HIV self-testing and PrEP, fighting health misinformation, innovations in GPP, and more!
This week AVAC is hosting a webinar on Innovations in GPP, sharing two new briefs to support PrEP access, a new podcast on strategies to counter health misinformation, and much more!
Inform your advocacy on HIV self-testing & PrEP, PrEP for girls and women, and health misinformation
Scale-up of PrEP since 2021 has allowed implementers and researchers to generate significant new evidence on opportunities and challenges for reaching adolescent girls and young women (AGYW) in Eastern and Southern Africa with PrEP services. This brief summarizes these insights.
In a new podcast by Health Nonprofit Digital Marketing, AVAC’s Director of Communications, Kenyon Farrow discusses how nonprofits can combat medical mistrust and disinformation around infectious diseases in a time of increasing epidemics and pandemics.
This webinar will feature site-level, national, and funders from across the globe who have non-traditional approaches to GPP. Examples multiple perspectives – sponsor to site-level, will illustrate the evolution of GPP from CABs and town hall meetings to more innovative and partnership-based approaches.
Join AVAC and the Center for Indonesia’s Strategic Development Initiatives (CISDI) for a side event during the 79th UNGA High-Level Meeting. This event will draw lessons from the successful experiences of CSOs in enhancing inclusivity in multilateral discussions and implementation of agreements/treaties on topics such as one health, climate, human rights, and more. AVAC’s Samantha Rick will moderate alongside Eloise Todd of Pandemic Action Network, Lawrence Gostin of the O’Neill Institute for National and Global Health Law, Neil Vora of Preventing Pandemics at the Source and Olivia Herlinda of CISDI.
A big win for U=U in South Africa, learn how it was done
Podcast: PxPulse: An Advocacy Chronicle on U=U in South Africa with Mandisa Dukashe
Tune into to this episode to learn why U=U represents a vital strategy in the HIV response and how Mandisa Dukashe’s advocacy influenced the South African government to launch a national U=U campaign.
This month, AVAC will be presenting at the UN General Assembly and the STI Prevention Conference, hosting a handful of webinars and sharing important resources, so be sure to look out for our weekly roundups.
Navigating the PrEP Landscape
PrEPWatch is here to help!
With a growing number of PrEP products in development and approved for use in various countries, and an increase in PrEP initiations worldwide, the future of PrEP has never been more exciting. Check out our newly redesigned PrEPWatch website to help navigate the latest research, policy developments, implementation strategies, and advocacy efforts worldwide. The updated site features an array of expanded PrEP resources and improved navigation. We hope PrEPWatch and its resources will be helpful in your advocacy.
Explore the Latest on PrEPWatch
Enhanced Resource Library: An extensive collection of updated tools, research, and guidelines, making it easier than ever for users to access the latest information on PrEP implementation and best practices. Check out some of the most used resources like the Integrated Study Dashboard.
Interactive Global PrEP Tracker: Provides up-to-date information on PrEP initiations by country and delivery model, offering insights into the progress and impact of PrEP programs around the world.
Country Planning Tracker: Navigable matrix showing where PrEP products are currently approved and where approval is pending. It also tracks key indicators for the introduction of new PrEP options by country, including late-stage clinical trials and implementation research, procurement plans, and more.
CAB for PrEP Evidence Tracker: Summarizes the latest insights from the Biomedical Prevention Implementation Collaborative (BioPIC) on injectable CAB for PrEP, links to learn more, and information on where evidence is still needed, mapped against priority evidence gaps.
Updated Product Pages: Updated product information addressing frequently asked questions about PrEP options that are currently available and those in late-stage clinical development – including updates on the latest news related to injectable lenacapavir.
