Translating, Advocating and Catalyzing for HIV Prevention and Equity in 2022 & Beyond

This year was an incredible one of reflection, engagement, opportunity, and action. More than 40 years into the HIV epidemic – and in the midst of multiple other pandemics and persistent inequities – AVAC and its partners continue to reshape, reimagine and fight for effective HIV prevention.

We began 2022 with a new strategy reflecting an evolving field and critical opportunities for HIV prevention and for global health:

  • Research is accelerating, with more options available than ever before. But progress toward crucial targets has been far too slow, and these biomedical options are not yet real choices for the people who need them.
  • COVID accelerated science, but significant gaps in access underscored the necessity for smart, equitable, and people-centered pandemic preparedness, prevention AND response.
  • And a global movement for social justice continues to demand that we all reexamine critical questions of equity, including health equity.

As we close out the year, we’ve been asking ourselves, how have we done? And the answer, we hope, lays the foundation for bold action in 2023 and beyond.

Thanks to an incredible partnership network and committed donors and collaborators, I am proud to say that we’ve made significant progress. But, as Tony Fauci reminded us all last month when he and I had a chance to chat about history AND the future, “much accomplished; much more to do.”

In all that we do at AVAC, we keep three aims in mind. Track and translate the science so the research enterprise and the communities who need prevention most are working hand in hand. Advocate for evidence-based, high-impact, community-centered programs, products and policies. And catalyze the relationships, partnerships, coalitions, advocacy agendas, joint commitments and action plans that get it all done.

Here’s a look at just some of the work we’ve done to advance all three in 2022.

We served as a bridge between the scientific field and communities where research happens.

We deepened our investment in supporting the next generation of skilled and informed advocates with the belief that advocacy and action must be founded on principles of power-sharing.

  • Developed and continuously track our Plan for Accelerating Access and Introduction of Injectable CAB for PrEP to ensure time is not wasted and opportunity is not squandered, and importantly, that civil society plays a meaningful role.
  • Supported the African Women’s HIV Prevention Accountability Board and our CASPR and COMPASS partners in meeting with global leaders, including Winnie Byanyima of UNAIDS, Amb. John Nkengasong of PEPFAR and Atul Gawande and Han Kang of USAID, to make the urgent case for faster and more equitable access to both the dapivirine vaginal ring (DVR) and injectable cabotegravir – and to listening to and engaging with civil society before making decisions.
  • Welcomed the 12th class of the flagship Fellows Program with 8 new Advocacy Fellows working on access to the DVR, U=U campaigns, and integrating SRH with HIV services.
  • Established CureROAR to support a cadre of advocates to gain knowledge in the science and process of cure research, and to develop an advocacy agenda to ethically advance cure research.
  • Introduced The Choice Agenda (TCA), a global forum for advocacy on HIV prevention, with agenda-setting conversations, deep-dive webinars on key issues in the field and moderated passionate, highly-informed discussions with 1,000 advocates and experts across the field.
  • Launched an advocacy campaign with PrEP4All and other partners to ensure the US National PrEP Program reaches those who need prevention most – with a huge year-end victory this week when the US Congress included as part of its fiscal year 2023 budget a call for the Centers for Disease Control and Prevention (CDC) to expand equitable national PrEP access in order to end the HIV epidemic!

We expanded our work to cultivate and sustain dynamic partnerships that set a bold and innovative agenda for HIV prevention.

Yes, together we’ve been able to do so much this year. But there remains a long, unfinished agenda for all of us in 2023 and beyond, that no one organization can address alone. The challenges ahead can only be defeated by building global solidarity, sharing responsibility and accountability, and mobilizing a response that leaves no one behind.

Thank you to all of our partners, AVAC staff, board, donors, and the remarkable individuals and organizations around the world who allow us to continue this critical work as part of a comprehensive and integrated pathway to global health equity.

In solidarity and with enormous gratitude,

Mitchell Warren and all of us at AVAC

P.S. We are grateful for all forms of support and partnership. If you can, please do consider a financial contribution to AVAC to help keep this work moving, together.

AVAC Fellows Took Charge on World AIDS Day

World AIDS Day is a day to remember and reflect, but it can also be a day to intensify advocacy, which was the case for many of our 2022 AVAC Advocacy Fellows.

From broadcast interviews, to an open forum on religion and sexuality, to a symposium attended by the Prime Minister of Lesotho, AVAC Fellows took World AIDS Day to task with a day of conversation and advocacy. Check out highlights from the day below.

