Px Pulse: A season of listening

As we look ahead to 2024 and the vital work AVAC and partners will be carrying forward, the conversations from 2023 offer guidance and insights. Px Pulse, AVAC’s podcast on critical issues facing HIV prevention research, hosted several not-be-missed conversations in 2023 that will reverberate into the year ahead.  

From a stalled PEPFAR reauthorization to LGBTQIA+ voices fighting persecution in Uganda; from efforts to bring equity to a new global architecture for pandemic readiness to advances in HIV vaccine science and advocacy to include pregnant people in research—we hope that all of these conversations can inform our advocacy in 2024. Click on the episode for both recordings and resources.

PEPFAR at 20: Keeping the promise (23:16)

Considered one of the greatest US foreign policy and global development achievements of the century, the program has saved upwards of 25 million lives since it launched in 2003. But PEPFAR is marking its 20th anniversary while fighting for its future. LISTEN HERE.

LGBTQIA+ Advocacy in Uganda: Facing down fear and fighting for justice (24:19)

In March 2023, the Ugandan Parliament moved forward broad-reaching legislation to further criminalize LGBTQIA+ people. This podcast features Ugandan advocates and AVAC partners discussing the specifics of how these attacks have gained momentum and their ties to US-based religious extremists. The advocates discuss what needs to happen next. LISTEN HERE.

The Shape of Pandemic Preparedness is Being Decided. Now is the Time for Collective Action (15:14)

Health leaders around the world are in the midst of creating a new architecture to deal with pandemics. Chris Collins, the CEO and President at Friends of the Global Fight Against AIDS, Tuberculosis and Malaria, talks about what’s at stake, which policymakers get it already, why this year matters so much, and what advocates can do about it. LISTEN HERE.

PPPR Advocacy 101: Find out what it means to you (19:05)

Over the coming months, global leaders will make key decisions about several initiatives to prepare for the next pandemic. This podcast explores what they commit to, how much they will spend and how well these plans safeguard equity. LISTEN HERE.

Inclusion of Pregnant and Lactating People in HIV Research: What you need to know (34:28)

AVAC’s Manju Chatani-Gada takes us through conversations with a trial participant who became pregnant, researchers, policymakers and donors to understand why this population gets excluded, the impact it has and what to do about it. LISTEN HERE.

Evolving Strategies for an HIV Vaccine: One researcher explains where the field is going and why? (21:23)

Evolving Strategies for an HIV Vaccine: One researcher explains where the field is going and why? Dr. Katy Stephenson explores the implications of recent trial results, the big questions driving next generation vaccine development, and new strategies underway in early phase research. LISTEN HERE.

Happy listening—and let us know what topics you want to hear more about in 2024! 

The Search for an HIV Vaccine Must Continue

Field Will Learn for Halted PrEPVacc Arm

By Jeanne Baron

Today the PrEPVacc trial team announced at a special session at the International Conference on AIDS and STIs in Africa (ICASA) in Harare, Zimbabwe, that they were stopping vaccinations in the study following a review by an independent data safety committee that determined there was little chance the vaccines being tested could stop HIV acquisition. The oral PrEP arms of the study will continue. 

PrEPVacc was testing two different vaccine strategies against a placebo: one regimen combining a DNA vaccine with a protein-based vaccine (AIDSVAX), and another regimen combining DNA, MVA and a protein-based vaccine (CN54gp140). 

“We always hope for a positive outcome in HIV prevention trials, and this news is disappointing,” said Mitchell Warren, AVAC executive director. “We look forward to seeing the full PrEPVacc data in 2024 and hope it will add to the body of evidence that is helping scientists understand how to develop better vaccine candidates that will one day protect against HIV.”  

“The PrEPVacc outcome underscores yet again that the science of HIV vaccine development is extremely challenging,” he added. “Now is not the time to step back from vaccine research. There are several promising strategies in early-stage research that must continue, along with research for other HIV prevention options. We will not end HIV without ensuring that everyone who is vulnerable to HIV infection has a choice of effective and desirable prevention options.”  

Importantly, PrEPVacc’s PrEP arms will continue. The study is testing two different formulations of daily oral PrEP, looking to see if a new formulation – F/TAF (also known as Descovy) – is at least as good in the trial population at protecting against HIV acquisition as F/TDF (also known as Truvada and the most widely used version of PrEP). The trial will provide the first data for F/TAF among cisgender women (who make up 87% of the just over 1,500 PrEPVacc trial participants). F/TAF is approved for use in the US and UK, but not for those individuals who have receptive vaginal sex, since previous trials regrettably did not enroll cisgender women. 

