Plants, PrEP Posters and People: The Research Literacy Networking Zone at AIDS 2016

We didn’t know how it would go.

Photo Montage

We knew it would take a lot of work—and even more frustration. We also knew it was an exciting new venture, especially in a time of headlines like, “Biomedical Prevention is Experiencing a New Frontier”. Our goal was for the first ever Research Literacy Networking Zone (RLNZ), set up in the Global Village at the 21st International AIDS Conference in Durban (AIDS 2016), to be place where conference goers and community members could unpack the science and the status of HIV prevention, treatment, and cure research. We hoped people would come, we hoped it would be a valuable service for attendees and mostly we hoped it would broaden awareness and support around these fields.

We never anticipated that our hopes would be exceeded—through five days of constant action in the Global Village, the buzz at the RLNZ was nearly relentless.

AVAC and partners IRMA, NHVMAS, TAG, WACI Health, and WRHI worked together to make the Zone come to life. We spent five days on our feet distributing materials, playing educational games, running sessions, and mostly, talking to people. We saw formal sessions with dedicated speakers draw participants who filled the space and spilled into the aisle-way around the Zone. We saw the impact of having a researcher sit in a circle, rather than stand at a podium, to speak with community members. We saw the power of working one-on-one to make sense of data from an infographic about the effectiveness of PrEP for women. We saw what can happen when someone from Philadelphia sits on a couch with someone from Nairobi and talks about vaccine research in their respective countries. It’s hard to capture in words the richness we experienced, but here are some highlights of what we saw, heard, and felt in the Zone.

Monday: Today’s highlight came when Nobel Laureate Françoise Barre-Sinoussi made a surprise appearance at the session Understanding HIV Cure Research. She took the microphone, ignored the podium and warmly addressed the large group attending the session. She urged them to find meaningful ways to explain “cure” to their communities. Much of the session’s discussion focused on the meaning of “functional cure”, “remission” and “sterilizing cure”, highlighting the importance of being able to explain these terms in lay language. Many walked away with a new appreciation for the challenges of cure research and the many steps along this path.

Tuesday: Another leader in the AIDS world visited the Zone today—Emilio Emini, the Director of HIV at the Bill & Melinda Gates Foundation. Dr. Emini has a long and distinguished career in HIV research and may have been the perfect person to sit with community members and discuss research issues across the board. Dr. Emini caught our attention at this session when he said the research field will be taking a page from colleagues working on the contraceptives pipeline. Like them, he wants to roll out what we have, as imperfect as it is, while we urgently seek new options that address the needs of end-users. As various HIV prevention research fields move into later phase trials and potential rollout, this is a space to watch!

Wednesday: One of our highlights today was a packed session about advancing PrEP advocacy. We heard loud and clear in this session, and all week, that people know PrEP. This is a marked difference from even two years ago at the International AIDS Conference in Melbourne, highlighting the rapid expansion and success of PrEP advocacy at community, policy, healthcare and funding levels across the globe.

Speaker Ntando Yola addressed a packed crowd

Thursday: Preventive vaccines were on the table at the Ask the Researchers session. Community members heard in lay language about this exciting time for multiple vaccine concepts and movement into efficacy trials. But one highlight came outside the day’s formal sessions. Foot traffic had died down a bit as Thursday was the last full day of the Global Village. During a quieter moment, three women arrived at the Zone wanting to play our “Test Your Research Literacy” game. They may have been mostly motivated to win a T-shirt for answering one of the questions from the hard column, but when they didn’t quite have the answers, they combed through the fact sheets and other tools available in the Zone until they found the info they needed. Prizes well-deserved!

curious delegates hunt for answers in our quiz game

Friday: Exhausted but inspired, we broke down the Zone. Looking around, we reflected on this packed week, which our co-organizers, advocacy partners, visitors, and research representatives across the board agreed in force was a massive success. Maybe it was the plants and their welcoming green, I thought, that invited so many people in and made the Zone a comfortable space. Maybe it was the striking posters from Chicago’s PrEP 4 Love campaign. The moment these posters went up in the Zone, people stopped, stared, said things like “Those are beautiful,” and “Thank you for including people with real bodies,” and then asked, “What is the Research Literacy Zone all about?”

I wasn’t sure, but something worked.

guests linger and debrief in the zone

A group of advocates lingered on the couches as we packed up. I stopped and nodded to one, a 2016 AVAC Advocacy Fellow, who was taking his final opportunity to charge his phone at our charging station. I said, “You are going to miss this place.” He responded, “This is our home.” I realized then that the most important ingredient in all of this was the people. The people with their questions, their hunger to learn, their desire to debate, and their ability—in this space—to interact and engage in research. Just as in research, it was the people themselves that were the most important metric of success of the Research Literacy Networking Zone.

This was a first for an AIDS conference—but it surely can’t be the last.

session participants discussed and debated actively all week

See you at the next Zone!

Prevention, Treatment and Human Rights

AVAC Executive Director Mitchell Warren and international gay rights activist Bisi Alimi dig into the tough realities of fighting HIV in 2016 in this interview, originally livestreamed from the AIDS 2016 conference in Durban.

