Drum Roll for 2020. Will it be a turning point for HIV prevention?

As we approach 2020, we see enormous possibilities to advance toward our collective goal to end the HIV epidemic–and we see even more enormous opportunities for our work together!

Several new interventions face critical moments in 2020: from an anticipated regulatory opinion on the dapivirine ring to trial results on the first AMP studies; from the development of a novel trial design to study oral F/TAF as PrEP in women to advances toward a possible dual pill for HIV prevention and contraception; from setting new global targets for prevention to evaluations of innovative prevention delivery under PEPFAR’s DREAMS program; from understanding the results of the recent “universal test and treat” trial results to acting on their implications and expanding the concept to testing that connects to both treatment and prevention.

2020 will have much to teach us. The year will offer unique opportunities to move HIV prevention forward, and we must not squander them. The challenge of stalled or rising rates of new infections remains formidable, with new infections around 1.7 million annually, a far cry from the 2020 target of fewer than 500,000. AVAC looks squarely at this challenge with cross-cutting analysis and an advocacy agenda to match in our 2019 annual report, Now What?. In 2020, we hope you’ll join us in helping to answer the question and achieve an ambitious set of commitments.

In addition, 2020 marks AVAC’s 25th year of action! Without your long-standing support, we could not have reached this milestone, and we hope you’ll help us reflect, celebrate and recommit to our work bringing together the voices and ideas that push HIV prevention center stage in the fight against HIV.

Please consider a contribution by visiting www.avac.org/donate. You can also shop online at Amazon via smile.amazon.com and select “AVAC” and a portion of your purchase is donated to us—at no additional cost to you.

Many thanks for your partnership and for your continued support, and warmest wishes for the New Year!

Now what with F/TAF for PrEP? A call for action in 2020

A new episode of our Px Pulse podcast is ready for download!

What’s all the fuss about F/TAF? Listen to this episode for a snapshot of the issue and a preview of what will take much of AVAC’s – and our partners’ – attention in 2020. The US Food and Drug Administration (FDA) approved F/TAF (Descovy) as daily oral PrEP in October 2019. But there’s was one notable caveat: the label excluded those who are at risk from “receptive vaginal sex”, indicating that more data is needed for the drug to be approved as HIV prevention for cisgender women. The FDA’s supplemental approval requires Gilead to conduct a safety and efficacy trial in cisgender women to produce the lacking data by 2025, with a draft trial protocol before the end of this year.

As Gilead drafts the protocol, civil society, advocates, communities and all stakeholders must engage with planning for this trial from A-Z. In this episode, we look at what’s different and what’s the same between F/TDF (Truvada) and F/TAF, what’s driving innovation in the proposed trial design, why it’s so essential for advocates to engage and more.

For the full podcast episode, highlights and resources, visit avac.org/px-pulse. And subscribe on Apple Podcasts, Spotify or wherever you get your podcasts!

The latest on AVAC.org

Check out the resources below for the latest AVAC material, including our just-released AVAC Report 2019: Now What?, our opinion piece on Devex highlighting priorities for 2020 and beyond, and several new resources and publications!!

AVAC Report 2019: Now What?

Our November publication of our annual report asks Now What? as we look ahead to 2020 and the certainty of missing HIV prevention targets set by UNAIDS. In answer, we issue a call to action: enact bold, activist, visible leadership on HIV; sustain investment; use today’s evidence to guide tomorrow’s prevention targets; and double down on multilayered prevention approaches.

Check out these additional resources in the report:

The Global Development Community is Listening

On December 3rd, Devex published AVAC’s opinion piece exploring the critical challenges and opportunities we laid out in Now What? Read on for the actions we think will make the difference from leaders and communities at every level.

Youth Leadership Will Turn the Tide Against HIV

We commemorated World AIDS Day 2019 with the launch of a series of blogs from the new generation of leaders who must carry the torch to end the epidemic. Learn why we call these leaders Generation Now and have pledged our support to their remarkable efforts. And read the blogs to see their responses, framing the challenges ahead.