Lenacapavir for PrEP has taken center stage at the 25th International AIDS Conference, #AIDS2024, which opened Monday with many highlighting its potential for long-acting PrEP for HIV prevention. Some advocates took to the halls in protest calling on LEN’s maker to price the product low. Leaders across HIV voiced the need for urgency in galvanizing support for the introduction of lenacapavir. “It is gobsmackingly exciting to see zero in a clinical trial” AVAC’s Mitchell Warren told Forbes. The potential to bend the curve of the epidemic depends on speeding access to prevention options like LEN, that show high efficacy.
At the same time, it’s imperative to remember that neither lenacapavir, nor any other single product, now or in the future, will ever be a ‘miracle drug’, and LEN must not be equated with a vaccine, as seen in some conference media reports.
Ongoing investment in the pipeline for HIV prevention must be founded on the principle of choice, offering a range of products to meet diverse needs among people facing the risk of HIV. We hope that vaccines will one day be among those choices, as will long and short-acting products, and topical and systemic products. Clear communication that allows product users to understand how products are different supports widespread adoption of HIV prevention and moves the world toward finally ending the epidemic.
See AVAC’s statement calling for early planning to accelerate LEN’s regulatory review and for ambitious introduction plans, and the joint civil society call to action with specific priorities about what needs to happen next. Our primer, the Lens on LEN, also offers advocates a guide in explaining the findings from the Purpose 1 trial and next steps for advocacy.
As Albert Liu from UCSF’s Center for AIDS Research told delegates in the symposium on breakthrough and insights in long-acting technologies, “It’s never just the ‘product.’ New options can’t solve everything.” Atul Gawande of USAID reiterated a similar message at the satellite focused on women’s prevention, “The critical message to understand is that there isn’t going to be a magic bullet for prevention. What we have to understand is that there are also considerations that affect the likelihood that women will have what they want and what they’re likely to use.”
People First
The conference theme, “Put People First,” is the main message we all must hear. Lillian Mworeko of the International Community of Women living with HIV/AIDS East Africa (ICWEA) captured the essence of the meeting: “I am not just a recipient of care. I need a seat at the table to meaningfully engage and tell people what I need and how I need it.”
Monday’s opening session underscored the vital role of community engagement and the necessity for inclusive policies that address disparities affecting marginalized populations. Jay Mulucha of Fem Alliance, Uganda, the first trans man to speak at the International AIDS Conference, delivered a compelling message to the 12,000+ delegates attending both in person and online: “As a trans man living in Uganda, I am asking you to stop leaving us behind. Nothing about us, without us.”
New UNAIDS Report
UNAIDS released a report, The Urgency of Now, AIDS at a Crossroads calling out funding disparities and the need to dismantle the discrimination and stigma that are pushing the most marginalized people away from health care. The report warned of the peril in delayed funding decisions; investment needs to happen urgently for long-acting treatment and prevention options to reach all low- and middle-income countries and meet 2025 targets.
Money, Money, Money
Making the most of investment in HIV prevention fundamentally depends on political will, but the field needs the right data, too. Monday’s satellite session, Money, money, money: Building towards a sustainable end state for HIV prevention, called for better data that goes beyond PrEP initiation numbers. “[PrEP initiations] alone do not tell us how much product is needed or how long people stay on PrEP. We are not collecting the right data,” said Katherine Kripke of Avenir Health. AVAC’s Mitchell Warren described the vicious cycle of small pilot projects generating limited data on PrEP use, resulting in unpredictable demand and cautious investment. “We have lots of small examples, and then we don’t scale it up because governments don’t know what it will cost. And still the world has 1.3 million new infections. We have to break the cycle.”
Sharon Hillier of Magee-Women’s Research Institute noted, “What we’ve learned in our research is that women care about efficacy, but it’s just one element of what they consider when they decide on prevention. They’re quite interested in safety, ease of use, discretion, price, availability, and accessibility.”
Stay tuned for more highlights from AIDS 2024 and visit our curated conference webpage, which includes new resources and summaries of the preconference sessions.