Alimi asks Warren to make sense of scientific advances and new discoveries that are answering big questions and raising others. And Warren shows the imperative connection between prevention, treatment and human rights. Click to view.

Ighodaro spars with Bisi over some provocative questions about the role of Africa’s activists and an agenda for the future. View the video here.

Reflections from Durban

Throughout the week AVAC didn’t try to be comprehensive, or even objective. Our priority was to be alert, curious, sometimes critical and always committed to prevention. Observations from advocates and scientists brought exciting and sobering news from the frontlines, of which there are many, about what works and what doesn’t. Take a look at our conference diaries for what we saw, what we heard, what we learned, and how we stood up.

Reflections from Durban – Day 6 at AIDS 2016

After all the presentations, talking, and advocating, success depends less on a few days in Durban and more on a reimagined AIDS response—one that brings urgency to the major gaps in treatment, prevention, funding and human rights that we’ve just explored in so much depth for a few concentrated days in Durban. So rest up. We’ve got lots of work to do.

Respect the Data, Respect the People – Day 5 at AIDS 2016

We’ve rounded the corner here in Durban. With just one full day to go, we’re drilling down into the foundation of the global effort to defeat HIV, which rests on two fundamental imperatives: respect the data, respect the people.

I Bleed, I Rise – Day 4 AIDS 2016

Hello again! It’s day four of Durban week. Some folks may be starting to feel saturated with talk and facts. You may have missed lunch or a session you wanted to get to. Maybe, just maybe, you feel a little short-tempered with the conference hub-bub or the problems of the world, but a source of fresh energy coalesced on today with a galvanizing message: I bleed, I rise.

The Vagina Dialogues – Day 3 at AIDS 2016

At its best, today’s dialogue was led by and for women and centered on rights, realities and engaged discussion on the whole body, from head to toe and heart to mind. In some fascinating sessions, the vagina seized center stage and all but lost the head and heart that go with it. Today, in our update, we’ll try to put the pieces together and so, of course, the theme is: The Vagina Dialogues.

Long Waits and Long Queues: Hurry Up! – Day 2 at AIDS 2016

It’s Day 2 of the daily updates… and the conference has just barely begun with the official opening on Monday evening. Not everything is in motion, though. Long queues to undergo security screening are keeping people standing in place or, at best, shuffling along. The security lines do have an upside though… they’ve provided our theme for today: Hurry up!

Magical Thinking and Surge Pricing – Day 1 at AIDS 2016

The streets in and around the International Conference Center in Durban are thronged with badge-wearing delegates, the Uber taxi prices are surging, and there are already piles of publications scattered across the floor of some of the session rooms where the pre-conferences have taken place. And all this means that there are already things to report, even though the official meeting only starts tomorrow.

More on AIDS 2016

For even more about AIDS 2016 and additional resources, visit www.avac.org/aids2016.

Reflections from Durban: Day 6 at AIDS 2016

It’s the end of the week and the last of the Durban diary entries from the AVAC team. Bags are bursting with materials, goodbyes are rushed and coffee is extra strong after a long and sleep-deprived week. As AIDS 2016 draws to a close we reflect on the week and reimagine a new way forward.

Reflecting on the New

At AIDS 2016 we found ourselves in a new zone—the Research Literacy Networking Zone, to be specific. AVAC and partners, IRMA, NHVMAS, TAG, WACI Health and WRHI, were on their feet for five days distributing materials, running sessions, playing educational games, and most importantly, translate lots of questions about HIV research into understandable language. Everyone came to the Zone, including Nobel Laureate Françoise Barré-Sinoussi and Emilio Emini, the Director of HIV at The Bill and Melinda Gates Foundation, and a steady stream of conference goers and Durban community members. Next week look out for a full update with a montage of what we saw and heard at the Zone!

Reflecting on the Community Voices

The Truth Booth, an impromptu recording studio booth at the Global Village, and the What’sUpHIV blog amplified the voices of diverse delegates who took on a range of vital issues. At the top of the list; a global effort to defeat HIV should be grounded in perspectives offered by affected communities, key populations, young people, girls and young women—but these perspectives are woefully neglected. We heard from these missing voices, about the barriers they confront, and the role of activism as the conference returned to Durban.

Hear the voices from the Truth Booth.

Read news and opinions from advocates and journalists at What’sUpHIV including:

Dispatches from Durban

If you missed any of our updates from the week, check them out below!

Rest and Reimagine

We think of Durban 2000 as a watershed, but the conference was only the beginning. It was the action that came next that made all the difference.

After all the presentations, talking, and advocating, success depends less on a few days in Durban and more on a reimagined AIDS response—one that brings urgency to the major gaps in treatment, prevention, funding and human rights that we’ve just explored in so much depth for a few concentrated days in Durban. So rest up. We’ve got lots of work to do.

Respect the Data, Respect the People: Day 5 at AIDS 2016

We’ve rounded the corner here in Durban. With just one full day to go, we’re drilling down into the foundation of the global effort to defeat HIV, which rests on two fundamental imperatives: Respect the Data, Respect the People.

