Sexually Transmitted Infections

A Review of the 2022 Vaccine and Diagnostic Research and Development Pipeline and Investments

As overall sexually transmitted infections (STI) rates continue to rise globally, STI diagnostic and vaccine research and development (R&D) investments remain underfunded and neglected compared to other infectious diseases, a new AVAC report finds.  

This report, Sexually Transmitted Infections: A Review of the 2022 Vaccine and Diagnostic Research and Development Pipeline and Investments, examines disbursements by the U.S. National Institutes of Health (NIH) and the Bill & Melinda Gates Foundation—the largest investors across a vast range of global health R&D areas—and is one of few reports to track funding trends in vaccine and diagnostics R&D, and pipeline investments for some of the most common STIs, including chlamydia, genital herpes, gonorrhea, hepatitis B, human papillomavirus (HPV), syphilis, and trichomoniasis.  

It found that leading philanthropic and public funding for STI vaccine and diagnostic R&D totaled just US $103 million in 2022 with most of the funding coming from the NIH, at US $78 million, approximately 76 percent of total reported funding disbursements. 

“We’re seeing the gap widen—as the global burden of STIs continues to increase, funding for R&D tools to reduce this burden lags behind,” said Alison Footman, PhD, senior program manager for STIs at AVAC and lead author of the report. “If we’ve learned anything from the HIV and COVID-19 epidemics, it’s that we need to get ahead of transmission by prioritizing the health of people and communities and committing the resources needed to develop user-centered diagnostics, treatments and prevention methods. Point-of-care tests that are effective, affordable, and user-friendly, and vaccines to prevent and treat STIs are on the horizon but will only be developed and delivered if money is made available with urgency and scale.” 

Of the total US $103 million in STI vaccine and diagnostic R&D funding reported, only seven percent (US $6.8M) was dedicated to diagnostic research—a much lower amount than vaccine research, which was funded at US $93 million or 90 percent of the total funding. The remaining 3 percent was directed towards projects that examined both vaccine and diagnostic R&D. As with vaccine R&D, the NIH accounted for most of the diagnostic R&D investments (73 percent). 

“Many STI testing programs rely on patients to present with symptoms. But considering that most STIs are asymptomatic, this approach is missing the mark,” Footman added. “We need to be investing in tests for STIs that will improve detection, and therefore limit the time between test and treatment, and hopefully prevent transmission. The overall STI R&D investments are already too little overall, and just seven percent of total funding dedicated to diagnostics is not commensurate with the public health need.”  

Other Key Findings

  • Six institutes and centers within the US NIH contributed the bulk of funding (US $78 million) toward STI diagnostic and vaccine R&D.
  • 59 organizations were funded worldwide to conduct STI R&D; of those, 78 percent (n=46) were located in the US.
  • Institutions in South Africa and Zambia were the only African countries where local organizations were funded to conduct STI vaccine and diagnostic research. In total, US $814,279 was provided directly to these two countries, representing less than 1 percent of total funding spent.
  • By pathogen, most funding (51 percent) was dedicated to HPV R&D, with gonorrhea and syphilis rounding out the top three pathogens funded.
  • US $50 million was spent on HPV vaccine R&D, $18 million on gonorrhea vaccine R&D, $9 million on syphilis vaccine R&D, $8 million on chlamydia vaccine R&D, $3.5 million on genital herpes vaccine R&D, and $2.8 million on Hepatitis B vaccine R&D.
  • NIH spending accounted for most STI diagnostic R&D investments (73 percent).
  • Of diagnostic funding available, 66 percent was dedicated to multi-pathogen research, 33 percent towards HPV, and 1 percent towards hepatitis B. (Multi-pathogen diagnostic projects included research on syphilis, gonorrhea, genital herpes, and chlamydia).

The report also includes spotlights on DoxyPEP; on WHO’s new reports and manuals that provide information on diagnostics currently available to guide development; and on seven AVAC partners in East and Southern Africa who received funding to conduct projects on community needs to prevent, detect, and treat STIs. These advocacy projects helped build a stronger advocacy movement to improve funding and commitments in and around STI vaccines and diagnostics.  

For years, AVAC has been tracking investments and funding trends in HIV prevention and cure R&D. 

This new report on STI vaccine and diagnostic R&D is intended to help decision-makers and advocates identify current funding investments, opportunities, and gaps. Tracking investments over time can also demonstrate the effects of public policies and guidelines, such as WHO’s STI Vaccine Roadmap, on funding decisions and inform research priorities. 

