Summary of UNAIDS High-level HIV Prevention Meeting

On May 24, health ministrers from across the globe joined health advocates and experts through the Global HIV Prevention Coalition for a UNAIDS high-level discussion to take stock on progress toward ending the epidemic and how the fight for equity in HIV prevention is instrumental to preparing an effective response to current and future pandemics.

UNAIDS executive director Winnie Byanyima kicked off the meeting by highlighting how punitive legislation around stigma and discrimination are holding back the HIV response from achieving the global targets for new HIV acquisitions. She stressed that meaningful investments on prevention and taking action on harmful policies will help prepare for future pandemics. This applies directly to Uganda’s recent passage of the Anti-Homosexuality Act 2023. Read AVAC’s statement, which condemns the policy and shows how discriminatory policies can and will impede efforts to end the epidemic, and the Joint Statement by the Leaders of the Global Fund, UNAIDS and PEPFAR on Uganda’s Anti-Homosexuality Act 2023.

PEPFAR Acting Principal Deputy US Global AIDS Coordinator Mamadi Yilla addressed the need to aggressively scale-up the world’s already available prevention products and provide access and availability of choice to those who need it most. She said, “We must treat and provide services for the epidemic we have now. Not the one we used to have or the one we wish we had.”

The Global Fund executive director Peter Sands said the process of requesting investments in HIV prevention isn’t always an easy task noting that money travels further by removing stigma, discrimination, and other barriers to access. “Community led interventions are not just effective at reaching the people most in need [key populations], but they’re also on the whole, very cost effective. Providing comprehensive sexual reproductive health services to adolescents has a huge return on investment way beyond HIV.”

AVAC’s Executive Director, Mitchell Warren, who also co-chairs the Global HIV Prevention Coalition, closed out the meeting by summarizing the evening’s discussion—of which he noted many of the parallels and similarities made throughout the meeting, and by also saying that history will judge us harshly on how we act during this pivotal moment in the epidemic. “The things we say in these rooms, the things we say in Geneva don’t prevent infections. They’re the things we do when we walk out of this room that do. This is the best chance we’ve ever had, in probably the entire history of the AIDS pandemic, to reimagine HIV prevention and to do it with equity and with impact.”

Watch the full recording of the meeting here, and read UNAIDS alerts countries to an unprecedented opportunity to stop new HIV infections, end AIDS and prepare for future pandemics.

New Publications On The Dual Prevention Pill And The MPT Landscape

The research journal Frontiers in Reproductive Health has published a special issue on multipurpose prevention technologies (MPTs) with ten articles exploring the latest thinking on MPT development from “bench to bedside.” Among them, an article co-authored by AVAC’s Kate Segal and partners in our Dual Prevention Pill (DPP) Consortium, Equipping providers to offer novel MPTs: Developing counseling messages for the Dual Prevention Pill in clinical studies and beyond, reports on recommendations for counseling users on the DPP.

Another article, co-authored by CHAI and other members of the DPP Consortium, Cost-effectiveness of the dual prevention pill for contraception and HIV pre-exposure prophylaxis, discusses the results of a modeling study that identified the conditions for the DPP to be cost effective.

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These two articles, and the other articles in the special issue, Multipurpose Prevention Technologies for HIV, STIs & Pregnancies, provide updates on new options being tested, user preference research, strategies for product introduction, and elaborate on where the field needs to go to bring an array of new MPTs to market.

This comes in the midst of growing awareness that HIV, sexually transmitted infections (STIs), and reproductive health are inextricably linked. Integrating services is essential to address the pernicious effects of STIs, prevent HIV, and to offer people of childbearing age interventions that fit into their lives. MPT research and development is a central component to offering integrated services. External and internal condoms are the only MPTs currently on the market, but a growing body of evidence makes clear that people all over the world want and need choices to protect against pregnancy and other health threats, such as STIs and HIV. A variety of MPT strategies are in development now, including vaginal rings, pills, micro-array patches, injectables, implants, rectal and vaginal fast-dissolving inserts, and rectal and vaginal gels.

