Biomedical HIV Prevention Summit and PrEP in Black America Summit

AVAC Highlights

Last week, 1,000+ community advocates, researchers, policy experts, federal public health leadership, medical and service providers from around the US and Puerto Rico attended the NMAC annual Biomedical HIV Prevention Summit in Seattle, Washington. The discussion and debate on PrEP access, especially for racial and ethnic minorities and key populations, PrEP research, care, policy and community-based programs are ones to follow. AVAC’s John Meade (Senior Program Manager, Policy), Jessica Salzwedel (Senior Program Manager: Research Engagement) and Kenyon Farrow (Communications Director) presented in workshops and satellite sessions at the Summit and at the PrEP in Black America preconference

The Summit included sessions that updated community advocates on the latest in biomedical research for new diagnostics, PrEP, PEP, STIs and vaccines. Meade co-presented a Clinical Trials 101 for community advocates to learn more about the research process. Farrow presented an epidemiological overview on HIV and Disparities in the United States for NMAC’s Gay Men of Color Fellows. 

AVAC’s John Meade Jr. and Danielle Campbell at the PrEP in Black America: The State of HIV Prevention Research in the Black Community pre-conference

All three AVAC staff contributed to the PrEP in Black America: The State of HIV Prevention Research in the Black Community pre-conference, organized by PrEP in Black America (PIBA). PIBA began in 2022 as a community-led effort to increase Black community mobilization and engagement in PrEP research, policy and access programs. Farrow and Meade are PIBA cofounders, and Meade facilitated the day’s agenda, with more than 200 attendees focused on identifying the research gaps that need to be addressed to increase knowledge, access and use of PrEP. Data shows that while Black people in the U.S. make up 42% of all new HIV diagnoses in 2021, they were only 14% of all PrEP users. By comparison, white Americans are 65% of all PrEP users, but only 26% of all people diagnosed with HIV in the same year.  

Salzwedel co-led the closing consensus session at PIBA, a discussion where attendees named research priorities to be later released as part of a National Black-Centered Biomedical HIV Prevention research agenda. One of the most important priorities named, however, goes beyond singling out the right research questions. Attendees showed strong consensus that the research process itself needs to change. Attendees expressed a need and desire for more investment and commitment to community-led research, that can reflect non-traditional ways of gathering data and designing trials and ending the extractive approach that characterizes conventional researcher/community relationships.  

To stay up to date with PrEP in Black America, follow them on Instagram and Facebook

Join AVAC, The Choice Agenda, PrEP4All and HIVMA on Friday, April 26 for a special follow-up webinar, We Can’t End HIV in the United States Without Equitable PrEP Access: Strategies for success. Register here.

Introducing Advocacy Chronicles: A new AVAC podcast takes you behind the scenes with leading advocates

AVAC is thrilled to announce our new PxPulse podcast series, The Advocacy Chronicles, featuring conversations with leading advocates who take us behind the scenes on critical issues at the forefront of global health equity. In each concise conversation, a leading advocacy champion will talk about a priority community issue they identified, the tactics they used to address it, and the wins and outcomes they achieved.   

Our debut episode of PxPulse: The Advocacy Chronicles is with Yvette Raphael, the Executive Director of Advocacy for Prevention of HIV and AIDS (APHA), and one of South Africa’s leading human rights activists. Yvette co-chairs the African Women Prevention Community Accountability Board (AWPCAB), which launched The HIV Prevention Choice Manifesto in September 2023. Yvette discusses the manifesto – a global call, developed and implemented through support from the CASPR project, for increased political and financial commitment to ensure every proven method of HIV prevention is integrated into the HIV response. She lays out why The Choice Manifesto matters, how advocates are leveraging it, and what tactics will advance its priorities.  

Find the full episode here. Follow The Advocacy Chronicles on PxPulse to hear about the issues that advocates are taking on to advance HIV prevention and what they are learning in the process. Upcoming episodes will feature champions behind campaigns to decriminalize sex work; new advocate-created platforms for ongoing engagement between government and young women; successful efforts to set targets and secure funding from PEPFAR; advocacy to challenge anti-gay hate laws and protect communities of key populations, and more!  

Subscribe on Apple Podcasts to catch every episode! 

Save the Date!

Discussing Early Results from the SEARCH Dynamic Choice Study

Join AVAC and SEARCH in conversation with Professor Moses Kamya of Makerere University to find out why the early results of the SEARCH Dynamic Choice study were some of the most exciting news to come out of the CROI meeting in 2024. The webinar will consist of a presentation by Professor Kamya, followed by a robust discussion about the role of choice in HIV prevention.