Upcoming Webinars and a Roundup of New Resources
Last week’s interim result of the PURPOSE 1 HIV prevention study of injectable lenacapavir is captivating headlines. Check out AVAC’s statement here and one from the PURPOSE 1 Global Community Accountability Board and the African Women’s Prevention Community Accountability Board here. But there are LOTS of other things also happening in HIV prevention, and we’re delighted to share this roundup.
Project 2025 is part of an ongoing multi-pronged backlash to the sexual and reproductive health, gender and LGBTQ+ movements. Building on the experience of the HIV movement in fighting these same far-right forces, join this Choice Agendawebinar discussing potential responses through the lens of HIV affected communities and programs. Register here
The data collected on a program determines its path and priorities. This Choice Agendawebinar will cover the current state of PrEP monitoring and evaluation, and efforts to improve and simplify data-gathering to better reflect how people use PrEP and to support choice amongst the growing array of PrEP methods. And the discussion will also focus on how data can be used to enhance the stories we tell about PrEP program implementation. Register here
Earlier this month, AVAC hosted a webinar highlighting our series of issue briefs, From The Lab To The Jab, covering research and development, mRNA technology, vaccine production, issues relevant to equitable global access to vaccines. The webinar featured panelists from theInternational Vaccine Institute,International Treatment Preparedness Coalition, and æqua, a think tank focused on equity and economic justice for health. Panelists discussed international initiatives for vaccine development, the current state of vaccine research and access, and how they can be improved. Read more
GPP is an essential part of clinical trials research, and an ethical imperative to creating equitable and effective clinical trials. GPP is created by and for communities, so it looks different and takes multiple forms in different cultural contexts. This kind of responsiveness is inherent to GPP, but it also makes it difficult to measure and evaluate. In this webinar, participants will learn from the Realist Review of Community Engagement and the REAL2 review of participatory research. Each examined frameworks for evaluating community engagement efforts. We’ll also learn about the Global Health Network’s new course on evaluation, and other efforts in the field to evaluate the impact of GPP. View the recording
GPP enhances every stage of the research lifecycle. In this webinar, our partners at TB Alliance, SMART4TB, and THINK shared experiences, lessons learned, and innovative approaches in integrating GPP at the organizational, network and situational level, from drug development through delivery. View the recording
Doxycycline, an oral antibiotic, can be used as a post-exposure prophylaxis, commonly referred to as DoxyPEP, when used to prevent the acquisition of some bacterial STIs after sex. Doxycycline is inexpensive, easily tolerated, and widely available. However, questions remain regarding who will benefit most from DoxyPEP and how to implement this strategy broadly to ensure equitable access and minimize antimicrobial resistance. This guide seeks to explore and address these critical questions. Read the guide
Our Mitchell Warren speaks to ViiV’s Kimberly Smithin this episode of the Foreign Policy podcast series ‘can we end epidemics?’ about the future of HIV science and the challenges we need to overcome on our journey to finding a cure. Listen
We hope these conversations and resources are helpful in your advocacy. Stay tuned for our upcoming advocates’ primer on lenacapavirand our roadmap to the AIDS 2024 conference in Munich.
Pride and a Transnational Anti-LGBTQ+ Reaction
For five decades LGBTQ+ communities and their allies have come together in June to celebrate Pride, to demand recognition of our human rights, and to honor Queer lives. It was movement that ignited out of a climate of fear and ignorance, one that de-humanized trans people and same-gender loving people and made possible their continual persecution.
As we mark the 54th anniversary of the New York City Stonewall Uprisingof 1969, we celebrate the diversity and resilience of LGBTQ+ communities around the world and we must call out the transnational anti-LGBTQ+ reaction that is propelling gay-hate legislation, systemic violations of human rights, and violence against Queer people in countries across Africa, Asia and the US.
Read on for details on an important advocacy movementagainst the anti-LGBTQ+ legislation in Uganda, a new podcast capturing the highlights and personal story of one advocate’s work, and the work of a cross-country collaboration strengthening advocacy for key populations.