Abuja Commitments for Spending on Health Put in Context

To coincide with the recent ICASA conference Accountability International published, with support from the AVAC-led Coalition to Accelerate & Support Prevention Research (CASPR), Mind the Gap: African HIV Financing Scorecard. This report tracks current African domestic investments in HIV treatment and prevention. The report also makes the case for the importance of considering other indicators, beyond the 2001 Abuja pledge of 15 percent of annual budget investments into the health sectors, when evaluating political will and opportunities to increase investment and access to health.

Learning from “Like” Products to Accelerate the Introduction of New Prevention Options

As part of the OPTIONS Consortium, which AVAC co-leads, we published The Dapivirine Ring: Key learnings from like-product introductions, which examines historical experiences introducing products that share characteristics with the dapivirine vaginal ring, specifically, products that were vaginally inserted or partially efficacious.

The Complex Challenges of HIV Vaccine Development Require Renewed and Expanded Global Commitment

Several AVAC staff and partners contributed to a new viewpoint in The Lancet journal describing what it will take to develop and deliver an HIV vaccine. In The Complex Challenges of HIV Vaccine Development Require Renewed and Expanded Global Commitment, the authors highlight the need to plan now for regulatory review, procurement, and implementation of a potential HIV vaccine to speed its availability. Additionally, drawing on our Resource Tracking Working Group data, the authors call for increased funding for HIV prevention research and the need for strengthening the pipeline of early stage HIV vaccine candidates.

Support AVAC

As the end of the year approaches, we hope you’ll remember AVAC in your charitable giving. Help us sustain this essential work with your support in one or more of the following ways:

Learning from “Like” Products to Accelerate the Introduction of New Prevention Options

As part of an analysis funded by the OPTIONS Consortium (of which AVAC is a part), AVAC examined historical experiences introducing products that share characteristics with the dapivirine vaginal ring, specifically, products that were vaginally inserted and/or partially efficacious. Both are characteristics of the dapivirine vaginal ring and can represent a challenge to acceptance and use. However, products ranging from the rotavirus vaccine to the contraceptive ring have overcome these challenges. In our analysis – entitled The Dapivirine Ring: Key learnings from like-product introductions – we interrogate what facilitated their success and uptake, and conclude that with adequate planning and education, it is possible for products such as these to make an impact.

Developed by the International Partnership for Microbicides (IPM), the dapivirine vaginal ring is a silicone ring which looks similar to a contraceptive ring, but releases dapivirine (an antiretroviral drug) slowly over the course of one month. The ring is vaginally inserted, rests high inside of the vagina, and a woman can remove and reinsert the ring herself if she wants to. Also, its effect is localized (limited to the vagina) rather than systemic (affecting the whole body). The ring can give women control over their HIV prevention choices, without need to negotiate with or disclose to her partner.

Final results of the open-label studies HOPE and DREAM found the ring to be partially efficacious (with participants seeing a 39 percent and 63 percent reduction in HIV-risk respectively). These results were an improvement over the results of previous phase III trials ASPIRE and The Ring Study, in which the ring was demonstrated to reduce women’s risk of acquiring HIV by only 27 percent and 31 percent respectively.

Partially efficacious products and procedures have played a pivotal role in public health interventions for decades, and have been an important component of the HIV response for many years. For example, voluntary medical male circumcision (VMMC) is a well-known and effective tool for HIV prevention, and reduces the risk of HIV acquisition by 60-75 percent. The malaria vaccine and rotavirus vaccine are two other partially efficacious products that have become staples in prevention efforts.

In order to address concerns about partial efficacy, providers and implementers have employed a few key strategies. By focusing on interpersonal communication and using small groups to discuss the nuances of the products with both end-users and providers, it is possible to build confidence in a partially effective product. Product champions can also help drive up demand and acceptability of something like the ring. Integrating the ring with other health services may also draw new clients in and support uptake.

Researchers have noted that vaginal insertion of the ring has proven to be a barrier for some women, particularly due to lack of experience with these types of products in the African context and cultural norms which stigmatize female genitals.