The PrEPVacc study is scheduled to conclude in 2024 and data from all arms of the study are expected to be reported in the last half of 2024. 

“The PrEP arms of PrEPVacc will provide important insights into the potential of expanding access of F/TAF for PrEP to women in East and Southern Africa who need additional options to protect themselves from HIV. Equitable access to new interventions should be a goal of every research program,” said Stacey Hannah, AVAC’s director of Research Engagement. 

“PrEPVacc is a complex, innovative trial design, and, while the vaccine result today is disappointing, the trial team has worked from the outset to implement the Good Participatory Practice (GPP) Guidelines. The team’s hard work on the front-end to apply GPP to this trial is paying off especially now in the ability to deliver complex, disappointing results to trial participants, advocates, policymakers and other key supporters of PrEPVacc and of HIV prevention broadly.” 

ICASA 2023: Demands for equity and investment in the HIV response

By Jeanne Baron

At the ongoing International Conference on AIDS and STIs in Africa (ICASA), the struggle to sustain an evidence- and rights-based HIV response is heating up. HIV prevention and global health equity depend on continuing to build on the gains to date, to learn from mistakes, and to invest in scaling up now-proven solutions while developing additional ones. But all these principles are increasingly threatened by political reaction and short-sighted investment. AVAC and partners released four major calls to action at ICASA to confront these urgent challenges, which are imperiling the communities most burdened by HIV and other health inequities. Each of these resources set an agenda to address critical gaps. 

Upholding Civil Society Voices in Health International Conferences: A response to the suppression and cancellation of community voices at ICASA 2023

A permitted People’s March scheduled for December 5 in Harare was cancelled due to acute safety concerns following the arrest of conference attendees at a demonstration, and other intimidating police actions against civil society and key populations at the conference. AVAC is part of coalition that issued an open letter to the conference secretariat condemning the suppression of community voices and calling for the People’s March to go forward and future guarantees that ICASA host countries commit to allowing community voices to be heard and ensuring their activities are unhindered. 

The Global HIV Prevention Roadmap for Key Populations

This roadmap outlines a strategy for the equitable expansion and delivery of HIV prevention services to key populations (KPs) globally and regionally. It introduces a critical, coordinated approach led by KPs to accelerate the implementation of existing and new HIV prevention interventions. Developed by the Global KP HIV Prevention Advisory Group (KPAG) and allied stakeholders, this roadmap represents near-term priorities for funding, U=U, PrEP targets, the advancement of rights— particularly decriminalization of key populations and more for key stakeholders and regions to achieve by mid 2025. This roadmap is a terrific complement to the recently-released Choice Manifesto, led by women advocates throughout Eastern and Southern Africa.

“This is nothing new, we’ve been saying this for years, but now it is more urgent than ever: Funding to key populations must go beyond services to support our advocacy and our activism.  Decriminalization is imperative. We are not criminals, and with a stroke of the pen decriminalizing key populations could lead to lower incidence of HIV,” said KPAG member and former AVAC Fellow, Josephine Aseme at a press conference promoting the importance of this roadmap.

Mobilizing People of Faith to Build Networks to Protect Human Rights and Overcome Homophobia

Faith leaders from across the region convened by African Services Committee, AVAC, GALZ & Inerela joined in solidarity in defense of human rights and evidence-based HIV prevention, including for vulnerable populations. Among the pledges, participating faith leaders are committing to engage in cultural and legislative initiatives related to LGBTQIA+ issues that promote love, grace, compassion, equity and justice for all. 

Call to Action for Voluntary Medical Male Circumcision: The job is not done yet

Despite impressive achievements in bringing voluntary medical male circumcision (VMMC) to scale, the pace of funding and the expansion of programs delivering VMMC must intensify to reach 2030 global targets for HIV prevention. Modeling studies suggest the approximately 30 million VMMC’s conducted between 2008-2020 averted 615,000 new HIV infections. By 2030 that number could be 1.6 million infections averted, if the HIV response sustains and expands VMMC. This joint report was prepared by AVAC, Azali Healthcare, Bill & Melinda Gates FoundationJhpiego, the Coalition for Health Promotion and Social Development (HEPS-Uganda), Treatment Advocacy and Literacy Campaign (TALC), the Joint United Nations Program on HIV/AIDS(UNAIDS) and the World Health Organization (WHO). Find a two-page summary here and the full report here

“VMMC offers us an exceptional opportunity to get men into the healthcare system but we have gone off track. We can’t afford to lose momentum. The job is not yet done. New funding is needed now. Integration is needed now. Sustained commitment is needed now.” – Chilufya Kasanda Hampongo, TALC Zambi

All four initiatives launched at ICASA take aim at critical gaps in the HIV response. Each provide resources that outline next steps and roles for stakeholders across the field to advance equity, and in turn help the world reach global targets to end the epidemic.  