See AVAC.org’s dedicated page on MPTs to learn more, or check out our recent The Choice Agenda webinar on all things MPTs and our MPT factsheet.

AVAC Condemns Uganda’s Anti-Homosexuality Act 2023

AVAC strongly condemns Uganda’s new Anti-Homosexuality Act of 2023 that President Yoweri Museveni signed into law and stands in solidarity with the LGBTQIA+ community in Uganda.

“This newly signed legislation expands on a previous attempt to legislate hate and oppression of the LGBTQIA+ community in Uganda nearly a decade ago,” said Angelo Kaggwa-Katumba, Senior Program Manager at AVAC. “As LGBTQIA+ people and allies, AVAC and our partners have been tireless in our work to change attitudes and policy – in Uganda and around the world – because we’ve seen the direct link between criminalization and stigma and the devastating impact both have on HIV incidence. This new law is a direct 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.”

The new law increases penalties for consensual sex among same-sex individuals, provisions that Uganda has had on the books as anti-sodomy laws from the British colonial era. It also criminalizes advocacy that supports LGBTQIA+ Ugandan rights, and could even bring death sentences, for so-called “aggravated homosexuality,” a clause that can be applied to people living with HIV, intensifying stigma and a cascade of other harms. Such provisions drive people underground, discouraging the most vulnerable populations from seeking testing, treatment and prevention, and they will setback the fight against HIV.

Advocates have pledged to challenge the constitutionality of the law before the courts, as detailed in this statement from Convening for Equality (CFE), a Ugandan LGBTQIA+ community-led Coalition working alongside a broad range of national and international partners. In addition, leaders of the Global Fund, UNAIDS and PEPFAR have also issued a Joint Statement by the Leaders of the on Uganda’s Anti-Homosexuality Act 2023, stating their “deep concern about the harmful impact” of the law “on the health of its citizens and its impact on the AIDS response that has been successful up to now.”

“We must come together and make our voices resoundingly clear: we must stand as one, united in our determination to dismantle this oppressive regime of intolerance,” said Richard Lusimbo, a Co-Convener of CFE, Director General of the Uganda Key Populations Consortium (UKPC), and long-time AVAC partner. “Today, we reaffirm our unwavering commitment, declaring that we will not rest until the shackles of this dangerous law are broken. We will tirelessly strive until equality and justice prevail over discrimination and hate. Let this be the rallying cry igniting change, fueling our collective efforts to create a future where everyone is celebrated for their uniqueness and embraced unconditionally.”

Uganda’s Anti-Homosexuality Act is one of the world’s most extreme anti-gay laws, in a period when several other countries, including the US, are seeing an increasing number of anti-LGBTQIA+ laws proposed.

“This law is part of a global increase in extremism focused on moralizing behavior related to sexual and reproductive health that could set back decades of progress in building community-focused health services,” said Mitchell Warren, AVAC executive director. “The now signed anti-gay bill in Uganda is the latest in a wave of anti-LGBTQIA+ actions in several countries, from arrests in Zambia to a backlash in Kenya, to anti-trans laws in several US states and elsewhere, all of which threaten lives and livelihoods, and our ability to connect key populations with the resources they need and deserve to prevent and treat HIV and to live their fullest lives. If this were happening in any one country, it would be alarming, but the fact that it’s happening in multiple countries, in multiple parts of the world, is downright chilling.”

“Global, regional, national and local leaders must stand up and fight back against these heinous laws. If we don’t deal with the fundamental reality of stigma, discrimination and criminalization, 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.

AVAC Statement on Uganda’s Anti-Gay Law and Other Resources

As we prepared this collection of highlights and resources on a wide range of issues, we learned that Uganda’s President Museveni had signed into law the Anti-Homosexuality Act of 2023. You’ll find our statement condemning Uganda’s enactment of the hate-filled and dangerous new law at the top our newsletter, and we hope you’ll follow the links in this statement to our partners who are working in solidarity to defeat it. Around the world, the voices of advocates have never been more important, and our joint action to oppose hate and discrimination is imperative now, to sustain the gains that have been made against HIV, to save lives, and to fulfill the promise of equity in global health.