The introduction of vaginally inserted products like the female condom, the progesterone contraceptive vaginal ring, tampons and the menstrual cup provide valuable lessons when considering how the dapivirine ring might be introduced. For example, peer-to-peer communications that include a product user can be effective in recruiting new users. Additionally, encouraging providers to try the ring themselves can help overcome provider bias. Acceptability of the ring among even a small group of vocal providers can influence uptake nationally, so those providers need to be found, encouraged and given a platform.

Finally, empowering women to explain the ring to partners, by promoting body awareness and knowledge of sexual and reproductive health, will be an essential component to ring introduction. To this end, education & communication (IEC) materials demonstrating how the ring fits in a woman’s body can alleviate concerns about the ring getting stuck or causing infertility.

With these strategies in mind, the HIV prevention field can better prepare for possible introduction of the dapivirine ring and ultimately help policy makers, health care providers and women interested in a new HIV prevention option make informed decisions about the ring. By clearly articulating the value of the ring as one component of the HIV prevention portfolio, and educating women and their providers about the benefits of a discreet and female-controlled prevention option, it is possible to accelerate the impact of the dapivirine ring in improving women’s health and reducing HIV incidence.

We Won’t Meet the 2020 AIDS Targets. Now What?

Mitchell Warren is the Executive Director of AVAC. This piece first appeared on Devex.

As we approach 2020 — a pivotal year on many levels — we have more options and a clearer picture than ever of what must be done to end the HIV epidemic globally.

But in 2019 we learned some hard lessons about how far we still have to go: a range of prevention trials brought new data on both the potential and the limitations of biomedical strategies in the global HIV response. The data wasn’t necessarily surprising, but it put the obstacles we still face in stark relief.

New data shows that community-wide HIV testing, followed by treatment for people living with HIV, has health benefits for the individual and reduces the incidence of HIV by up to 30 percent. That is both invaluable and insufficient to end epidemic levels of new infections.

We learned that among general populations of women seeking family planning services in east and southern Africa, HIV incidence is far higher than we thought. Research in South Africa confirmed that young women today often prioritize the need for pregnancy prevention and take a more passive approach to HIV prevention.

All of this underscores the critical need for family planning and HIV prevention services to work together — delivered in the same place at the same time, and eventually in the same product — to better meet women’s real-world needs.

2020 is the deadline that UNAIDS set for reducing new HIV infections to fewer than 500,000 worldwide. However, in 2018 alone, 1.7 million< people became newly infected with HIV.

It is time — in fact, well past time — to redouble efforts and investments in HIV prevention. The need is clear. In sub-Saharan Africa, adolescent girls and young women are 5 to 14 times more likely to be infected with HIV than their male peers.

PEPFAR’s DREAMS partnership that focuses on adolescent girls and young women in specific regions of priority countries is using multilayered biomedical, behavioral and structural interventions to address the many factors that make girls and young women particularly vulnerable to HIV. But this is just the beginning.

Today, to be young, female, black and having sex in a high-prevalence sub-Saharan setting is to be at risk of HIV. To be gay or transgender in Africa or the United States — and many other places around the world — is to be at risk of being murdered, harassed or physically violated. People who use drugs are criminalized, excluded from care, and denied human rights and access to highly effective harm-reduction strategies.

The number of young people in sub-Saharan Africa is increasing dramatically — as it is worldwide. With such large numbers of youth, the absolute numbers of new HIV infections in this age group will be similar to, or even larger than, those earlier in the epidemic. Without prevention that fits into the lives of young people living with and at risk of HIV, there will be no end to epidemic levels of new infections.

The good news is there are energized, committed new leaders in this fight: 2020 is the year of diverse, brave activist leadership in HIV — from the grassroots to Geneva.

For example, over the past decade, AVAC’s Advocacy Fellows program has supported promising and powerful advocates to design and implement advocacy campaigns that advance HIV prevention research and implementation in their countries and communities.

These fellows, along with the Africa Free of New HIV Infections youth cohort, DREAMS ambassadors and numerous other leading community voices, have been responsible for advancing policy for the implementation of voluntary medical male circumcision, testing, pre-exposure prophylaxis and treatment, as well as informing gender and key and vulnerable population-sensitive HIV programs and research.