Ruth Akulu, who is hosted at ICWE/EA in Uganda, took on several broadcast interviews including Radio City and UBC TV to share perspective as someone living with HIV and to discuss the latest advances and opportunities in HIV prevention. These media appearances were supported by the Uganda AIDS Commission.

Pictured: Ruth Akulu and Radio City staff.

Onward Chironda, hosted by GALZ in Zimbabwe, organized a media cafe to launch a series discussing religion and sexuality, featuring religious leaders and members of the LGBTQ+ community. Read more about the event here.

Pictured: Reverend Maxwell Kapachawo in “Digital Conversation on: RELIGION, SEX & SEXUALITY”

Catherine Madebe participated in a panel discussion with the US Ambassador to the United Republic of Tanzania, Donald Wright, as they discussed youth priorities and challenges in HIV prevention and gender-based violence. Catherine offers perspective on where prevention is in Tanzania here.

Pictured: Catherine Madebe (second in on right) with Ambassador Wright and community members and PEPFAR leaders.

Prince Mikel Juao, hosted by Lesbians Intersex Trans and other Extensions (LITE) in Malawi, organized an event in Mzuzu to educate communities on new HIV prevention technologies such as injectable CAB for PrEP, the dapivirine vaginal ring, and HIV self test kits.

Pictured: A healthcare worker demonstrating how to use an HIV self-test kit.

Natasha Mwila and her host organization, The Network of Zambian People Living with HIV/AIDS (NZP+), commemorated World AIDS Day by distributing condoms and sharing information about additional HIV prevention strategies.

Pictured: Natasha Mwila (second in on right) and The Network of Zambian People Living with HIV/AIDS (NZP+) staff.

Pictured: Clever Chilende (2012 fellow), Esnart Sikazindu (2020), Chilufya Hampongo (2016 fellow), and Natasha Mwila (2022)

Peter Katleho Ntheri and his host, Lesotho Network of AIDS Service Organization (LENASO) collaborated with the National AIDS Commission and other AIDS-service partners for a World AIDS Day symposium in recognition of the community’s progress in ending the epidemic. Lesotho Prime Minister Sam Matekane attended this event!

Pictured: Lesotho King Letsie III and Prime Minister Sam Matekane attending the Lesotho Network of AIDS Service Organization symposium with LENASO Executive Director Mamello Makoae.

Elizabeth Atieno Onyango, who is hosted by the Coast Sex Workers Alliance in Kenya (COSWA-Kenya) collaborated with organizations such as Reachout Center Trust and HIV/AIDS People Alliance (HAPA-Kenya) to voice concerns around the lack of HIV prevention options in their communities. Their main message was saidia usiadhibu which means “support, don’t punish” in Swahili.

Pictured: Elizabeth Atieno Onyango at a World AIDS Day event in Kwa Khanyayo, Kenya.

Liyema Somnono hosted by Passionate Unlimited Peers in Action (PUPA) with the help of both government and non-governmental organizations hosted a World AIDS Day event in a hard-to-reach rural area called Kwa Khanyayo where community members were offered clinical services and HIV education. Liyema shared information on the dapivirine vaginal ring and held a Q&A session on PrEP.

Pictured: Community members in Kwa Khanyayo receiving HIV-related services and education.

To learn more about the AVAC Advocacy Fellows program and the work and achievements of our 2022 class as well as the past 11 years of Fellows, visit the AVAC Fellows page.

The Choice Agenda: 1000 Members Setting the Agenda

The Choice Agenda (TCA), a global forum for advocacy on HIV prevention, is just a few new sign ups away from the 1,000 member mark!!! It’s a milestone reminding us of what the TCA has achieved in such a short time, with agenda-setting conversations and deep-dive webinars on key issues in the field and a full program to come in 2023.

Since its launch earlier this year, The Choice Agenda has hosted monthly webinars and moderated passionate, highly-informed discussions with advocates and experts across the field. The Choice Agenda program, and all of its participants, representing over 40 countries, takes on a wide range of topics. Together, the TCA community drills into critical choices, including the need for short acting, non-systemic, user-controlled options, and a wide range of tailored implementation strategies that must define advocacy, the HIV response, and global health equity at large. Participants are also provided with links to a curation of exceptional resources to support further education and advocacy.