Scroll down for other resources and updates that are shaping global health and the HIV response. These include: new data and infographics in PxWire; perspectives from the World Health Assembly; upcoming webinars on vaccine manufacturing and broadly neutralizing antibodies; new publications on multipurpose prevention technologies (MPTs); highlights from the PrEP in Black America Summit; new STI resources; and a recent webinar on expanding HIV cure research across Africa!

AVAC Condemns Uganda’s Anti-Homosexuality Bill 2023
AVAC’s statement denounces the decision by Uganda President Yoweri Museveni to sign the legislation into law and calls for solidarity with Uganda’s LGBTQIA+ and civil rights advocates who are demanding the courts uphold Uganda’s constitution and prevent this law from going forward.

The Latest Px Wire
Our quarterly snapshot of biomedical HIV prevention R&D, implementation and advocacy features updates and infographics on oral PrEP uptake, implementation science studies with injectable cabotegravir for PrEP and the dapivirine vaginal ring, and incidence rates from HIV prevention trials over the past 25 years.

The World Health Assembly and PPPR
As the World Health Assembly made news last week by approving a 20 percent increase to the WHO budget, advocates are calling the early draft of the pandemic accord a step backward for equity. Several moving pieces are setting up a new architecture for global health. Learn how all this work on pandemic prevention, preparedness and response (PPPR) fits together, and where advocates can engage in AVAC’s Advocates Guide for PPPR in 2023. For further background, read our position paper on PPPR and find links to related webinars and podcasts here.

For perspective on increased funding to the WHO and the evolving new architecture for global health, listen to A Shot In The Arm podcast episode, “Too Fund or Not Too Fund The WHO. That is the question”, featuring a conversation with AVAC Executive Director, Mitchell Warren, Global Health Council Executive Director Elisha Dunn-Georgiou and podcast host Ben Plumley.

And, UNAIDS and the Global HIV Prevention Coalition hosted a special session, A High-Level Dialogue on Accelerating HIV Prevention and Future Pandemics. Check it out to hear civil society representatives, ministers of health, and leaders of UNAIDS, The Global Fund, PEPFAR and AVAC talk about the opportunities and challenges in delivering on the promise of current HIV prevention options.

SAVE THE DATE: Two Upcoming Vaccine Webinars
On May 18th, AVAC and the Coalition to Accelerate & Support Prevention Research (CASPR) marked HIV Vaccine Awareness Day (HVAD) with a package of resources, and highlights of activities. Our HVAD program continues with two upcoming webinars exploring the changing landscape of vaccine research, development and advocacy.

What’s All the Buzz About: mRNA, manufacturing, vaccines access
Thursday, June 1 at 10am ET / 4pm SAST. Register here.

To bNAb or not to bNAb? The case for broadly neutralizing antibodies
Wednesday, June 7 at 10 AM ET / 4 PM SAST. Register here.

Paving The Way for The Dual Prevention Pill
Frontiers in Reproductive Health published a special issue on MPTs! AVAC’s Kate Segal is a co-author of Equipping providers to offer novel MPTs: Developing counseling messages for the Dual Prevention Pill in clinical studies and beyond, and partners from CHAI and the DPP Consortium contributed the article Cost-effectiveness of the dual prevention pill for contraception and HIV pre-exposure prophylaxis.

PrEP in Black America
The 2023 summit on PrEP in Black America ended May 19 on a high note with a crucial policy conversation with the Director of the White House Office of National AIDS Policy, Harold Philips, on a proposal to advance a national PrEP program in the US. Interested to learn more? Check out the 2023 report from PrEP in Black America, For Us, By Us: PrEP In Black America: A Master Plan For HIV Prevention In Black America.