Respect the Data, Part 1

We gathered at 7am this morning for a satellite session on hormonal contraception (HC) and HIV, put together by the WHO’s Reproductive Health and Research Department. The program provided an update on ECHO, a randomized trial looking at the impact of three contraceptive methods (the copper IUD, Jadelle implant, and the injectable progestogen-only method DMPA or Depo Provera) on HIV risk. The main event, though, was a presentation by Chelsea Polis, a senior research scientist at the Guttmacher Institute. Polis presented results of the latest systematic review of observational data regarding contraceptive use and HIV risk. Systematic reviews, explained in depth here, look at all existing data on a topic and apply strict criteria to identify high-quality studies. These high-quality studies are then examined as a group to see what sorts of conclusions they support.

Two prior systematic reviews of the data on hormonal contraception and HIV concluded that some studies show evidence that DMPA increased women’s risk of acquiring HIV, while others do not. There was, in short, official uncertainty. The latest systematic review has a different conclusion—an association exists between DMPA and heightened risk. Dr. Polis said, “Newer data are increasingly concerning and converging around HR 1.2-1.6.” In lay-person terms, “1.2-1.6” means that an HIV-negative woman using DMPA would have a 20–60 percent increased risk of acquiring HIV compared to an identical HIV-negative woman who was not using DMPA. This is the first time that a systematic review on DMPA has moved out of the realm of uncertainty and taken the additional step of estimating the risk of infection. (It’s important to remember that overall risk of HIV for many women is quite low and that there are only some communities—largely in East and Southern Africa—where DMPA use and HIV prevalence are both high enough to warrant concern. In addition, in a companion systematic review of hormonal contraception and ART, DMPA seems to have no negative interactions with ART and may be one of the better contraceptive choices for women living with HIV.)

What’s next? AVAC and collaborators will push WHO and other stakeholders to respect the data. Partners like the International Community of Women Living with HIV-Eastern Africa (ICW-EA) will be front and center as the group that anchors collective action in Africa on hormonal contraceptives, organized through the HC-HIV Advocacy Working Group.

Current WHO guidance is based on the previous systematic reviews. Women at risk of HIV who choose DMPA should no longer be counseled about uncertainty. Now counseling must reference the new findings of an increased risk associated with DMPA. As we, and others, have said for years, whenever and wherever women receive this kind of counseling, alternative, comparable and long-acting methods must also be available for them to choose. This range of choices, also known as contraceptive method mix, is a must-have. Now more than ever.

Respect the People, Part 1

Many African advocates follow the HC-HIV question closely—attending WHO consultations, participating in the ECHO trial’s Global Community Advisory Board, and educating and informing their own communities. These advocates expressed surprise to learn the WHO satellite program results were released without a single panelist from civil society. This led to an eleventh-hour invitation for civil society to attend—which we did, in force. A mobilizing flyer called for advocates to “make some noise”. We have to assume that this flyer is what caused the session organizers to include a slide we haven’t seen anywhere else at the conference reminding participants to show “respect”. This slide was nowhere in evidence at yesterday’s plenary when Dr. Aaron Motsolaedi was interrupted. We heartily agree that everyone in the HIV community has a right to be heard, and that right means all stakeholders should receive timely invitations to share their views, informed opinions and valued input. A slide like this isn’t the way to create that environment. We look forward to WHO’s proactive engagement with African women who are impacted by this issue and working on it with urgency, all the more so now that powerful new data is reshaping what we know about the risks.

Respect the Data, Part 2

The single most important data point from AIDS 2016 is undoubtedly from the funding analysis that shows an unprecedented decline in resources for global AIDS. Representing the work of the Resource Tracking for HIV Prevention R&D Working Group, AVAC has provided preliminary findings to this critical field of inquiry in an oral abstract. Our findings show investment in biomedical HIV prevention research and development has declined significantly, from US$1.25 billion in 2014 to US$1.18 billion in 2015. Funding is down in nearly every sector (except industry) and for almost every prevention option. Resource tracking holds great value for advocates. AVAC also collaborated with FCAA, TAG, MSMGF, CEGAA Health GAP staffer, former AVAC fellow and superstar Maureen Milanga on a workshop titled Advocates Guide to Resource Tracking. Panelists shared their diverse projects on resource tracking, and Maureen stunned with her incredibly insightful perspective as an advocate. She has found ways to use RT data to demand changes and accountability from government bodies. We put together a guide to resource tracking for all you activists looking to get into the RT game!

Respect the People, Part 2

Cure research is incredibly complex. As a field of research it seeks to rid the body of HIV completely or send the remaining traces of virus into a perpetual state of inactivity—without ART. Doing this requires multi-stage protocols of potent products, some with intense side effects. Also, people who participate in cure studies usually stop ART regimens—exchanging proven strategies that preserve health and provide prevention benefits for partners in favor of experimental and unproven strategies. How should these trials be designed and conducted, and how should they engage participants and other stakeholders?