AVAC Commemorates World AIDS Day

This World AIDS Day we at AVAC are reflecting on remarkable gains and increasing threats to progress against AIDS. Our latest issue of PxWire, tracking trends in research, development and delivery of HIV prevention options, speaks to this important progress: 

However, as we look to 2024, all these gains could be imperiled by political and financial choices facing leaders today.

The answers to these questions will require donors and political leaders to do the right thing, and it will depend on us, a global movement of advocates with a track record of world-changing achievements, to stay the course and build the road to reach everyone one of these goals. Below are a few key resources to support your work. 

From the Lab to the Jab

A series of advocates guides on key issues to ensure equitable access to safe, effective, and affordable vaccines.

Learn more.

Call to Action for Voluntary Medical Male Circumcision

A report on next steps to advance the role of VMMC in ending the epidemic.

Learn more.

Good Participatory Practice: Body of Evidence

An online package of resources to support advocacy for GPP as an international standard for clinical trials.

Learn more.

The HIV Prevention Choice Manifesto

A historic milestone in the power of community-led leadership and prioritization of choice in HIV prevention.  

Learn more.

Progress Against HIV and AIDS is Fragile

POZ Magazine’s interview with Mitchell Warren, with a comprehensive look at the status of the fight against HIV/AIDS and the scientific breakthroughs to date and still needed to end the epidemic.

Read more.

The Anti-HIV Jab is Coming to South Africa

Bhekisisa’s Mia Malan and AVAC’s Mitchell Warren breakdown what it will take to get injectable CAB for PrEP to everyone who needs it.

Listen here.

A Call to Action: Scale Up HPV Vaccination in People Living with HIV

In a new call to action, Mitchell Warren and Heather White, executive director of TogetHER for Health, argue that the time is now to invest in efforts to ensure that people living with HIV can live their lives without the threat of cervical cancer.

Read more.

At AVAC, we believe it’s up to all of us to make sure the world does not squander another decade in slow, fragmented rollout of life-saving innovation in HIV prevention or risk underfunding research and development. If we work together to build equity into the rollout of options that exist already and support the promise of expanding choices in the near future, the world will at long last bend the curve of HIV.  

Scale Up HPV Vaccination in People Living With HIV 

A Call to Action

By Mitchell Warren, Executive Director of AVAC, and Heather White, Executive Director of TogetHER for Health. This post first appeared at togetherforhealth.org.

HIV/AIDS and cervical cancer are two global health emergencies that impact millions around the world – and unfortunately, the relationship does not end there. The dire synergy between HIV/AIDS and cervical cancer can be expressed in some startling statistics: 

  • Cervical cancer is on the relatively short list of “AIDS-defining illnesses”—cancers and opportunistic infections that can be life-threatening to people living with HIV. 
  • Women living with HIV are up to six times more likely to develop invasive cervical cancer than their HIV-negative peers. 
  • Women testing positive for infection with the human papillomavirus (HPV) that causes almost all cervical cancers are twice as likely to be infected with HIV.  
  • The proportion of cervical cancer cases attributable to HIV is greater than 40% among the eight countries with highest HIV prevalence in sub-Saharan Africa, compared to less than 5% in 127 countries with lower HIV prevalence, highlighting major disparities in the global burden.

Additionally, HIV/AIDS and cervical cancer share many barriers to effective prevention, treatment, and care. Efforts to provide services to address both diseases are beset with social stigma and misinformation. 

Due to their elevated risk of disease, women living with HIV, and those at risk of HIV are considered priority populations for cervical screening. The US President’s Emergency Plan for AIDS Relief (PEPFAR) invests more in cervical cancer screening and treatment in low- and lower middle-income countries than any other funder. The Global Fund to Fight AIDS, TB, and Malaria will also fund requests for cervical cancer prevention aligning with HIV prevention programs. The SUCCESS collaboration funded through Unitaid and implemented by Expertise France, Jhpiego, and the Union for International Cancer Control (UICC) is introducing and promoting the best available screen-and-treat tools to prevent cancer in women most at risk, especially those living with HIV.