All these conversations and resources are here for you to follow, in the TCA archive of listserv discussions and webinar recordings, including:

● “PEP Needs Some Pep! Addressing PEP Neglect in HIV Prevention Research, Programming and Uptake” (Recording/Resources)

● “Doxycycline for STI prevention: Evidence and Current Research” (Recording/Resources)

● “RINGing the Bell for Choice: Actions and Solutions on Dapivirine Ring Access” (Recording/Resources)

● “Faster, Smarter and More Equitable – Accelerating Roll Out and Uptake of CAB for PrEP” (Recording/Resources)

● “The Research Says Yes, YES, YES – Just Like That”(Recording/Resources)

● “Efficacy is Not the Only HIV Prevention Attribute that Matters – Lessons from Contraception” (Recording/Resources)

Join the listserv to access the archive and participate in the discovery and debate of ongoing and emerging topics. And don’t miss the final TCA program of the year: More than Vessels: Pregnant people deserve inclusion in HIV prevention clinical and implementation research on Wednesday, December 14, 2022 at 9:00am-10:30am ET; 1:00pm-2:30pm GMT. Register Here

We’ll be announcing the 2023 TCA kickoff webinar shortly, which will include a series of convenings and webinars before and during February Conference on Retroviruses and Opportunistic Infections (CROI), including the beloved Margarita Breakfast Club offering daily research updates, all available whether you are attending the conference or not.

You won’t want to miss a thing!

PLOS Publication Correlates Key Policies with PrEP Uptake

New research published in the journal PLOS today from AVAC and COMPASS partners shows the importance and value of an enabling policy environment to increase the uptake of HIV prevention services, including for PrEP.

Using data from 194 countries gathered by the HIV Policy Lab and AVAC’s Global PrEP Tracker, the team analyzed the impact of a series of policies: broad PrEP eligibility, HIV self-testing, and lowered age of consent to HIV testing and treatment services. Each was found to be correlated with increased PrEP uptake. The results show:

● A significant and positive correlation between countries authorizing HIV self-testing and cumulative number of PrEP initiations in-country.

● A significant and positive correlation between countries authorizing lowered age of consent to HIV testing and treatment and cumulative number of PrEP initiations.

● Similarly, and not surprisingly, policies authorizing broad PrEP eligibility also show significant and positive correlations with PrEP uptake.

These findings suggest that HIV self-testing is a vital step towards increasing access to PrEP, and support existing evidence that HIV self-testing serves as a gateway to PrEP uptake. They also suggest that young people may be motivated to access PrEP and that countries with policies that expand PrEP eligibility may see a strong benefit, with greater adoption of PrEP by people who need it. With these findings in mind, it’s vital to remember that inequities in PrEP access across populations and settings, based on complex social factors such as stigma and discrimination, can begin to be addressed by enabling policies, but require comprehensive strategies that build on that environment. The right policies cannot do the job alone. Community leadership in every aspect of the HIV response from local to national and to international levels is needed.

Read the full publication here: Correlations Between Oral Pre-Exposure Prophylaxis (PrEP) Initiations and Policies that Enable the Use of PrEP to Address HIV Globally.

Domestic Resource Mobilization (DRM) Learning Collaborative – Save the Date!

Coming off World AIDS Day, we are reminded of the importance of robust domestic investment in all aspects of the HIV response, including research and development (R&D), to see an end to the epidemic and build sustainable systems for health. This Thursday, December 8 at 15:00 PM EAT / 14:00 PM SAST/ 13:00 PM WAT / 7:00 AM EDT marks the launch of the inaugural Domestic Resource Mobilization (DRM) Learning Collaborative.

The collaborative builds on work with our partners in both the COMPASS and CASPR programs and will be a facilitated virtual space that brings together global health advocates, civil society organizations and other key stakeholders from Africa to engage in peer-to-peer learning and collaboration. We will explore priority topics, including: local investments in HIV services and other health infrastructure; pandemic preparedness; and research and development (R&D). And we will use the time to explore opportunities and frame what questions must be answered to develop a unifying advocacy agenda. This comes exactly a month after Africa Health Week where over 80 community members and leaders came together online each day to reflect on lessons learned and best practices in health R&D.

You won’t want to miss this opportunity to build on what was learned and brainstorm with community leaders and advocates on ways to advance health R&D investment in Africa.

Save the date and register here!

Request for Applications 2022-054: MATRIX Technology Accelerator Domain 1

Funded by USAID, the MATRIX consortium is seeking applications to advance research applications for development of new HIV prevention approaches, including novel drugs, delivery devices, and diagnostics. Applicants from a wide range of US, Kenyan, South African, and Zimbabwean institutions are invited to apply to this request for applications. Proposals ($150,000 for 18 months) are being collected from now until March 2023.