At a session today on Community Engagement in HIV Cure-related Research, AVAC’s Jessica Salzwedel provided a look at how to apply the Good Participatory Practices Guidelines for HIV Prevention Research. A key take-home from the session was that communicating concepts behind cure research, even the concept of cure itself, is complicated. A lot of work will need to go into translating all this for multiple communities and in multiple languages as cure trials roll out in more and more countries.

Respect the People and the Data

Today’s program also featured a tribute to Dr. Ward Cates, a tremendous scientist, advocate and friend to many of us in the HIV prevention arena. For everyone who knew him—and everyone who touched the projects he worked on—Cates showed us what it means to deeply respect people and data. AVAC’s annual report, Big Data, Real People, is dedicated to Ward. We remain inspired by him, and miss him every day.

Friday at the Conference

And if you’re still keen on more coverage after this update, head straight to www.aidsmap.com/aids2016, the official scientific news reporter from the conference. The aidsmap team has been churning out great articles covering the myriad studies presented here.

The Global Village finished up its fun and dynamic programming today, but there are still some intriguing sessions on tap for Friday. And don’t miss the closing session where the rapporteurs do the party trick of the week—distill a five-day conference into a 90-minute session.

  • 11:00 – 12:30 – Why Do We Need Prevention Justice in the Era of Bio-medical Interventions?, Session Room 13
  • 11:00 – 12:30 – Prepped for PrEP, Session Room 1
  • 11:00 – 12:30 – HIV Prevention in Women, Adolescents and Girls, Session Room 11
  • 14:15 – 17:15 – Rapporteur & Closing Session, Session Room 1

Keep following on social media and stay tuned for a final wrap-up tomorrow!

I Bleed, I Rise: Day 4 at AIDS 2016

Hello again! It’s day four of Durban week. Some folks may be starting to feel saturated with talk and facts. You may have missed lunch or a session you wanted to get to. Maybe, just maybe, you feel a little short-tempered with the conference hub-bub or the problems of the world, but a source of fresh energy coalesced on today with a galvanizing message: I bleed, I rise.

I bleed, part 1

That’s one of the signs that young activists held up during a powerful demonstration during the morning plenary session. The protest, directed at the South African government, involved singing, signs and a strong call for South Africa to provide condoms and sanitary napkins in all of its schools. That such an actionable demand is being made in 2016 is a reminder of both the work that remains, and the impact of simple things that can be solved quickly if people in power heed the voices of young activists.

I rise, part 1

AVAC’s own Micheal Ighodaro was among the plenary speakers on the stage when the action took place and the only speaker to express solidarity—rising with the protesters and holding a sign over his head. The reward for this action? An IAC employee raced over to ask him if he could hurry the protest along. Micheal, up on his feet with the other young people, did not comply.

I bleed, part 2

The people who talk about leaving no one behind ask people like me to be polite, to stay calm, to grieve quietly, while my brothers and sisters are dying or imprisoned. Our bodies are seen as an abomination or deserving of HIV—and you still want to know the source of my rage. I cannot decorate this pain for you, I cannot make a beautiful homage, and I cannot invoke hope and prayers. I cannot smile. I need to see action now, today…” Micheal Ighodaro, Plenary Speech, July 20, International AIDS Conference 2016

These words need no additional explanation. We have posted the complete text of Micheal’s speech here and we urge those who weren’t there in person to watch the webcast when it becomes available.

Later in the day, Micheal and Nigerian comrades held a unique session in the Global Village that combined dance and discussion to promote the right of African gay men, other men who have sex with men and transwomen to access PrEP. The session opened with a video memorial to the 49 people killed in the mass shooting at Pulse, an LGBT nightclub in Orlando, Florida. The Global Village truly lived up to its name as LGBT people and their allies from every corner of the world shared in a moment of mourning for this loss.

I rise, part 2

Micheal’s plenary drew a standing ovation. We were proud to be there.

Prevention advocacy was also on the rise in amazing sessions across the conference today including a session on women’s prevention, moderated by AVAC’s Manju Chatani-Gada. Courageous women raised their voices to share their experiences using the dapivirine vaginal ring in the ASPIRE study in South Africa, using PrEP as part of the SAPPH-IRe demo study in Zimbabwe and using PrEP outside research settings in South Africa. They also answered questions about accessing it through the private sector. Women-controlled prevention is too good and important not to share in detail.

“I miss my ring,” Thobile—one of the participants from the ASPIRE study—said emphatically when asked if she would be joining the open-label study (HOPE) that has just begun inviting back participants from the study. She went on to say she did not feel it when she was having sex, and said she felt good wearing it. Mrs. Shabalala talked about her husband’s support and his involvement in her decision to join and stay in the trial. He waved at us from the audience and invited questions.

Bathabile, a sex worker, who had been part of the SAPPH-Ire demo study, said many sex workers did not take up PrEP initially “because they did not really understand what it was all about. The informed consent form was confusing and I had to ask people to translate it for me. But then I got it.” She talked about the stigma sex workers experience, and her initial distrust of the intent of the study. But she wanted to try it, she said, and has benefited from ongoing support.