STI Advocacy
AVAC has been expanding our advocacy for STI prevention, from better diagnostics to vaccine development. The recent conference of the National Coalition of STD Directors (NCSD) featured key discussions on resource allocation and on DoxyPEP, with guidelines expected from the CDC before the end of year. See our new STI factsheet, watch the TCA October 2022 webinar on Doxy for STIs, and bookmark STI Watch.org for further background.

Pioneering HIV Cure Research Where It’s Needed Most
AVAC and a number of partners hosted Advancing HIV Cure to Africa: What is needed? The webinar features two panel discussions on how researchers, communities and other stakeholders from high income countries can work equitably with low- and middle-income countries in the interests of an HIV cure for all. Find the recording and learn more here.

New Issue of PxWire: A look at where we are in HIV prevention

Our new issue of PxWire is here and shares the latest PrEP updates including new data from the PrEP Tracker, the HIV prevention pipeline, the prevention playlist and more! Check out the full issue here.

HIV Vaccine Awareness Day 2023: Hard lessons, innovation & new directions

May 18th is recognized as HIV Vaccine Awareness Day (HVAD), and this year it is a time of deep reflection and potential. Three major HIV vaccine trials have ended in no efficacy since 2020, but the field knows more than ever that a vaccine is still needed for a durable and sustainable end to the pandemic – and has new insights into possible vaccine strategies that might one day effectively protect against HIV.

This year, AVAC and CASPR partners are casting a spotlight on the many issues and opportunities for HVAD 2023. Check it all out here! And read on for details about a wide range of new resources.

New PxPulse Podcast Episode!

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Listen to the newest PxPulse podcast, “Evolving Strategies for an HIV Vaccine: One researcher explains where the field is going and why,” featuring Katy Stephenson of Harvard Medical School, Beth Israel Deaconess Medical Center, and the Center for Virology and Vaccine Research. In conversation with AVAC’s Jeanne Baron, Katy provides an accessible breakdown of where the field of HIV vaccine research is, including details on recent trial results that proved ineffective and what’s next (and exciting) in HIV vaccine advocacy and research.

Save the Date for Two Upcoming Webinars!

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What’s All the Buzz About: mRNA, manufacturing, vaccines access

Thursday, June 1 at 10am ET / 4pm SAST
Featuring Caryn Fenner of Afrigen Biologics, Ike James of Medicines Patent Pool, and Mike Frick of Treatment Action Group. Register here.

To bNAb or not to bNAb? The case for broadly neutralizing antibodies

Wednesday, June 7 at 10 AM ET / 4 PM SAST
Featuring Slim Abdool Karim of CAPRISA, Pervin Anklesaria of Bill & Melinda Gates Foundation, Khadija Richards of Wits RHI, and Huub Gelderblom of HIV Vaccine Trials Network (HVTN). Register here.

CASPR Partner and Collaborator HVAD Events

Communities across the globe will be engaged in a wide array of events focused on HIV vaccine awareness in the coming days. Here, we provide details on activities the Coalition to Accelerate & Support Prevention Research (CASPR) partners are leading – be sure to watch AVAC’s Twitter for real-time highlights!

New Series of Advocate Briefs

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In the weeks to come, we’ll release From the Lab to the Jab, a series of briefs on next generation vaccine research and development; the basics of mRNA technology; initiatives that support local manufacturing; and understanding and overcoming barriers that undermine equitable access to vaccines. Each brief also highlights the advocacy needed to keep these efforts on track and in line with what communities need and want.

New Resources

AVAC has updated our recent HIV vaccine primers. And we’re sharing a viewpoint written in the Journal of the International AIDS Society.

As the science continues to advance, we hope these resources inform our collective advocacy. With the knowledgeable voices of advocates guiding the response, scientific successes will not be squandered, communities won’t be left behind, programs will be people-centered, and epidemics will end.

United States Government Listening Session Ahead of World Health Assembly 76

The US Department of Health and Human Services (HHS) is charged with leading the US delegation to the 76th World Health Assembly, and convened a Stakeholder Listening Session on May 3, 2023. The Stakeholder Listening Session is designed to seek input from stakeholders and subject matter experts to help inform and prepare for US government engagement with the World Health Assembly.