The appointment this year of UNAIDS Executive Director Winnie Byanyima gives us significant hope. In her first week on the job, she spoke about AIDS as a human rights issue and noted the role of “intersecting inequalities, such as gender, age, sexual orientation, race and ethnicity, that are at the root of the higher vulnerability to HIV of women, girls and key populations.” And one of her first actions as executive director was an important one: meeting with young women affected by HIV.

We urge Ms. Byanyima to continue to stand strong as an activist leader — brave, clear and unwavering in her commitment to the populations in greatest need of attention. We enthusiastically support a comprehensive and ambitious agenda for addressing unmet goals in HIV prevention. Ending AIDS demands nothing less.

Support AVAC this Holiday Season

#GivingTuesday, the Tuesday after the Thanksgiving holiday in the US, is meant to be a day of giving during the holiday season. We are enormously grateful for our partnerships around the world, and we hope you will consider offering your support to AVAC.

Your charitable contribution helps AVAC to continue what we do best—advocating for comprehensive, integrated and sustained HIV prevention.

In the recently released AVAC Report 2019: Now What? we look ahead to 2020, the deadline UNAIDS set for reducing new infections to fewer than 500,000 per year worldwide—a target that we’ll miss by a long shot—and ask, Now What? Our answer—and our call to action for 2020 and beyond – is to enact bold, activist, visible leadership on HIV; sustain investment; use today’s evidence to guide tomorrow’s prevention targets; and approaches. Devex has just published AVAC’s opinion piece exploring these critical challenges and opportunities.

In the Report, you’ll also find AVAC’s commitments for 2020 and beyond, made possible by our donors and the generous support of our members. Help us sustain this essential work with your support in one or more of the following ways:

  • Donate: Visit www.avac.org/donate.
  • Amazon Smile: Shop at Amazon.com? Visit smile.amazon.com and select AVAC as your charity of choice and a portion of your purchase price is donated to AVAC—at no additional cost to you!
  • US Combined Federal Campaign: If you are a US government employee, support our mission through the Combined Federal Campaign, CFC #12308.

Generation Now Responds

On World AIDS Day 2019 this year we are thinking about how communities make the difference with a series of blog posts, a blog carnival, that amplify the voices of young advocates who are doing remarkable work to shape the global HIV/AIDS response.

In AVAC Report 2019: Now What?, we called out to these advocates, members of “Generation Now”, encouraging them to sustain their bold efforts in the fight against HIV. Four stalwart fighters responded with their firsthand perspectives:

Look for additional responses in the weeks to come!

The Challenges for Young Nigeria

In AVAC Report 2019: Now What?, we called out to these advocates, members of “Generation Now”, encouraging them to sustain their bold efforts in the fight against HIV. Below is one response and more are available here.

The author, David Ita, is a community HIV prevention advocate from Nigeria and 2019 AVAC Advocacy Fellow with New Vaccine and Microbicide Advocacy Society (NHVMAS).

Dear AVAC,

Reading your letter to Generation Now, made me think of my own work in HIV advocacy and the particular challenges young people in Nigeria face accessing both sexual and reproductive health services and HIV prevention options. These barriers have a particularly negative affect on young women. Adolescent girls and young women contract HIV earlier in life and have higher incidence of HIV infection than their male peers.

As an AVAC Advocacy Fellow, I promote the integration of sexual and reproductive health (SRH) services and HIV prevention for young people in Nigeria and I’m working to increase young people’s capacity to serve as HIV prevention advocates in their community. This work makes connections that simply must be made if we want to succeed in defeating HIV. For example, I have worked with civil society, the Ministry of Health and the Ministry of Education to address reducing the age of consent for HIV testing and treatment. I want to equip young people with the knowledge necessary to make informed choices regarding their health. This means integrating SRH curriculum in schools and disseminating information regarding PrEP amongst youth. Sharing knowledge is essential amongst this population. Imagine, a 2017 National Health Survey showed that only 29 percent of young women and 27.9 percent of young men in Nigeria were able to name accurate prevention methodologies! We all must awaken to how important this work is, now imperative it is to change numbers like those. It’s also important to be very serious about incorporating a range of perspectives into the work I do. I have surveyed young people throughout Nigeria on their experiences, and opinions regarding SRH and HIV prevention. These perspectives continue to inform my work with young people.