It’s been one year since the Ugandan legislature passed one of the most draconian gay-hate laws in the world, the Anti Homosexuality ACT (AHA), which has since been approved by a Ugandan court ruling, now on appeal. The AHA intensifies the criminalization of LGBTQ+ people, including up to life imprisonment for consensual same-sex conduct, and even the death penalty in certain circumstances. A new report by the Strategic Response Team (SRT), UNWANTED, OUTLAWED AND ILLEGAL: THE CRY OF LGBTIQ+ UGANDANS, documents evictions, arrests, imprisonment, forced anal exams, and community violence against LGBTQ+ people since the passage of AHA.
In a new edition of PxPulse: The Advocacy Chronicles, Allan Mwasa of SMUG International in Uganda discusses the Anti-Homosexuality Act (AHA), rising violence against LGBTQ+ communities in Uganda, how advocates are organizing, and what allies can do now. A donation to SMUG supports the work of the Strategic Response Team documenting civil rights violations and intensifying persecution of LGBTQI+ Ugandans. Click here to donate to SMUG.
And follow the work of the Key Population Trans National Collaboration(KP-TNC), a cross country collaboration strengthening advocacy for key populations. Working in Ghana, Kenya, Malawi, Nigeria, South Sudan, Tanzania, Zambia and Zanzibar, the KP-TNC strengthens relationships between KP-led organizations and development partners, regional organizations, the African Union, PEPFAR, The Global Fund and country governments, and develops strategies to advance advocacy for global health equity at large, and for HIV prevention and treatment among key populations.
This moment requires global solidarity to push back against the lies, prejudice and discrimination that imperil LGBTQ+ people everywhere. Here’s to a powerful Pride!
Announcing the Next Class of Advocacy Navigators
We are thrilled to announce AVAC’s 3rd class of Advocacy Navigators! This group of 12 emerging advocates from nine countries was selected from 100s of interested applicants. They will be paired with six mentors, seasoned advocates who are alumni of AVAC’s Advocacy Fellows program. These mentors provide support and guidance as the Navigators strengthen and expand their skills in HIV prevention advocacy.
Following the model of the AVAC Advocacy Fellows program, Navigators tackle curated coursework, focused networking, and personalized mentorship over six months.
Meet the 2024 Mentors
Anna Miti, Zimbabwe; Chilufya Hampongo, Zambia; Cleopatra Makura, Zimbabwe; Eric Mcheka, Malawi; Dr. Lilian Benjamin Mwakyosi, Tanzania; Simon K’Ondiek, Kenya.
And a big congratulations to the graduating cohort of Advocacy Navigators who recently completed the 2023 program. Nine Navigators implemented new advocacy projects in their communities on the rollout of CAB for PrEP and DVR, meaningful engagement of adolescent girls and young women (AGYW) in HIV prevention, changing the age of consent, and advocacy for accessible HIV prevention for people with disabilities, sex workers and other key populations.
About the Advocacy Navigators Program
Since 2009 with the establishment of the AVAC Advocacy Fellows program, AVAC has recognized the imperative to support HIV prevention advocates with the knowledge and skills they desire. The Fellows Network represents a global movement of seasoned veterans and passionate newcomers, who call out neglect, insist on equity, monitor commitments and identify solutions. Now the Advocacy Navigator program, which is part of the Coalition to Accelerate & Support Prevention Research (CASPR), is leveraging the strength of this extraordinary program and its alumni community to expand and strengthen the network and continue to support and engage advocates for the long-term.
The Advocacy Navigator program combines training and mentorship to young and emerging advocates in the field of HIV prevention advocacy. The program mobilizes a cohort of ambitious individuals and provides them with resources to build their knowledge, skills and confidence to meaningfully advance HIV prevention advocacy in their communities and countries. The program includes online coursework, personalized mentorship, and opportunities to directly apply learning through a community advocacy project. The program begins with three months of coursework and project development, followed by three months when advocates implement their plans.