But these lifesaving efforts are only reaching a fraction of those in need. 

While efforts to develop a preventive vaccine against HIV are underway, vaccines against HPV have proven to be safe and effective for people already living with HIV—greatly reducing their chance of developing cervical cancer. Given their enhanced likelihood of developing cervical cancer, it is critical to focus additional attention on vaccinating people living with HIV, as well as young people vulnerable to both HIV and HPV infections. Unfortunately, few targeted efforts to ensure widescale uptake of HPV vaccination in people living with HIV have been made. 

According to data from the  World Health Organization (WHO), only around 25 percent of women living in the Africa Region – the region with the highest burden of HIV/AIDS—are currently vaccinated against HPVCurrent WHO guidance recommends at least two doses of HPV vaccine for people living with HIV, requiring not just effective implementation of initial vaccination but also efforts to ensure subsequent follow-up to complete the recommended regimen. A lack of disaggregated data on the proportion of people living with HIV who remain unvaccinated against HPV hampers the creation and implementation of targeted HPV vaccination strategies in populations with increased chance of acquiring HIV.

It’s well past time to build an evidence-based plan to ensure access to critical comprehensive health services for adolescent girls and young women at risk for HIV, or those living with the disease, using a lifecourse approach. Specifically, to improve coverage of HPV vaccination, we call on global bodies to take urgent steps to: 

  1. Assess the current status of HPV vaccination among girls and women living with HIV. A dearth of reliable global and regional data must be addressed if we are to ensure wider uptake of HPV vaccination in populations of people living with HIV. Effective monitoring of is a critical first step toward addressing the gap in HPV vaccination coverage for people living with HIV. 
  1. Create evidence-based HPV vaccination strategies for people living with HIV. Programs should take advantage of opportunities to integrate HPV vaccination alongside HIV prevention, treatment, and care services, alongside outreach and awareness activities to break down stigma and combat misinformation. 
  2.  Build the evidence base supporting HPV dosing schedules for people living with HIV. Current WHO guidance has shifted to a single-dose regimen for HIV-negative populations. Clinical research can affirm the need for multi-dose regimens for people living with HIV, but may also support a shift to single-dose schedules that can ensure wider access to more individuals. 

This call to action couldn’t be more timely, as one lingering constraint to accelerating access to HPV vaccination for people living with HIV—limited vaccine supply—is expected to be all but removed in the near future. UNICEF projects that by 2024 the supply of HPV vaccines will for the first time align with the demands of the programs UNICEF services, most notably Gavi, the Vaccine Alliance, the most prominent implementer of HPV vaccination services in low- and lower middle-income countries. Gavi’s ambitious goal of vaccinating 86 million adolescent girls in its focus countries against HPV by 2025 presents a unique opportunity to close a vaccination gap in people living with HIV. 

Today – December 1st – is World AIDS Day. Two weeks ago on November 17th, the world marked the third annual Cervical Cancer Elimination Day of Action. The proximity of these two days of advocacy provides an opportunity to highlight another connection shared by HIV/AIDS and cervical cancer: the opportunity to invest to end these dual health threats by scaling up effective services and meeting global targets – the 95-95-95 HIV treatment goals set by UNAIDS and the 90-70-90 cervical cancer prevention goals set forth by WHO. 

UNAIDS’ Global AIDS Strategy incorporates sub-goals for women and girls vulnerable to developing cervical cancer, representing a confluence of these two remarkable global health endeavors. The Strategy calls for: 

  • 90 percent of girls aged 9–14 in priority countries gaining access to HPV vaccination; 
  • 90 percent of women living with HIV being provided access to integrated or linked services for HIV treatment and cervical cancer; and
  • 90 percent of women, adolescent girls and young women accessing sexual and reproductive health services, including for HPV and cervical cancer, that integrate HIV prevention, testing and treatment services. 

The alignment of HIV/AIDS and cervical cancer targets reflects an evidence-based understanding that ending preventable deaths from these two diseases is best done in tandem.

We know that effective plans supported by sufficient political and financial support can achieve these goals—saving millions of lives. The time to invest to ensure that people living with HIV can live their lives without the threat of cervical cancer is now.