Another woman at the session, Buhle, said she “recently rediscovered her sexual freedom as a young, African women on PrEP”. She spoke about her experience educating her physician about PrEP. Her doctor had no idea what PrEP was, confusing it for PEP. Buhle went onto the CDC website in her doctor’s office and they walked through the site together. She said her physician warned her repeatedly that the side effects would be too awful to bear. Buhle took it anyway. Six months later, she says adherence is easy. Now Buhle wants to see the use of PrEP normalized so that her friends will accept it too, and get the same benefits she does. “Make it funky to use,” she said. That’s what would work for her friends.

We need to hear more of this and all the time. It’s the only way to move beyond the numbers and the PowerPoints and reach real people in the real world.

I rise, part 3

As an antidote to any creeping impatience during tomorrow’s conference, we offer this poem by the great African-American poet Maya Angelou.

Still I Rise

Maya Angelou

And still I rise
You may write me down in history
With your bitter, twisted lies,
You may tread me in the very dirt
But still, like dust, I’ll rise.

Does my sassiness upset you?
Why are you beset with gloom?
‘Cause I walk like I’ve got oil wells
Pumping in my living room.

Just like moons and like suns,
With the certainty of tides,
Just like hopes springing high,
Still I’ll rise.

Did you want to see me broken?
Bowed head and lowered eyes?
Shoulders falling down like teardrops.
Weakened by my soulful cries.

Does my haughtiness offend you?
Don’t you take it awful hard
‘Cause I laugh like I’ve got gold mines
Diggin’ in my own back yard.

You may shoot me with your words,
You may cut me with your eyes,
You may kill me with your hatefulness,
But still, like air, I’ll rise.

Does my sexiness upset you?
Does it come as a surprise
That I dance like I’ve got diamonds
At the meeting of my thighs?

Out of the huts of history’s shame
I rise
Up from a past that’s rooted in pain
I rise
I’m a black ocean, leaping and wide,
Welling and swelling I bear in the tide.
Leaving behind nights of terror and fear
I rise
Into a daybreak that’s wondrously clear
I rise
Bringing the gifts that my ancestors gave,
I am the dream and the hope of the slave.
I rise
I rise
I rise.

Thursday at the Research Literacy Networking Zone

In addition to having a Help Desk (have a question about prevention research or looking for a resource—stop in!) and a comfortable space to rest your feet, come check out all the programming in the RLNZ (Global Village, Booth 606). See Thursday’s schedule below:

  • 11:00 – 12:30 – What is Health Research and Development and Why Should Advocates Advocate for Increased Funding for Health R&D (PATH)
  • 12:45 – 13:45 – How is that Rectal Revolution Coming? Update on Global Rectal Microbicide Research (IRMA)
  • 14:15 – 15:15 – Engage Yourself: Responsible and Responsive Science (AIGHD)
  • 15:30 – 16:30 – Ask the Researchers: Vaccine Research (HVTN)
  • 17:00 – 18:00 – The PROUD Study: A video documentary and discussion (Nicholas Feustel, georgetown media)

A Few Sessions We’ve Starred

See below for a highly selective list of sessions for all the data geeks out there!

  • 11:00 – 12:30 – Financing the Response to HIV: Show Us the Money, Session Room 1
  • 11:00 – 12:30 – Targeting Reservoirs for Cure, Session Room 7
  • 11:00 – 12:30 – Treat Early and Stay Suppressed, Session Room 12
  • 14:30 – 15:30 – Using Funding Data to Advocate for Global and Domestic Resources in the Critical Push Towards the End of AIDS, Global Village Room 2
  • 14:30 – 16:00 – The Use of Economic Interventions to Promote HIV Prevention and Treatment Objectives, Session Room 12
  • 14:30 – 16:00 – The Future of Chemoprophylaxis: New Concepts, Session Room 6

Follow along in real-time on Twitter, and look for the next update on our blog tomorrow!

The Vagina Dialogues – Day 3 at AIDS 2016 

We head into day three of the Durban Diaries a little deafer than we were before from the unceasing din of the Global Village—a beat that breaks down into equal parts information, activism and celebration of all the shapes and sizes and colors of our lives. Between the pink-peacock-feather-clad dancers in the condom area and the music of Ugandan singer Moses Supercharger on the Global Village mainstage, it’s a feast for all five senses, and a reminder of the beauty of the bodies we live in every day.

Over in the main conference building, the beauty of those bodies was in and out of focus today in a series of sessions focused on women, HIV risk and HIV prevention. At its best, the dialogue was led by and for women and centered on rights, realities and engaged discussion on the whole body, from head to toe and heart to mind. In some fascinating sessions, the vagina seized center stage and all but lost the head and heart that go with it. Today, in our update, we’ll try to put the pieces together and so, of course, the theme is: The Vagina Dialogues.

The morning’s plenary featured a number of powerful women who reminded delegates of the role of gender in the global response to the epidemic. Eminent Kenyan scientist and advocate Elizabeth Bukusi, of KEMRI, reminded the audience that, “HIV operates in a gendered world and it thrives because of that.”