New Options and New Opportunities for Accelerating Prevention

Each World AIDS Day is an opportunity to reflect, remember and, hopefully, reenergize. This year is no different, but, more than 40 years into this epidemic – and in the midst of multiple other pandemics and persistent inequities – this could be the year that marks a fundamental reshaping and reimagination of HIV prevention, if everyone does their part.

This week alone, we heard global leaders – including PEPFAR Ambassador Dr. John Nkengasong on AVAC’s PxPulse podcast, Dr. Anthony Fauci, Director of NIAID on our webinar, WACI Health director and CASPR partner Rosemary Mburu at the African Union and APHA director and CASPR partner, Yvette Raphael, on IAS’s HIV Unmuted podcast – all remark on this once-in-a-lifetime opportunity to accelerate access to new prevention options and prepare for future ones.

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Let’s start with long overdue conversations about a new approach to delivering proven products (see AVAC’s plan for accelerating access to injectable cabotegravir for PrEP), and doubling down on investing in HIV prevention. At AVAC, we’ve long called for tailored, community-led prevention programs that integrate sexual and reproductive health, and most importantly, offer choices at scale. This means a range of products offered across a spectrum of programs. It means investment that will deliver these products and programs at a scale that will reach everyone who needs prevention. Global leaders, confronting heartbreaking rates of HIV infection that have been stalled at about 1.5 million new diagnoses a year for several years, are calling for bold new initiatives.

In the latest episode of AVAC’s PxPulse podcast, New Products are Needed and a New Paradigm is Essential: A new era in prevention?, Ambassador Nkengasong issued a call to action for an for an aggressive strategy to scale up combination prevention, including injectable cabotegravir for PrEP (injectable CAB). As the Ambassador said, “Imagine if we did this in five high incidence countries, what will happen in two years? That is where we are going to begin to break the backbone of this vicious cycle. As I said, the most difficult thing is making that decision to act. The rest is tenacity.”

Listen to the full podcast for the details.

Also in this podcast, Executive Director of HEPS-Uganda, current COMPASS partner and former AVAC Advocacy Fellow and Kenneth Mwehonge, talks about the commitments needed from a range of stakeholders to bring Global HIV Prevention Coalition’s new roadmap to life, and hit 2030 targets for ending the epidemic. Chief among the priorities: leadership must come from donors to fully invest in coordinated planning, and expanded roles for civil society leadership in the design and execution of these plans. And Lilian Benjamin Mwakyosi, the Executive Director of DARE in Tanzania, another former AVAC Advocacy Fellow and current COMPASS partner, explains why choice, programs and products, and community leadership are essential to overcome the real-world barriers that have stalled and frustrated prevention efforts to date. As Lilian said, “Sustainability is guaranteed when communities are engaged. So that’s one thing…to strengthen immediately.”

Embracing these priorities now is a once-in-an-epidemic opportunity to end the public health threat of HIV, and prepare for future ones. This week, South Africa has become the fourth country in the world to approve injectable CAB for PrEP, the dapivirine vaginal ring (DVR) is approved in a growing number of countries, and oral PrEP use is on the rise, passing the mark of three million initiations earlier this year. For the first time, the world has multiple biomedical interventions to offer choice, and it’s essential to develop the programs that bring the fruits of science to the communities facing public health threats.

During AVAC’s conversation with Tony Fauci earlier this week, he said it clearly: “We’ve got to get user-friendly PrEP to [people]. That’s going to involve implementation that integrates itself into the health care delivery system. Otherwise, we’re going to have highly effective interventions that are not being maximally utilized, and that would really be a big mistake.”

AVAC has been spearheading efforts to advance these priorities across our programs. In Montreal, at AIDS 2022, The Coalition to Accelerate Access to Long-Acting PrEP launched, with AVAC as the secretariat. As part of COMPASS and CASPR coalitions, we are joining civil society partners to lead key initiatives for stakeholder engagement on programs and projects delivering injectable CAB and DVR. These initiatives must be part of truly comprehensive and integrated prevention programs that link biomedical options with structural and behavioral programs. We championed the creation of the African Women’s Prevention Accountability Community Board and the Key Population Advisory Group. These two groups, representing affected communities, are offering essential leadership to ongoing planning for the introduction of these new prevention options. This leadership is crucial to reaching the 2025 UNAIDS target of less than 370,000 new annual HIV infections. It’s a vital part of our work, which has pushed community leadership, global access to proven interventions and accelerated research and introduction from the very beginning. And now it’s crunch time, when all this work must come together and yield results.

Highly effective options now exist and new discoveries continue to improve on them; it’s up to all of us to marshall the will, the money and the innovative partnerships to put people at the center of programs so these biomedical options translate into actual choices and deliver impact.