For more information on the state of STI vaccines and diagnostics R&D, visit, or get in touch at

Tell Congress to Reject Cuts and #SaveHIVFunding

Last October when an unprecedented proposal to cut $767 million in federal funding for domestic US HIV programs was put forward in the Congress, AVAC joined PrEP4AllHIVMAPrEP In Black AmericaNASTAD, the HIV+Hepatitis Policy InstituteThe AIDS InstituteAIDS UnitedNMAC, and several members of the Federal AIDS Policy Partnership to launch the #SaveHIVFunding campaign. Since then, thousands of advocates and community members, along with over 100 organizations, joined the fight to demand Congress continue the bipartisan commitment to fund Ending the HIV Epidemic (EHE) efforts.

With key deadlines in the FY24 budget process quickly approaching, it is more important now than ever that you join us in telling Congress to reject cuts and #SaveHIVFunding by sending letters to your Congressional representatives.

The House bill also proposes to cut 53 percent of spending for the Minority HIV/AIDS Initiative, which seeks to eliminate racial and ethnic health disparities in HIV. The bill would also completely eliminate funding for the Minority AIDS Initiative within the Substance Abuse and Mental Health Administration.

Together, these funding cuts would eliminate all activities of the EHE, reverse recent progress in bringing down annual HIV rates, and leave state and local health departments and community-based organizations without critical funding to provide services to their communities. With 70 percent of the 1.2 million Americans living with HIV projected to be age 50 and older by 2030, the impact on the aging HIV community would be severe.

In contrast, the Senate bipartisan spending bill proposes to maintain HIV funding for Fiscal Year 2024 (FY24) and includes a proposed increase of $3 million dollars to continue the fight to end the epidemic and begin work toward a National PrEP Program. 

Please help us push Congress to pass a final FY24 spending bill that rejects cuts to HIV programs and instead would #SaveHIVFunding by sending letters to your Senators and Representative now! Please also review the #SaveHIVFunding social media toolkit that you and your organization can use to urge our leaders in Congress to #SaveHIVFunding.

Decolonizing Global Health in 2024 and Beyond

In the year ahead, staking out a course that will advance the HIV response and global health equity faces serious headwinds.

Several African countries are seeing historic attacks on civil rights aimed at persecuting the LGBTQIA+ community, and most notably, Uganda is embroiled in crises with the enactment of Anti-Homosexuality Act. PEPFAR Re-authorization has been stalled by utter dysfunction in the US House of Representatives, the same body that has proposed massive cuts in domestic HIV fundingNegotiations on the WHO’s Pandemic Accord have so far failed to prioritize meaningful commitments to equity—jeopardizing global preparedness against future health threats. And at least 43 countries are holding elections in 2024, with several countries, including the US, facing serious threats from authoritarian candidates.  

But in HIV prevention, there’s also momentum. The scale-up of PrEP began accelerating in 2021 and has kept apace, with more than 6.2 million people initiated oral PrEP, and another approximately 4000 people have initiated either injectable cabotegravir or the dapivirine vaginal ring. If planning, policies and programs get it right and offer choices in programs that are co-designed by communities that need prevention most, modeling indicates the world could reach UN targets of 10 million PrEP users by 2025. But what does it take to ensure choice, what priorities will ensure policies, programs will serve the communities burdened by HIV? 

Decolonizing global health can and must be a guide star for these efforts. In 2024, it’s time to double down. Decolonizing global health is not a dream. It’s not an “extra” to reach for only when it’s easy. It’s not wishful thinking. Decolonizing global health is a cornerstone in reaching global targets, making prevention a reality, ending the epidemic, and preparing for the next one. 

It demands changes across the field, from research to rollout. AVAC is tracking this progress, developing strategic resources, and supporting the advocates who know that global health will advance or decline depending on progress in key areas:

Empowering Community Leaders & Following Community Priorities

Models of leadership that center communities necessarily involve money but must go beyond the size of the check and whose name is on it. New structures are needed, based on collaboration, transparency, and trust. The COMPASS coalition is pioneering a model to do just that. Read more about this exciting work here.

Pursuing a People’s Research Agenda

A community driven agenda is needed to define research questions and recommendations for HIV prevention research, rollout and investments. With an active HIV pipeline in research and development that is increasingly weighted toward early-phase science, a need for unstinting support for vaccine research, and momentum in cure research, it’s critical for informed and intensive community advocacy to shape the research enterprise. See the pipeline here. 