What exactly is going on in that gendered world? Some insights came from a special session, New Evidence: Why Do Young Women in Africa Have High Rates of HIV Infection?. It started out with a presentation on the “direction” of transmission in a South African community—in other words, who is passing on the virus to whom, by gender and age-bracket. By sequencing viruses and grouping them according to their genetic relatedness, researchers established that the majority of young women [16–24 years old] are acquiring HIV from significantly older men—an average of 11 years older, in fact. The age disparity between male and female partners decreases as young women age. But many of them are getting HIV from older male partners so that by the time they are 24, they are also in a position to transmit HIV to their male partners, setting up a cycle that looks like this.

The session also presented data drawn from women who participated in the CAPRISA 004 trial of a 1% microbicide gel. This investigation explored the presence of specific vaginal bacteria (the flora that live in all women’s vaginas) and how it might increase HIV risk and affect the absorption of the tenofovir gel. The good news is that there is no evidence these findings apply to the use of oral PrEP.

This session provided great food for thought including this comment—voiced in the follow-on session on women’s rights and health: “We heard all about vaginas. But vaginas are attached to people…” The challenge will be to put these important scientific findings into practice in ways that explore young women’s practices in relation to their vaginal health, and their whole bodies—all while treating and PrEPing as needed.

Speaking of vaginas, another study presented today focused on new analyses of data from the ASPIRE dapivirine vaginal ring study. While initial data were presented at CROI, new analyses showed that individuals with high levels of adherence achieved extremely high levels of protection.

Back in the Global Village, no surprise here, women’s bodies and lives were fully present in all sorts of sessions; a vibrant discussion in the Women’s Networking Zone ensued from a project documenting the experiences and perspectives of women living with HIV and undergoing treatment. Women at the session, who were primarily from sub-Saharan Africa, found the findings from this project personally resonant and were eager to obtain the full report as an advocacy tool. Download the four-page summary here.

Wednesday at the Research Literacy Networking Zone

In addition to having a Help Desk (have a question about prevention research or looking for a resource—stop in!) and a comfortable space to rest your feet, come check out all the programming in the RLNZ (Global Village, Booth 606). See Wednesday’s schedule below:

  • 11:00 – 12:30 – Safer Conception for HIV-affected Individuals and Couples: Synopses of Findings (HIVE)
  • 12:45 – 13:45 – Addressing Known Causes of Poor Participation by Black MSM in HIV Prevention and Treatment Research (APEB, PxROAR)
  • 14:00 – 15:00 – Advancing PrEP Advocacy Opportunities and Challenges in Settings Where it Has Been Approved and Where it Has Not (IRMA)
  • 15:30 – 16:30 – Hope vs. Hype in Reporting HIV Cure Research (AVAC, TAG, UNC)
  • 17:30 – 18:30 – Ask the Researcher: Preventive HIV Vaccine Research (HVTN)

A Few Sessions We’ve Starred

See below for a highly selective list of sessions for all the data geeks out there! Check them out in-person or find them on the webcast archive the following day.

  • 8:45 – 10:55 – What is our goal?, Session Room 1, Wednesday’s plenary features AVAC team member Micheal Ighodaro speaking on the role of young people leading in the response
  • 11:00 – 12:30 – Making PrEP Real for Those Who Need It Most: Optimization Strategies, Session Room 1, Data from IPERGAY and HPTN 073 and Partners Demo studies and SEARCH test and treat study in Uganda and Kenya
  • 13:00 – 14:00 – Accelerating the Decline of the Burden and Incidence of HIV in Sub-Saharan Africa Special Session, Session Room 1
  • 13:00 – 14:00 – Circumcision: Where to, How to, Who to?, Session Room 5, Oral poster discussion on VMMC uptake, barriers, new devices and more
  • 13:00 – 14:00 – Prevention for Women: The Need for Multidisciplinary Approaches, Session Room 8, Oral-poster session including additional qualitative data from FACTS 001, preferred PrEP formulation in ASPIRE sub-study, vaginal bacteria and its relation to increased risk of HIV, and more

Follow along in real-time on Twitter, and look for the next update in your inbox tomorrow!

Long Waits and Long Queues: Hurry Up! – Day 2 at AIDS 2016

It’s Day 2 of the daily updates… and the conference has just barely begun with the official opening on Monday evening. Nevertheless, delegates have already covered a lot of ground—taking to the streets for a vibrant, sun-baked, song-filled March for Health.

Not everything is in motion, though. Long queues to undergo security screening are keeping people standing in place or, at best, shuffling along. While shuffling ourselves, we overheard an activist wondering why there wasn’t a “fast track” lane for people living with HIV. Perhaps the queue slowed down for US Global AIDS Ambassador Debbi Birx, who participated in the march—and raced into a press conference 15 minutes late. The security lines do have an upside though… they’ve provided our theme for today: “Hurry up!”