AVAC’s Samantha Rick, Manager: Multilateral/Pandemic Preparedness and Response (PPR) Advocacy Specialist, delivered these remarks orally at the Listening Session.

“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.

As the document for the World Health Assembly for this topic has not been released, we reference the document provided for the EB earlier this year. In regard to the proposals for strengthening the Health Emergency Preparedness, Response and Resilience (HEPR) framework, we have some concerns about implementation. The governance piece relies on the development of the Pandemic Accord under the Intergovernmental Negotiating Body (INB), and the current draft text does not have sufficient accountability measures to ensure that Member States adhere to the provisions set out for actions in health emergencies. In addition, the suggested textual edits, particularly by the US, weaken any language that could compel Member States to take actions for the global good by inserting ‘voluntary’, ‘suggest’, ‘should’, and ‘intend to’ in front of many of the agreements. These negotiations give us less hope that the HEPR framework governance reforms will be effective.

The systems proposals are intriguing, but can only be implemented if there is a recognition that in order to have strong surveillance and reporting mechanisms, we must also guarantee access to benefits of these mechanisms, namely through true access to medical countermeasures developed from the data shared in the course of collaborative surveillance. The EB document references ACT-A as an example of access to medical countermeasures – this is concerning, as the ACT-A system did not provide access broadly, in a timely manner, or in an equitable fashion and relied heavily on voluntary donations. An end-to-end system for access to medical countermeasures must be based on need (both financially and degree to which an outbreak is acute and posing national and regional risk).

Proposal 10 also needs some significant additional thought. The reputation of the WHO within countries and globally is at a low point and more creative communication strategies to strengthen WHO’s position in the center of the HEPR architecture are needed. To that end, a more inclusive WHO would go a long way. The exclusion of NSAs and civil society from the INB negotiations is a glaring example of squandering an opportunity to open up proceedings and dispel any misinformation around the process. Within the WHO, civil society organizations are treated the same as philanthropies and corporations. Expanding the pool of CSOs would help to gain trust in the WHO as a central coordinating body for health emergencies. A key lesson from US support for both PEPFAR and the Global Fund has been the essential role of civil society in governance and accountability, and we now look to the US to champion civil society inclusion in WHO processes.”

About the World Health Assembly

The World Health Assembly is the decision-making body of WHO. It is attended by delegations from all WHO Member States and focuses on a health agenda prepared by the World Health Organization Executive Board. The main functions of the World Health Assembly are to determine the policies of the Organization, appoint the Director-General, supervise financial policies, and review and approve the proposed programme budget.

Celebrating One Year of The Choice Agenda

HAPPY ANNIVERSARY! It was one year ago that we introduced The Choice Agenda (TCA) with Jim Pickett in the hopes of creating a space to continue the discussion, debate, and information sharing that has been core to four decades of HIV advocacy and activism in HIV treatment and prevention – and is central to global health equity.

In its first year, we’ve seen close to 1,000 threads on a list serve of 1500+ subscribers covering a broad range of topics from HIV prevention research to sexual health, STIs, PrEP implementation, pleasure, LGBTQIA+ rights, public health, human rights, abortion rights, funding, politics, pandemic preparedness and so much more. We also hosted 18 webinars on an exciting range of topics – with many more to come.

We take this moment to honor the life and work of two of our first subscribers who died this year – the US CDC’s Dawn Smith and Italian activist Giulio Maria Corbelli – each highly consequential, deeply-involved, community-focused and adored.

Today, as we work to make complex science accessible, identify where advocacy and action are needed and pursue bold agendas that improve global responses to HIV and prepare to prevent future pandemics, the TCA’s agenda-setting conversations are more important than ever.

Thank you to everyone who started with the TCA a year ago, who has been a part of the discussion and debate along the way and who are using this platform to continue and who have been part of the discussions and debate.