Program for Choice 

The promise of new options in HIV prevention must not be squandered in siloed programs, or by poorly planned supply chains, or because of disconnected policy decisions. People have diverse needs and face complex challenges; ending HIV depends on finding the option that works best for each individual. Read more about the choice initiatives and the Choice Manifesto and the Global HIV Prevention Roadmap for Key Populations.

Create a New Global Architecture Founded in Equity for Pandemic Readiness

When the next pandemic hits, allocating tools to the most vulnerable is the most effective and efficient way to fight it. County commitments, engagement with civil society, funding levels, and how well planning incorporates equity as a principle has yet to be secured in the Pandemic Accord or other agreements related pandemic planning. Advocates have a role to play in demanding engagement and ensuring equity. Find resources to keep you up to date on the issue here. 

Embrace the Role of Prevention in Global Targets

To end AIDS as a public health threat by 2030, prevention efforts must make dramatic strides to reach fewer than 370,000 new infections by 2025. As the UNAIDS HIV Prevention Roadmap documents, the most successful HIV responses have come from countries who “have directed resources towards high-impact combination HIV prevention programs and supported and worked with community-led responses that reach the populations and places most in need”. UNAIDS targets will continue to falter at the global level if the field fails to learn the lessons of countries such as El Salvador, Kenya or Thailand where incidence saw steep reductions by centering prevention programs around the needs of key populations.   

In the months to come, AVAC will be following progress toward these goals and reaching out to you to discuss, debate, collaborate and unite.

What is PrEP Access Right Now and What’s Next in 2024?

AVAC is thrilled to see the launch last week of injectable cabotegravir for PrEP (injectable CAB) in Zambia—the first program outside of the US to do so. And earlier this week the Desmond Tutu Health Foundation in South Africa also announced “the first jab” of injectable CAB administered in its FASTPrEP study. This news comes on the heels of another important gain—the announcement of a new licensing agreement that will double the supplies of the dapivirine vaginal ring (DVR) across Africa. 

All represent significant milestones that we hope will be the first of many in 2024. Leveraging these achievements so that people who need and want HIV prevention can access choice is the prevailing question on our minds at AVAC. Choice is the key: it requires robust investment in the policies, planning and programs that ensure every proven product—oral PrEP, injectable CAB and the DVR—are included in the package of HIV prevention options, along with sustained research and development of new interventions.

So what is the status of access among PrEP options as 2024 begins?

As it stands, oral PrEP is offered in 122 countries with cumulative initiations reaching more than 6 million (2012 – December 2023). (Check out the Global PrEP Tracker for details.) Trends in initiations saw great progress over the last two years, but to reach UNAIDS targets of 10 million PrEP users by 2025, initiations of oral PrEP alone will not be enough. People will need to find an option they can use for as long as they need it. PrEP coverage, seeing the most people possible using an option that works as long as they need it, regardless of product type, is the goal—with programs and products to support them.  

Injectable CAB supplies are an important factor. Late in October 2023, Injectable CAB’s developer, ViiV, forecasted a 40% increase in available doses to low- and middle-income countries, reaching 1.2 million doses through 2025. These doses are headed to implementation science (IS) studies that are evaluating how to scale up delivery and to national programs supported by PEPFAR and Global Fund, including Zambia’s. 

Zambia is now the second country in the world, after the USA, to roll out injectable CAB outside the planned and ongoing IS studies. And more countries are expected to follow in Zambia’s path, including Malawi and Zimbabwe. Check out our Country Planning Matrithat tracks this progress of injectable CAB as well DVR. 

In addition, 11 countries have approved the DVR, and 38 implementation science studies are delivering or planning to deliver injectable CAB and/or the DVR. Check out our Integrated Study Tracker that catalogues these projects. 

As these products start arriving in country, key issues must be addressed:

  • increasing supplies and obtaining lower prices for both products;
  • ensuring the delivery mechanisms for rolling out injectable CAB and DVR are integrated into prevention programs that are well-designed to reach those who could benefit from PrEP products;
  • establishing how to deliver acceptable HIV prevention services to a wide range of populations, including adolescents, pregnant and lactating people, sex workers, LGBTQ+ communities and people who inject drugs; and
  • advancing a learning agenda across programs that are delivering HIV prevention—inclusive of injectable CAB and DVR—to ensure information, lessons and insights are shared.