Hurry up, Part I

Two consecutive sessions on voluntary medical male circumcision (VMMC) started the day off. The first introduced the new UNAIDS Strategic Framework for VMMC—which recommends positioning VMMC in the context of a comprehensive platform of services for adolescent boys and young men. This shifts VMMC away from a campaign-based model that provided a basic package of services at the time of the procedure—but didn’t seek to use the procedure to anchor people to a broader health platform. Given the absence of youth-friendly health services for adolescent boys and girls (not to mention those individuals who don’t fit into gender-binary categories!)—this is a welcome recommendation. But it’s not clear what this shift will cost or how it will impact the goal of roughly doubling VMMCs annually from 2.5 million to five million in order to meet the global target. The sole presenter who addressed cost indicated that Swaziland’s approach to providing VMMC within a program of comprehensive services for young men cost about US$180 per procedure, compared to less than US$100 for a standard approach. Moving to the UNAIDS-recommended model is going to cost money, and the money is not on hand. At the same panel, a representative from the GFATM reported that six VMMC priority countries requested a total of US$9 million for VMMC from dedicated funds during the last round. However, an additional US$65 million for VMMC was in the “above allocation” wish-list—e.g., money they wanted but weren’t likely to get. So—the model is changing, costs could be rising, and the money is missing. That’s the challenge for delivery of the most effective HIV prevention available for HIV-negative men today. It needs to be resolved. Fast. Hurry up.

Hurry Up, Part II

A lively discussion took place in an afternoon session on HIV prevention for pregnant and breastfeeding women. Participants considered PrEP, including daily oral TDF/FTC, which is available today, as well as emerging strategies like the vaginal dapivirine ring and perhaps long-acting injectable ARVs. At issue was the best way to offer PrEP to HIV-negative women in antenatal settings. Does additional safety information need to be gathered even though there are years and years of experience using TDF/FTC-containing regimens in pregnant women living with HIV? Or should daily oral PrEP be part of antenatal services offered to women who are at substantial risk? Opinions were heated and diverse. Could over-crowded, under-resourced and under-staffed antenatal clinics accommodate the required counseling associated with PrEP initiation and successful follow-up? Was it ethical to hold off on offering PrEP for women who would definitely receive ART if they returned with an HIV-positive result? “There is some deep level of inequity, of sexism…” one participant opined. “If men could get pregnant this would be a really different discussion.” The questions standing in the way of routine provision of PrEP for women at risk in ANC clinics need to be addressed ASAP. Hurry up.

Hurry Up, Part III

The session on fast track prevention targets also got our attention. As seen in the Lancet HIV, global targets will fail to control HIV if the rate of new infection continues to march along at current levels. There’s been too little investment, focus and commitment on prevention. The scale of the effort has been too small and the quality of implementation uneven. The UNAIDS–Lancet Commission on Defeating AIDS—Advancing Global Health reported that updated UNAIDS targets to reduce new infections below 500,000 by 2020—a 75 percent reduction from 2010 requires a full complement of prevention and treatment strategies scaled to reach a significant percentage of high-risk populations. Prevention advocates are pushing program targets for a worldwide plan that could spell the difference between success and failure. Hurry Up!

If you don’t want to read the whole the Lancet HIV piece see how Peter Piot and Mitchell Warren cast it here.

Hurry Up, Part IV

AVAC has been closely following the development of DREAMS, the PEPFAR-led, public-private partnership focused on adolescent girls and young women. AVAC was present in force and cheered on former AVAC Fellow Anna Miti, who served as the moderator at today’s update on the DREAMS partnership. One highlight, PEPFAR and DREAMS Partners announced the winners of their Innovation Challenge Fund, which is handing out a total of US$85 million to 56 groups. The call for applications encouraged groups to cover priority areas not fully addressed in the ten country work plans. The news is in and some of it is exciting: of those awarded, nearly half have never received PEPFAR funding. The organizations cover six main focus areas, including community capacity strengthening and keeping girls in school. Just four of the grants (7 percent of the total) are focused on PrEP—and it is not clear that all of these four are involved in providing services. The majority of the organizations are in Kenya, South Africa, Uganda and Tanzania. While 36 of the organizations are small in revenue, several on the list are large international NGOs and it remains to be seen what resource allocation will look like across the 56 organizations. DREAMS has an essential goal—reduce the incidence of HIV in adolescent girls and young women by 40 percent in 2017. Nothing could be more important and we support it 100 percent. Hurry up!

And here’s a look at some of what tomorrow will bring:

Tuesday at the Research Literacy Networking Zone

In addition to having a Help Desk (have a question about prevention research or looking for a resource—stop in!) and a comfortable space to rest your feet, come check out all the programming in the RLNZ (Global Village, Booth 606). See Tuesday’s schedule below:

  • 11:00 – 11:45 – Understanding HIV Prevention Research and Clinical Trial Process (WRHI)
  • 11:45 – 12.45 – Breaking Down Silos-Implementing GPP Across Diseases and Research Phases (AVAC, WRHI)
  • 13:00 – 14:00 – CUREiculum & Gene Therapy (Martin Delaney Collaboratory CAB)
  • 14:45 – 15:45 – Ask the Researchers: Antibodies for Prevention & Treatment (HVTN, PxROAR)
  • 16:00 – 16:45 – A Conversation about HIV with Emilio Emini, Director of HIV, Gates Foundation
  • 16:45 – 17:45 – PrEP Prepositions 4 Prevention (DTHF, WRHI)
  • 17:45 – 18:30 – AVAC Advocacy Fellows Info Session (AVAC)

A Few Sessions We’ve Starred

See below for a highly selective list of sessions for all the data geeks out there! Check them out in-person or find them on the webcast archive the following day.