Keep up to date with this year’s Navigators and stay tuned for updates on their upcoming advocacy projects!
Tracking PrEP Rollout & Learning Lessons
Accelerating the rollout of the full range of proven HIV prevention options depends on learning from what’s been done in the past and investing in coordination and innovation to put improved solutions in place. The Biomedical Prevention Implementation Collaborative (BioPIC) is doing just that. Over the last two years, BioPIC—a project led by AVAC with support from the Gates Foundation—has been gathering and sharing evidence on these critical lessons to ensure the next generation of HIV prevention products reaches everyone who needs and wants them with much greater speed and equity.
What We’re Learning—Highlights from 2024 Convenings
An ongoing series of think tanks, convened by BioPIC and WHO since 2021, are generating key insights for people-centered product delivery. Below, read the latest reports from these think tanks that are informing decision-making on priorities for accelerating access to PrEP. Go to the BioPIC’s page on PrEPWatch to find reports on all think tanks since 2021.
Early Insights from EBONI and PILLAR, February 2024: Early insights from ViiV Healthcare, the manufacturer of CAB for PrEP, from two CAB for PrEP implementation studies, EBONI and PILLAR. Conducted by ViiV in the US, these are among the first studies gathering data in real-world settings. Learn more
Taking Stock of PrEP Evidence, March 2024: An analysis of current data and priority evidence gaps. This inquiry was not focused on any one PrEP product, and its findings are informing the focus of future think tanks. Learn more
Discussing Early Results from the SEARCH Dynamic Choice Study, April 2024: Professor Moses Kamya of Makerere University shares early insights from the SEARCH Dynamic Choice Study in Kenya and Uganda, which gave participants a choice between oral PrEP, PEP, and CAB for PrEP, and analyzes the role of choice in PrEP coverage. Watch here
PrEP and the Role of HIV Self-Testing, May 23: Highlights from the WHO guidance on use of self-testing (HIVST) as an innovative way to increase PrEP access and coverage and further simplify PrEP delivery. Panelists also share experiences with procurement, costing, rollout and scale-up. Watch Here
We hope you will book mark these resources, and stay up to date on findings from future think tanks and webinars in 2024 on the BioPIC page of PrEPWatch.
Will the Pandemic Accord Fail to Learn the Lessons of the HIV Response?
In their statement at the 8th Intergovernmental Negotiating Body (INB) meeting, the Office of the United Nations High Commissioner for Human Rights (OHCHR) highlighted that from the HIV experience we know that if public health measures do not take human rights into account, we will leave marginalised populations behind, fail to address structural barriers to access to quality healthcare, and miss essential interventions altogether.
At the final negotiation meeting of the Pandemic Accord, Member States risk failing to learn these key lessons from the HIV response.
Local communities are pivotal in advancing the HIV response, leveraging local knowledge to enhance policy execution, and reaching groups left behind by government-led responses.This is true in the HIV response, and is true in public health programs more broadly: participation from communities and civil society is crucial to minimise the gaps of public programs, ensuring that they reach all vulnerable populations, including the most marginalised. Engagement at the community level also ensures that large-scale policies are effectively translated for local contexts, reducing barriers to access and strengthening impact. To not include organisations that already have a plethora of expertise in the areas the Accord aims to help with would be irresponsible, and would be ineffective on behalf of the communities they aim to serve. The HIV response is globally recognised for its inclusion of communities in governance and decision-making and it is critical the Pandemic Accord replicates this inclusion in the implementation and governance of this instrument.
At the final negotiation meeting, we must see Member States agree a Pandemic Accord that is grounded in human rights and supports the critical role of communities. We urge Member States to:
Introduce ‘the participation of civil society is essential in achieving the objective of the WHO Pandemic Agreement’ under Article 3 (Principles)
Include in Art 6.2.a ‘people living with Chronic health Conditions’ among people who needs particular attentions during pandemic response
Reintroduce language from the previous Article 16 (now incorporated into Article 19, International cooperation and support for implementation) to develop and implement policies to respect, protect and fulfil the human rights of all people
AVAC convened three important conversations in the last month on new data that delivered the analysis and evidence that choice and equity in access to PrEP products can make the difference between real-world population-level impact or an epidemic marching on for many years to come.