Register Here!

AVAC’s Samantha Rick Delivers Statement During High-level US HHS Meeting

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.”

Jeanne Marrazzo and Community Leaders Amplify Their Voices for Choice

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 AssociationHIV 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. 

Announcing the 2024/25 AVAC Advocacy Fellows

We are pleased to announce our 13th class of the flagship AVAC Advocacy Fellows Program for 2024-2025! This group of seven advocates will participate in an 18-month program that supports their advocacy efforts, invests in the further development of their skills, shapes the agenda for HIV prevention research, and influences how quickly new interventions move into policy and programs in their communities and countries. 

These Fellows were selected from a pool of 200+ applicants from seventeen countries to pursue evidence-based advocacy on a range of issues related to HIV prevention. The 2024/25 Advocacy Fellows and their host organizations include: 

Congratulations to our new class of Fellows and thank you to all the applicants and their proposed host organizations for the time and effort put into the application process, and to the independent review committee of advocates, scientists and former Fellows and hosts who guided our decision-making. 

About AVAC’s Advocacy Fellows Program

Achieving successful HIV prevention relies on programs and research shaped by communities and grounded by their needs and priorities. Skilled and informed community advocates drive this process.  AVAC’s Advocacy Fellows Program expands and strengthens the capacity of civil society advocates and organizations to monitor, support and help shape HIV prevention research and rapid rollout of new effective interventions in low- and middle-income countries facing substantial HIV burdens. 

The program provides intensive support to emerging and mid-career advocates to execute advocacy projects addressing locally identified gaps and priorities. Fellows receive comprehensive training, financial backing, and technical assistance to strategize and execute a targeted 18-month project hosted by an organization within their country. 

In its 15-year history, nearly 100 advocates working with 70+ partner organizations across 15 countries have participated in the program. They have influenced policy, championed community perspectives, strengthened healthcare systems, demystified HIV prevention research, advocated for fairness and transparency on local, regional, and global scales and now lead many national and regional organizations. Discover more about the program’s impact here. And view video reflections from Alumni Fellows both here and here

AVAC Response to Uganda’s Constitutional Court Ruling on the Anti-Homosexuality Act 

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.  

April Webinars!

This month we will host six webinars on a wide range of important issues, including choice in HIV prevention, PrEP in cisgender women, criminalization and HIV, syphilis in the US and DoxyPEP. Scroll down for what’s coming up later this week and later this month.

The More We Know: Evolving our understanding of PrEP for cisgender women
April 5, 9:00 – 10:30 am EST

Science and real-world experience continue to demand a re-assessment of our collective understanding of the safety and effectiveness of PrEP options for women, including oral, vaginal ring, and injectable options. Join us, Jeanne Marrazzo of NIAID, Joyce Ng’ang’a of WACI Health and Raniyah Copeland of Equity & Impact Solutions for a conversation with The Choice Agenda.

Watching the Watcher: Intersections of surveillance and criminalization in HIV and reproductive health care
April 9, 10:00 – 11:30 am EST

Positive Women’s Network-USA and The Choice Agenda invite you to join us for a webinar featuring leaders in digital technology, HIV advocacy, and abortion criminalization to examine the existential threat of our ongoing blurred boundaries between public health and policing. 

STI Awareness Week is April 14 – 20!

Join us for two webinars focused on syphilis and DoxyPEP. These webinars are intended for health care providers, civil society organizations, public health officials, and others working in the STI/HIV fields. 

Discussing Early Results from the SEARCH Dynamic Choice Study
April 23, 10:00 – 11:30 am EST 

Join AVAC and Professor Moses Kamya of Makerere University to find out why the early results of the SEARCH Dynamic Choice study were some of the most exciting to come out of CROI in 2024.

Conducted in Kenya and Uganda, the study offered oral PrEP, PEP or injectable cabotegravir to both men and women, and an option to switch products.

We Can’t End HIV in the United States Without Equitable PrEP Access: strategies for success
April 26, 1:00 – 2:30 pm EST

Join HIVMAPrEP4All and The Choice Agenda, as we assess some of the key challenges to delivering PrEP in the United States equitably, including cost, the complexities of our health care system, and other factors that inhibit uptake amongst the most vulnerable communities. Strategies to address these challenges will be offered, with lots of time for QA, discussion and much-needed debate. Please join us!