But above all, effective delivery must be defined by delivering choice through programs where end-users are supported to select the option that best fits their lives. AVAC’s Wawira Nyagah and Mitchell Warren outlined these issues—and the lessons from oral PrEP that need to be leveraged—in a recent commentary in BhekisisaBending the curve: What a decade-long roll-out of the anti-HIV pill can teach the world

As 2024 begins, at AVAC we see possibility. PrEP initiation trends, country approvals for new products, program launches, and efforts at transparency and coordination could pay enormous dividends. But fulfilling this promise is not certain. It depends on overcoming systemic challenges around access and choice.

Let’s not waste 2024.

What You Should Know About the FAPP, GAPP and PEPFAR Reauthorization

By Kenyon Farrow

Engaging the US government is vital to advocacy for HIV prevention, as one of the world’s largest contributors to implementation and research and development. The reach and scale of US funded global health programs have profound impact on the lives and health of people in the US and around the world. Two coalitions, founded by advocates, make it their central mission to inform and influence the US federal government to advance funding and policies to end the HIV epidemic.  

In 2024, their work will be as important as at any time in the history of HIV advocacy; as funding for US programs is at stake and advocacy continues for the reauthorization of PEPFAR, one of the greatest US foreign policy and global development achievements in history.

AVAC’s John Meade was just elected co-chair of the Federal AIDS Policy Partnership (FAPP), a national coalition of more than 120+ local, regional, and national organizations advocating for federal funding, legislation and policy to end the HIV epidemic in the United States. John and co-chairs, Mike Weir of NASTAD and Kathie Hiers of AIDS Alabama,  will support the work of seven affiliated working groups, including the AIDS Budget and Appropriation Coalition and the Research Working Group, to produce analysis, build relationships with federal entities, and champion policies and funding that are essential to making progress.  

And AVAC’s Suraj Madoori co-chairs the Global AIDS Policy Partnership(GAPP), a 70 member coalition that leads advocacy for continued robust funding, expansion and improvement of US global HIV/AIDS programming through PEPFAR and the Global Fund. With co-chairs Katie Lapides Coester of EGPAF and Shannon Kellman, formerly of Friends of the Global Fight, now at UNAIDS, this coalition — comprised of civil society and faith-based organizations, funders, professional membership organizations and organizations that implement programs — will continue working every channel to spotlight success, combat misinformation and seize opportunities to secure a new five-year reauthorization of PEPFAR. See AVAC’s blog here.  

Since its creation in 2003 and through previous 5-year reauthorizations, PEPFAR has received near universal, bipartisan support in Congress. This past year, partisan lobbyists and their congressional allies derailed easy passage of its next 5-year reauthorization. In 2024, the GAPP will be mobilizing against efforts to politicize this singularly successful program, and will be working for renewed bipartisan support through the final resolution of federal budget negotiations.  

The efforts of the GAPP and the FAPP will remain essential to ensure sustained funding for efforts to end the epidemic, to save overall HIV funding and advance a national PrEP program in the US, and to win the reauthorization of PEPFAR. Be sure to watch this space for updates. 

Webinars to Look Out for in February!

2024 is off and running and a slew of webinars are on the calendar. This selection of topics is both broad and deep, providing updates on the pipeline from cure to vaccines, insights on critical advocacy, a conversation with the new director of NIAID, and opportunities for you to engage. Scroll down for what’s coming up and recordings of webinars from December and January that you may have missed.  

Coming up!

AVAC in Conversation with NIAID’s Jeanne Marrazzo

February 27, 11:30 am – 12:00 pm EST 

Join AVAC in conversation with the new Director of NIAID, Jeanne Marrazzo. Register here.

The New Public Health Order: How is Africa preparing for pandemics?

February 29, 9:00-10:30 am EST 

WACI Health and The Choice Agenda invite you to join us for a webinar introducing key initiatives of the Africa CDC and the African Union. It will illuminate roles for civil society and community engagement. Register here.

The Adolescent Medicine Trials Network (ATN): Research addressing HIV health inequities among US adolescents and young adults

Join The Choice Agenda for an overview of the newest cycle of the Adolescent Medicine Trials Network! This webinar includes highlights of: ATN 165: Linking Youth to PrEP Services, which tests an innovative mobile delivery and mHealth intervention for PrEP adherence and persistence among sexual minority men; ATN 167: Legal, Economic, and Affirming Peer Support (LEAP) for transgender and gender diverse youth; and how the network prioritizes and amplifies the voices of youth directly impacted by the ATN’s pivotal research. Register here.