When taken together, their combined message is irrefutable: when programs offer people-centered choices for what type of PrEP product they want, and where and how to integrate it into their lives, incidence can drop to zero.
Read on for highlights from the three conversations and links to resources and recordings.
“This is the evidence we’ve all been waiting for. This is the first time in a community setting that we have scientific evidence that choice matters and choice works.” – AVAC Executive Director, Mitchell Warren
Professor Moses Kamya of Makerere University joined our webinar to discuss the early results of the Dynamic Choice study conducted in Kenya and Uganda by Sustainable East Africa Research in Community Health (SEARCH). First announced at the Conference on Retroviruses and Opportunistic Infection (CROI) in March, these data were among the most exciting of the conference.
SEARCH showcased what true choice and person-centered programming can mean – and the difference it makes. The study offered choices in products (PEP, oral PrEP, injectable cabotegravir); in testing (rapid and self-testing); in service locations (clinic, home, other community locations); timing of prescription for oral refills (up to three months); and the ability to switch products at any time. More than a quarter of the participants used two different products during the study. Many who selected injectable cabotegravir had used no form of prevention in the month before, and even oral PrEP use went up in the intervention arm. “It’s expanding the total pie of people using PrEP,” said Kamya. The result: The study arm ended with zero incidence of HIV compared to 1.8% in the control group. Adding to the method mix expands the number of people who continue with prevention—even as their needs change.
A collaboration between HIVMA, PrEP4All and The Choice Agenda, this webinar looked closely at PrEP uptake in the US and the American system of PrEP delivery. As a case study, these presentations show what happens when programs, policies and political will undervalue choice.
Intensifying disparities is one of the most pernicious effects of inequitable access to PrEP as seen in US data. Dr. Patrick Sullivan of Emory University highlighted these disparities by sharing that Black people in the US represent 40% of new HIV diagnosis but only 14% of the PrEP users, while 64% of PrEP users are White but represent only 25% of new diagnoses. Sullivan’s research shows that when states make it easier to choose PrEP by offering PrEP drug assistance programs, Medicaid expansion or both, PrEP coverage goes up and incidence goes down.
Rupa Patel of the Centers for Disease Control and Prevention (CDC) charted the patchwork nature of PrEP delivery, which involves numerous and complex processes for getting HIV prevention products to people. Patel underscored the need in the US for interventions in programming and product choice, interventions that should offer the kind of choices that have been successfully delivered by the SEARCH study.
Patel’s description of an unpredictable, confusing and costly journey to PrEP was reinforced by a deep dive on cost offered by Dr. Lorraine Dean of Johns Hopkins University. Dean explored the role of cost, showing how even small increases drive down use. And she explained how insurers circumvent protections that require zero cost to the consumer for generic PrEP under the Affordable Care Act. And Jeremiah Johnson of PrEP4All laid out an agenda for change to be integrated into a US national PrEP program. Learn more with PrEP4All’s report, Toward PrEP Access for All.
NIAID Director Dr. Jeanne Marrazzo joined the 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. This study provides reassuring evidence that oral PrEP can reliably prevent HIV infection in cisgender women— with data that show women taking 4-7 pills per week had very high protection against HIV, comparable to what is seen in cisgender men. 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.
Raniyah Copeland of Equity & Impact Solutions who moderated, noted that Marrazzo’s comments represent a powerful voice among a chorus of champions for choice. She then introduced 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. Ng’anga’a 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.
As the world marks twelve years since the FDA approved the first PrEP product, the field is long past due to make good on what advocates have been saying all along, and now the evidence is in hand. Make choice a reality and drive incidence to zero.
