A Look Back at Montreal

August 8, 2022

In Montreal the pressure was on.

AIDS 2022 showed the global response to HIV at a crossroads. The field has achieved groundbreaking advances in biomedical solutions. But intensifying disparities in HIV prevention and global health at large threaten to eclipse these achievements. Scrutiny of the inequities was center stage in Montreal. While the UNAIDS report In Danger, released at the conference, documents what HIV advocates have known—that during the earliest phases of the COVID-19 pandemic, progress against HIV did not just stall, it actively lost ground—the HIV Prevention 2025 Road Map by the Global HIV Prevention Coalition released just days later navigates a path to get back on track.

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Advocates see how much is at stake at this moment and were making the connections to crises across the field of global health. Their call to action was constant. Protests, formal and informal, were diverse and targeted. They demanded political support and full funding to rollout the dapivirine vaginal ring (PrEP Ring), confronted the developer of injectable cabotegravir for PrEP to go further in affordable and transparent pricing, took on an anemic response to monkeypox (POZ coverage here, TheBodyPro coverage here), challenged ongoing criminalization of sex workers and other key populations, and criticized Canada for blocking the visas of hundreds of delegates to the conference.

Veteran voices such as Fatima Hassan of the Health Justice Initiative were calling out the implications of “vaccine apartheid” in the COVID response and the “pandemic profiteering” that drives it. Global health activist and epidemiologist Gregg Gonsalves called on health advocates to go beyond “the technocratic solutions… and fight our way back to equity.” Advocates challenged the legacy of colonial imperialism in global health, and some voices demanded total reform of the intellectual property and trade system, to name a few of the issues and actions raising the heat.

Are They Listening?

Important steps in decolonizing global health are beginning to take shape. Advocates from the Global South hosted and co-hosted meetings with key decision-makers to make the urgent case for faster and more equitable access to new PrEP options—including meetings with Winnie Byanyima of UNAIDS, Amb. John Nkengasong of PEPFAR and Atul Gawande and Han Kang of USAID. These discussions, as they go beyond community engagement and towards community leadership, represent a model for how the global response must change—voices from communities where HIV is hitting the hardest must be in leadership at every stage, for every crucial decision. The UNAIDS, PEPFAR and USAID leaders say they are listening. Advocates are watching this space closely. Accountability, at every level, is essential—for HIV prevention, treatment, human rights, health systems and health equity.

Getting Rollout Right

Fulfilling the current promise of new HIV prevention options requires advancing a people-centered, integrated approach for introducing proven products. This priority was also center stage in Montreal. The Coalition to Accelerate Access to Long-Acting PrEP (with AVAC serving as the secretariat), The HIV Prevention Road Map announced by the Global HIV Prevention Coalition, and the just-launched WHO guidelines for injectable PrEP that simplify PrEP delivery, are helping to lay the groundwork. The agreement between the Medicines Patent Pool (MPP) and ViiV is also a welcome step toward a sustainable market of generic manufacturers for injectable CAB and future products.

But more must be done. Delivering the fruits of science must become as urgent as their development. Putting in place the right programs, policies and investment to deliver choices at scale and bend the curve of the epidemic utterly depends on a commitment to integrated, equitable, people-centered, and community-led approaches. Be sure to read AVAC’s Plan for Accelerating Access and Introduction of Injectable CAB for PrEP, (or a summary of it), which outlines why funding commitments, creating demand, WHO guidelines, implementation studies, technology transfer, generic manufacturing and more must be coordinated and expedited now.

Several sessions and events at AIDS 2022 took a deep dive into why and how this people-centered, integrated approach must frame product introduction. Here are quick highlights on key sessions:

Scientific Advances

The meeting saw incremental progress in research on several of the pandemics destroying life around the world today. Sessions on TB, HIV, COVID-19, monkeypox, and STIs drew lessons from the COVID-19 response. But with all that the world is learning, research and discussion have yet to tackle how to create the integrated systems needed for a truly effective global health response. This kind of pandemic preparedness means advancing health equity.

Our friends at aidsmap provided in-depth reporting on a number of sessions; you can check out their highlights here. In the meantime, here is a brief summary of some of the scientific advances we found interesting at AIDS 2022:

Populations and Products in Focus

The following sessions put an important spotlight on particular populations or products:

AVAC at AIDS 2022

For a look at AVAC’s work at AIDS 2022 go to our dedicated page. And in case you missed it, the latest webinar from The Choice Agenda provided a status update on the rollout of injectable PrEP, with presentations from providers, researchers, the WHO and others.

The picture of HIV prevention today is full of promise and peril. Navigating the challenges is both possible and imperative. Here’s how AVAC Executive Director Mitchell Warren put it at the launch of the new Global HIV Prevention Roadmap:

“In 41 years we’ve never had such opportunity in prevention. We have a package of proven methods for the first time, and global health leaders are offering renewed commitments to spearhead and sustain programs that are designed to reach those who need prevention most. These programs should be focused on integrating HIV services with sexual reproductive health and rights. But we won’t get this done without going beyond simple community engagement and the old siloed models of delivery. Now is the time to integrate, coordinate, and invest. Now is the time for a global response that is community led.”