Take a minute to review our archived resources and webinars, and be sure to sign up for our next two upcoming webinars. Also, if you are interested in joining The Choice Agenda’s global discussion list, reach out to Jim at jimberlypickett@gmail.com.

PrEP (In)equity: Documenting, measuring, and flipping the script towards justice
Tuesday, May 9 at 9:00 AM–10:30AM ET
Featured Speakers: Leisha-McKinley Beach, National HIV/AIDS Consultant, Michael Chancley, PrEP4All, and Patrick Sullivan, Emory University
Register

PrEP That Booty: The latest on rectal microbicide research for the back door
Thursday, June 29 at 9:00 AM–10:30AM ET
Featured Speakers: Jonathan Baker, #RectalRockstar, Craig Hendrix, Johns Hopkins, Juan Michael Porter II, The Body, and Sharon Riddler, University of Pittsburgh
Register

New Px Pulse Episode on LGBTQIA+ Advocacy in Uganda

Our latest podcast, LGBTQIA+ Advocacy in Uganda: Facing down fear and fighting for justice, is available now!

This episode looks at Uganda’s just-passed anti-homosexuality bill, that now awaits final action from President Museveni. The broad-reaching legislation further criminalizes LGBTQIA+ people and is part of a wave of anti-gay hate laws and actions by authorities that are sweeping across the region with recent crackdowns in Ghana, Kenya, Rwanda, Tanzania and Zambia.

The Ugandan bill would make it a crime to even identify as lesbian, gay, bisexual, transgender or queer, with sentences up to life imprisonment. It gives authorities wide powers to crackdown on anyone who does not report on same-sex couples or who promote gay rights, including prohibitions on news coverage and media. And the law could impose death sentences in some cases, including for the transmission of HIV. Uganda’s President Museveni has the power to stop the bill. But so far he is issuing statements for other African countries to follow Uganda down this path.

This podcast episode features several leading Ugandan advocates, whose fierce and imperiled voices are readying to fight for LGBTQIA + people in Uganda, but at AVAC, we know they are fighting for all of us. Listen as they dig into the specifics of how these attacks have gained momentum and their ties to US-based religious extremists. For the full podcast episode, resources to learn more on the issue, and the archive of previous episodes, visit avac.org/px-pulse. And subscribe on Apple Podcasts, Spotify or wherever you get your podcasts!

Uganda-based advocates are urgently organizing and raising money to challenge this law. You can donate to SMUG and Chapter Four Uganda.

Catch Up on the Advocacy for IP Waivers, Tech Transfers and PPPR

In case you missed it, highlights from our April 6 webinar, Global PPPR Equity: Why do we need agreements on IP and tech transfers?, are a must read. Panelists, bringing a range of expertise, explored lessons learned from the HIV/AIDS epidemic on IP and tech transfer advocacy and what’s next in the fight for global equity in pandemic prevention, preparedness and response (PPPR).

Featured speakers included:

-Fifa Rahman, ACT-A CSO and Health Poverty Action
-Brook Baker, Northeastern University and Health GAP
-Fitsum Lakew, WACI Health
-Esteban Burrone, Medicines Patent Pool

Listen to the webinar to learn:

-Why patents matter for diagnostics, despite assertions from industry that they do not
-The impact of intellectual property monopolies during COVD-19
-About the need for rapid scale up of manufacturing in African countries and more

“There are five key reasons we need licensing and tech transfer: they reduce prices, accelerate access to new and innovative treatments and other technologies, enable production of greater volumes, contribute to supply security, and support geographical diversification of manufacturing.” – Esteban Burrone, Medicines Patent Pool

Check out our summary of the webinar, watch the recording, download the slides and find links to a host of resources on PPPR, including an Advocate’s Guide to PPPR and two recent podcasts on the global architecture being put in place to make investments and coordinate resource sharing.

With pandemic prevention, preparedness and response an area of increasing investment and planning, these voices are sharing insights and messages that are instrumental for collaboration and advocacy. Tell us what you think and contact Samantha@avac.org to get involved!