  • 11:00 – 12:30 – PrEP: New Drugs, New Questions, Session Room 11, Data on maraviroc as PrEP, dapivirine ring and rilpivirine long-acting injectable
  • 11:00 – 12:30 – Progress in HIV Vaccines and the Road to the Clinic, Session Room 5, Review of P5, the AMP Study, Janssen’s ad26/MVA and new HIV vaccine concepts
  • 13:00 – 14:00 – Late Breaker Session, Data from the HVTN 100 vaccine trial, SAPPH-IRe PrEP demonstration project in FSWs in Zimbabwe, ATN 113 PrEP demonstration project in young Black men in the US and Truvada as PrEP utilization data in the US
  • 14:30 – 15:30 – New Evidence: Why Do Young Women in Africa Have High Rates of HIV Infection?, Session Room 1

Follow along in real-time on Twitter, and look for the next update in your inbox tomorrow!

Prevention Must be at the Forefront to Meet Global HIV Goals

In advance of the AIDS 2016 conference, AVAC Executive Director Mitchell Warren and Director of the London School of Hygience & Tropical Medicine Peter Piot co-authored a call inSTAT for an expanded focus on a comprehensive approach to HIV prevention. Alongside a fully-funded effort to provide treatment for people living with HIV, a range of prevention options are essential to defeat HIV and must be developed and delivered. This theme echoed again and again at Durban.

Read Prevention Must be at the Forefront to Meet Global HIV Goals for a succinct case for prevention.

Magical Thinking and Surge Pricing: AIDS 2016 update—Day 1 

Hello from the other side—also known as “Conference Land”. The streets in and around the International Conference Center in Durban are thronged with badge-wearing delegates, the Uber taxi prices are surging, and there are already piles of publications scattered across the floor of some of the session rooms where the pre-conferences have taken place. And all this means that there are already things to report, even though the official meeting only starts tomorrow. We can’t be exhaustive, only selective. In this update we offer a quick take on some of the day’s events, focused on the theme of “magical thinking”.

(And read on for more on what you can expect in each of our daily updates from Durban.)

Magical thinking that hurts

UNAIDS in its Prevention Gap report and the Kaiser Family Foundation in its report on the financing of the response have both identified the first drop in HIV funding in five years. There is US$7.2 billion funding gap in the price tag set for achieving the 90-90-90 goal. At a civil society dialogue session with UNAIDS head Michel Sidibe, Amanda Banda of Médecins Sans Frontières challenged Dr. Sidibe not to indulge in “magical thinking” that characterizes global leaders who claim that ending AIDS is possible in the context of this dire funding trend. Tomorrow, beginning at noon, thousands more will voice the same challenge at the March for Health: Quality treatment for all. AVAC will be there—join us!

Magical thinking that excites

At the UNAIDS workshop on the 90-90-90 targets, Nittaya Phanupak of the Thai Red Cross presented on a PrEP and “test and treat” initiative designed by and with key populations, particularly MSM. This multi-pronged effort includes use of MSM social networking sites to promote PrEP and allow visitors to the site to book appointments for testing, PrEP and/or ART. Seventy-six percent of the people who booked appointments online showed up in person. The program also allows for supervised self-testing via video conference—think a Skype chat with a trained counselor—that is reaching more first-time testers and finding more new HIV-positive individuals than traditional clinic-based testing. Okay, so this isn’t magic. But it’s major in terms of meeting people where they are.

Blogging from AIDS 2016

Check out the myriad voices covering the conference, in real-time, across a range of issues at the conference. Read WhatsUpHIV.

Daily updates

Each day you can expect quick updates and links to blogs on prevention activism, links to the great science coverage from NAM and sounds of the conference from the “Truth Booth” to give a flavor of what’s going on from the plenaries to hallway chats. We will also provide a preview of the next day’s events in the Research Literacy Networking Zone (RLZN) as well as some of the sessions we’ve starred on our calendars for the following day.

Monday at the Research Literacy Networking Zone

In addition to having a Help Desk (have a question about prevention research or looking for a resource—stop in!) and a comfortable space to rest your feet, come check out all the great programming in the RLNZ (Global Village, Booth 606). See Monday’s schedule below:

10:00 – 11:00 – Communicating Complex Science Clearly (WRHI)
11:15 – 12:15 – One Woman, Many Voices (AVAC, ICW EA, WRHI)
12:30 – 13:30 – Stories in Sisterhood: Using Digital Storytelling to Enhance Knowledge and Intent to Use PrEP (Texas Woman’s University)
14:00 – 15:30 – Understanding Cure Research (IAS)
16:00 – 17:30 – Regulatory Pathway for HIV Prevention Products: The Dapivirine Ring (IPM)

[The full program and session details are available to download here.]

Follow along in real-time on Twitter, and look for the next update in your inbox tomorrow!