Advocacy Navigator Program Info Session

February 13, 10:00-11:00 am EST

This webinar is intended for anyone interested in applying to participate in AVAC’s Advocacy Navigator program. The session will provide an overview of the program, expectations, eligibility, and application process, followed by Q&A with the AVAC team. 

In case you missed it!

Reporting the African Science Story: Decoding scientific research to support public health in Africa

Through the Media Science Café Program, AVAC partners with health media associations in Kenya, Tanzania, Uganda, Zambia and Zimbabwe to bring journalists together with researchers, implementers, civil society, policy makers, regulators and policy makers to build relationships that will foster accurate reporting of HIV, COVID and other science or health stories in those countries. Learn about the model! Recording, slides and resources.

PrEPVacc: An in-depth look at the trial, and what’s next

This webinar reviewed key aspects of PrEPVacc, including its innovative study design, implementation, integrated social science, and data analysis plans. An engaging conversation about what we’ve learned from PrEPVacc, what we can still learn, and what this may mean for the HIV prevention field. Recording, slides and resources.

Cervical Cancer Awareness Month Webinar Series

Check out our 4-part webinar series on cervical cancer, which featured a deep dive on: what cervical cancer is, who is impacted, and prevention and treatment options; advocacy strategies to bring more attention to cervical cancer and its impact on communities; options for screening and treating cervical cancer along with ongoing research; and the impact of cervical cancer on key populations and those vulnerable to HIV infections. Recording, slides and resources.

HIV Cure and the Environment: How location informs cure research

This webinar reviewed core concepts discussed in the previous webinar, Let’s Talk About HIV Cure Research: An Introduction to the science under investigation, and introduced how the environment may impact cure strategies. Recording, slides and resources.

Learn more about the townhall discussion on Black Gay Men and HIV in the US featuring influential figures in the Black Gay community, including Ace Robinson, Daniel D. Driffin, and Kenyon Farrow by checking out highlights on AVAC’s Twitter page and watch the full recording

Thanks for checking out these conversations. We hope you will join us in these rich discussions and watch this space for future webinars!  

Now accepting applications for the 2024 Advocacy Navigator program

Advocacy Navigator program accepting applications

Dear Advocate,  

Following a successful 2023 program, AVAC is delighted to launch the 2024 Advocacy Navigator program and invites applications from emerging advocates from Eastern and Southern Africa interested in strengthening their skills in HIV prevention advocacy. Applications for the Advocacy Navigator program are now being accepted through 8 March 2024. 

Find details about the Advocacy Navigator program and application process here. And join us for an informational webinar on Tuesday, 13 February

The Advocacy Navigator combines training and mentorship for young and emerging advocates in the field of HIV prevention advocacy. The program brings together a small group of individuals for online knowledge- and skills-sharing sessions and pairs them with a mentor from AVAC’s alumni Fellows’ network to apply their learning to a community advocacy project. The program begins with three months of coursework and project development, followed by three months of implementation, when advocates work on their plans. 

Twelve advocates from nine countries across Africa completed the Advocacy Navigator program in 2023. Their community projects ranged from advocacy for the introduction of and access to new prevention methods including the dapivirine vaginal ring and injectable PrEP, to the need for more available data for key populations, to a call for expanding choice in HIV prevention. Read testimonials from their experience here

“It’s not a one-size-fits-all approach; rather, it’s about recognizing the diversity of needs and implementing interventions that truly make a difference. It’s been eye-opening to witness how empowering individuals with the knowledge and skills to advocate for their rights and educate their peers can be a catalyst for change. This project has instilled in me the belief that advocacy is not just about speaking up; it’s about equipping those affected by an issue with the tools they need to be the agents of change themselves.”  

– Doreen Moraa Moracha, Advocacy Navigator 2023 (Kenya) 

Since launching the AVAC Fellows program in 2009, AVAC has recognized the imperative to invest in mobilizing a growing cadre of HIV prevention advocates. The Advocacy Navigator program is leveraging the strength of this extraordinary alumni community to sustainably expand this model through a short online learning and mentorship program to a larger number of people. 

Find the application and additional information at