AVAC’s Samantha Rick delivered a statement during a high-level US HHS meeting on Thursday, April 11. Read the full statement below.

“I am speaking as a representative of AVAC, an international non-profit organization that leverages global partnerships to accelerate ethical development and equitable delivery of effective HIV prevention options, as part of a comprehensive and integrated pathway to global health equity.

Without civil society having access to the proceedings, it is difficult for civil society to advocate around their own government’s positions. We urge the US to continue to push for civil society access, both to deliberations and to compilation text, so that we can effectively do our jobs and ensure that government priorities incorporate advocates’.

Without such access, we have come to some conclusions through hearsay and leaked documents, which is not ideal. One seemingly bright spot is the status of Article 9. From the most recently leaked version of the text including Member State textual edits from late March, it appears there is some consensus about what is to be included in Article 9, and little objection from the US on these points. We urge the US to push to keep the text in Article 9 as-is, particularly the provision to include access conditions in publicly-funded R&D for pandemic products. We look forward to discussing with the Administration how we can get to a place where this is standard operating procedure for all public funding regardless of its applicability to pandemics, as R&D usually builds on previous work and we may not know of a hypothetical product’s use in a pandemic situation.

A particularly dark spot in the negotiations is Article 12. From the leaked version from late March, it is clear that the US position on the pathogen access and benefits sharing system has significantly shifted. This has raised the ire of civil society advocates around the world and within the US. It is unclear why the negotiations have come this far without this level of disagreement from the US, as we had not seen nearly as many or as all-consuming edits in previous versions of the text that included the same provisions. The US must come to a position of negotiation on this topic – the Africa Group and Group for Equity, among others, have clearly stated that they will not accept lesser commitments to benefits sharing than to those required by the US around pathogen data sharing. This is a perfectly reasonable position. We implore the US to rethink its position on the PABS system and try to come up with a palatable system that has equal levels of commitments from both sectors of the system.”

Science and real-world experience continue to generate evidence that expanding access to PrEP options and making choice possible, must be the guidestar in HIV prevention.   

Last week, NIAID Director Jeanne Marrazzo joined our Choice Agenda webinar, The More We Know: Evolving our understanding of PrEP for cisgender women, to present a re-assessment of the safety and effectiveness of PrEP options for women—including oral, vaginal ring, and injectable options. She discussed her recent publication in the Journal of the American Medical Association, HIV Pre-Exposure Prophylaxis with Emtricitabine and Tenofovir Disoproxil Fumarate Among Cisgender Women, which provides reassuring evidence that oral PrEP can reliably prevent HIV infection in cisgender women, even if it’s not taken daily. The results challenge the notion that cisgender women need to be “super-adherers” to achieve protection utilizing oral PrEP and that a one-size-fits all approach to prevention will not work. 

Dr. Marrazzo’s research and her comments represent a powerful voice among a chorus of champions for choice. During the same conversation, Joyce Ng’anga’a of WACI Health and the African Women’s HIV Prevention Community Accountability Board, a coalition of women and girls living and working in Africa who are united in calling for continued political and financial support for more choice in HIV prevention, updated on the recently launched Choice Manifesto. This global call to action demands investment in choice and calls for enshrining a woman’s right to choose and for African women and girls to lead the HIV response. 

At the same time, PEPFAR’s Scientific Advisory Board grappled with the potential role of injectables for treatment and prevention, including an update on the current late-stage efficacy trials of injectable lenacapavir, with results anticipated later this year. It’s no secret that scale-up of all current PrEP options (daily oral, vaginal ring and injectable cabotegravir) has been slower than ideal, especially in the countries and communities with high HIV rates that need it most. So as the HIV prevention community awaits the results of the PURPOSE trials for the twice-annual lenacapavir injectable, discussing how an additional injectable option might be introduced and what infrastructure is needed to implement this new product faster than previous PrEP options is critical.  

“We are 12 years since many of us gathered in Washington, D.C., at the international AIDS conference that was just two days after the FDA approved oral TDF/ FTC,” said panel moderator, AVAC Executive Director and PEPFAR SAB member, Mitchell Warren. “Twelve years later, it’s actually an abomination how poorly we have done as a global community, and when we think about equity in this country and around the world, oral PrEP is still only beginning to find its place. The dapivirine ring has struggled for a number of reasons and cabotegravir is struggling still, but I do want to highlight that it is going faster than we saw with oral PrEP, certainly in terms of regulatory approvals. And the question is how might we apply those learnings for lenacapavir in the next months and years?”

As policy, practice and budgets strive to keep up with advances in research, advocacy around choice becomes a cross-cutting priority—so that the promise of new options in HIV prevention won’t be squandered in siloed programs, or by poorly-planned supply chains, or because of disconnected policy decisions. Be sure to watch this space in 2024 as the African Women’s HIV Prevention Accountability Board, the Young Women’s HIV Prevention Council and the Global Key Populations HIV Prevention Advisory Group, amongst others, lay the groundwork to advance efforts to accelerate prevention options that people want and need. 

AVAC is gravely concerned with the Constitutional Court of Uganda’s recent decision to uphold the core provisions of the Anti-Homosexuality Act of 2023 (AHA) that was signed into law nearly one year ago. AVAC stands in solidarity with the LGBTQIA+ community in Uganda, and globally, in calling out this dangerous law. 

“We had hoped that the AHA would be repealed in its entirety, as it is a clear violation of the health, rights and humanity of the LGBTQIA+ community, and will undermine and reverse Uganda’s progress in HIV prevention, destroying community wellbeing and taking lives along the way,” said Angelo Katumba, Senior Program Manager at AVAC. “We’ve seen the direct link between criminalization and stigma and the devastating impact both have on HIV incidence. Even with the partial repeal of four provisions within the law, the AHA remains in place and will continue to drive people underground, discouraging the most vulnerable populations from seeking testing, treatment and prevention, and they will setback the fight against HIV.” 

The Anti-Homosexuality Act of 2023 (AHA) was brought to the Constitutional Court of Uganda for ruling on its legality late last year with advocates challenging the constitutionality of the law before the courts for months. Civil society advocates for LGBTQIA+ and HIV prevention have worked tirelessly over the years to change attitudes and policy in Uganda and around the world. The failure to nullify this law in full intensifies the threats faced by communities that have fought tirelessly for safety and recognition. Advocates are expected to repeal the ruling to the Supreme Court of Uganda.  

Uganda’s Anti-Homosexuality Act is one of the world’s most extreme anti-gay laws, enacted at a time when several other countries, including the US, are seeing the right to health undermined through legal action and anti-LGBTQIA+ laws on the increase. Today, the Uganda’s Constitutional Court even referenced the 2022 United States’ Supreme Court opinion on Dobbs v. Jackson Women’s Health Organization as part of its justification for the legality of the Uganda AHA.  

“It is deeply disturbing to see how Uganda’s attack on human rights and evidence-based public health is influenced by and coordinated with extremist views in the US and on the US Supreme Court,” said Mitchell Warren, AVAC’s executive director. “This is a staggering message that a rights-based approach to healthcare is imperiled in many countries by reactionary movements that are gaining strength from each other.”  

“We must stand up and fight back against these laws everywhere or we will never end any epidemic. We stand in solidarity with all allies and partners committed to turning the tide from hate and fear to global health equity for all,” Warren added. 

Since the Ugandan law was passed last year, the number of clients attending drop-in centres providing HIV prevention and treatment services to key populations, including men who have sex with men, dropped from an average of 40 per week to two.