GFATM, UNAIDS and other stakeholders also attend the PEPFAR reviews and contribute to broader planning conversations.)
  • Commitments to troubleshoot and accelerate Uganda’s VMMC program, which has slowed down to address cases of tetanus in young men undergoing the procedure who hadn’t previously received a tetanus vaccine.
  • Inclusion, for the first time, of PrEP targets in the COPs for Uganda and inclusion of PEPFAR commitments to PrEP preparedness and policy development in Malawi and Zambia.

All of these gains happened in a process where civil society raised the need for comprehensive HIV prevention and made specific demands as to what it would like to see in next year’s plans.

The work isn’t over when the COP is signed—in fact, it’s just beginning. Smart, strategic analysis depends on access to PEPFAR’s quarterly review of country progress. AVAC and partners will be working on evaluating these quarterly updates, influencing PrEP rollout, keeping up demand for ambitious VMMC targets—and much more. We hope you’ll join us. If you’re interested, please contact us.

The Search Continues and Science Advances on HVAD 2016

Today, the US National Institutes of Health (NIH) announced that it will fund a large-scale efficacy trial in South Africa to test the prime-boost vaccine regimen that is a modified version of the RV144 vaccine that showed modest efficacy in 2009. This will be the first large-scale HIV vaccine trial to take place in South Africa in almost a decade, and an exciting development for the country and the field. In addition to the announcement, NIH also posted questions and answers about the new study.

Still have questions or want to hear more about what this all means? Then join us on Tuesday, May 31, at 10am US Eastern/4pm South Africa time (see www.timeanddate.com for the time in your area), for a webinar with Linda-Gail Bekker from the Desmond Tutu HIV Foundation and the lead investigator on the current HVTN 100 vaccine trial.

Register for the webinar here.

The announcement of the trial, known as HVTN 702, comes on HIV Vaccine Awareness Day, the annual event that allows us all to recommit ourselves to accelerate the search for an HIV vaccine. As we wrote on Monday, today and every day, we should all say, “I’m committed to ending the AIDS epidemic, and that means finding an HIV vaccine.”

The announcement that HVTN 702 will take place comes nearly seven years after the announcement of efficacy data from RV144. In the intervening years, global scientific collaborations have probed the responses from RV144 and developed plans, in combination with industry, to optimize the regimen so that it might work better, provide more durable protection and is tailored for the HIV subtype C that is most common in Southern Africa.

Today’s decision is based on an interim analysis of HVTN 100, a current trial in South Africa led by the NIH-funded HIV Vaccine Trials Network (HVTN) that is looking for immune responses and safety in South African volunteers of the modified vaccine combination. HVTN 702 will start later this year and will measure safety and efficacy in 5,400 participants.

Under the current plan, it will be at least four years before there are data from HVTN 702. Check out our new AIDS Vaccine Research Overview that shows the HVTN 100/702 trials in context of the larger field. Other HVAD materials are here. In addition, check out some of these new HVAD articles that just came out:

As is so often and so rightly said in this field: much accomplished; much to do!

Appointment of Dr. Maureen M. Goodenow as Associate Director for AIDS Research, NIH

“I am pleased to announce the selection of Maureen M. Goodenow, PhD, as NIH Associate Director for AIDS Research and Director of the NIH Office of AIDS Research. Dr. Goodenow brings nearly 30 years of experience in HIV/AIDS research and advocacy to the position. She is expected to join NIH in July 2016 to lead OAR’s efforts, working closely with NIH institutes and centers, to pursue new tools for preventing HIV infection.” Click here for more information.

Preparing for HIV Vaccine Awareness Day 2016

It’s that time again—HIV Vaccine Awareness Day. AVAC has worked with partners to develop a range of tools and resources for this day and for year-round advocacy. We hope you’ll find them useful whether you unfurl banners, strike up a band, hold a fishing boat race, host a town hall forum, or just turn to your closest neighbor and say, on May 18, “I’m committed to ending the AIDS epidemic, and that means finding an HIV vaccine.”

This year’s HVAD tools and resources include:

Technology and Health Coverage

Out of all the different book and movie genres, my favorite is science fiction. There’s something about “futuristic” technology and how society reacts to it that fascinates me. So when I had the opportunity to attend the Global HIV Vaccine Enterprise’s “Innovative Uses of Technology in HIV Clinical Trials” meeting, I didn’t want to miss out. As technology and global health both expand—and in some places converge—I find myself more and more drawn to understanding how the global health field might benefit or be hindered by this growth in technology.

The meeting, which was part of the Enterprise’s “Timely Topics” series, concentrated on how using new technologies like biometrics, mobile phone messaging, cell phones, tablets and smart pill bottles could help clinicians, researchers and clients. Here are four key takeaways:

1. Just because we have technology doesn’t mean that researchers should use it. This idea was particularly stressed when discussing data collection. We now have the ability to collect responses through technologies like tablets or SMS. However, this doesn’t mean that we should disregard paper methods. Technology can be harder to use because it may malfunction, may not be viewed favorably by locals, get stolen or even be inaccessible when batteries run out or power goes out. We need to be sure that we are thinking about the usability of technologies and whether or not they truly add worth.

2. Policy needs to catch up with technology / Health technology companies need to ensure there are protocols in place: It’s scary to think that technology is often ahead of policy. Though it is perhaps impossible to think of every worst-case scenario, governments should start thinking of health privacy laws. In addition, health technology companies and those who utilize the technologies should put sound protocols in place should data be hacked or misused. Though biometrics (a technique using physical characteristics to identify a person), seems like a safer way to guard identity because the human body is unique to every individual, companies must proceed with caution and consider robust and secure measures.

3. Those working in the global health field and technologies need to work together to push companies to create compatible structures and platforms, at the very least within country: As the speakers stood in front to present, one of the repeated questions pertained to the compatibility of the different technologies or data systems. Unfortunately, not all of the software used seemed to be compatible. Though these new technologies are currently being tested with smaller populations, going forward, governments, clinical trial sites and companies need to decide on how to make these systems compatible. Otherwise, data sets may not be transferrable and money wasted on either starting from scratch or having someone convert data.

4. Messaging needs to be well thought out and expectations managed: I’m a big proponent of using technology to improve global health. However, I also know that transparent communication is key to growing relations and trust. That’s why I was a little bit wary as to the messaging that is potentially being conveyed when introducing something as new as biometric scanning. Are the possible cons of biometrics thoroughly listed out before participants willingly give up scans of their eyes or finger prints? Are donors and implementers aware of the responsibility and gravity of what will happen if the information were ever to get into the wrong hands? After all, things like our eyes and fingerprints cannot be reset like passwords can.

The conference was eye-opening to the different ways that technology can impact global health. The convergence of technology and health is definitely a growing field that we should be watching out for in excitement. However, we also need to pause and think before jumping into new innovations.

You can view the meeting presentations here.

Request for Information: FY 2018 Trans-NIH Plan for HIV-related Research

Feedback is invited from investigators in academia, industry, health care professionals, patient advocates and health advocacy organizations, scientific or professional organizations, federal agencies, and other interested constituents and the community [regarding] possible future directions to maximize benefits of investments in HIV/AIDS research. Click here for more information.

Funding Opportunity Revision: Applications for US-South Africa Program for Collaborative Biomedical Research

Purpose: To provide supplementary funds to current R01 [U01] awardees to add or expand activities focused on establishing or enhancing substantive research opportunities for underrepresented scientists in the biomedical research workforce in South Africa. Letters of intent are due by July 2, 2016 and applications are due by August 2, 2016. Visit here for more information.