I have learned much from what they have shared with me. As the youth in my community work together to respond to serious structural obstacles and demand access to necessary services, I see their passion and dedication. To look to the future with optimism, I have made a dedication of my own, putting the younger generation in the center of my advocacy. We all must awaken to how important this work is.

David Ita

Their Insights are Crucial: Young women and the integration of SRH & HIV Prevention

In AVAC Report 2019: Now What?, we called out to these advocates, members of “Generation Now”, encouraging them to sustain their bold efforts in the fight against HIV. Below is one response and more are available here.

The author, Ulanda Mtamba, is a behavioral change and communication specialist from Malawi who served as a 2018 AVAC Advocacy Fellow with the organization Advancing Girls Education in Africa.

Dear AVAC,

Thank you for highlighting the importance of engaging youth in HIV prevention advocacy in your letter to Generation Now. In my own experience working with young people, I have developed a deep appreciation for the vital role youth play in pushing for social change. Young people understand their own challenges intimately and their participation in HIV prevention advocacy and research is essential in developing and implementing technologies that work for younger generations.

Young women, in particular, possess crucial insights concerning the relationship between HIV/AIDS and sexual and reproductive health. They understand the importance of integrating HIV/AIDS and sexual and reproductive health services because their lives are affected by siloed interventions. My belief in the importance of young women’s participation in the field has propelled me to establish community education programs that increase their knowledge of oral PrEP and the dapivirine ring in my home country of Malawi. I believe that by familiarizing young women with HIV prevention research, we can better empower this generation to engage in national dialogues and inform the HIV research agenda in Malawi and around the world. I look forward to continuing my work with young women to advance our participation in biomedical research and advocacy. I also call on leaders in the field to prioritize the integration of sexual and reproductive health services in HIV/AIDS prevention, care and treatment as an essential public health intervention.

Ulanda Mtamba

Youth Voices are Weapons in the Fight Against HIV

In AVAC Report 2019: Now What?, we called out to these advocates, members of “Generation Now”, encouraging them to sustain their bold efforts in the fight against HIV. Below is one response and more are available here.

The author, Mercy Mutonyi is a young advocate from Kenya and 2019 AVAC Advocacy Fellow with Bar Hostess Empowerment and Support Programme.

Dear AVAC,

Your letter to Generation Now in AVAC’s 2019 Report identified important issues regarding youth organizing that spoke directly to my personal experience as an advocate working on the frontlines of HIV prevention advocacy. As a young woman and HIV prevention advocate, I understand firsthand the importance of youth engagement in HIV prevention advocacy. I believe that young people need to be directly involved in shaping discussions that affect us personally and demand a primary role in co-creating prevention campaigns that speak to my communities’ particular concerns. While young people may tune out sexual health messages from the adults in their lives, they pay close attention to their peers and it is essential that we are empowered to help shape the messages and their dissemination amongst our generation. Youth voices and peer-to-peer education are powerful weapons in the fight against the AIDS epidemic.

I am proud to represent my community as a leader in key decision-making forums such as Kenya’s HIV technical working group and to have played a key role in developing Kenya’s national PrEP guidelines. I am also honored to have served as the lead PrEP Ambassador, Project Co-Investigator and Administrator of the medical and community education components of the oral PrEP (Truvada) pilot study project implemented by BHESP-LVCT-SWOP in 2015-2017. In this role, I coordinated and worked with 12 other PrEP ambassadors to create awareness of PrEP at different hotspots in Nairobi. We shared feedback from female sex workers on their views and opinion’s of PrEP and supported female sex workers interested in oral PrEP screening and enrollment. I have also shared my experiences using PrEP on national and local radio stations, social media and national TV stations, and community engagement meetings. This kind of participation from young leaders is essential to ending the epidemic where I live and work. Without it, young people will look in vain for faces and voices they trust as complex issues around HIV treatment and prevention unfold. Thank you for recognizing the significance of this work and the unique contributions young people, and particularly young women, bring to the field.

Mercy Mutonyi