Tell Congress to Reject Cuts and #SaveHIVFunding

Last October when an unprecedented proposal to cut $767 million in federal funding for domestic US HIV programs was put forward in the Congress, AVAC joined PrEP4AllHIVMAPrEP In Black AmericaNASTAD, the HIV+Hepatitis Policy InstituteThe AIDS InstituteAIDS UnitedNMAC, and several members of the Federal AIDS Policy Partnership to launch the #SaveHIVFunding campaign. Since then, thousands of advocates and community members, along with over 100 organizations, joined the fight to demand Congress continue the bipartisan commitment to fund Ending the HIV Epidemic (EHE) efforts.

With key deadlines in the FY24 budget process quickly approaching, it is more important now than ever that you join us in telling Congress to reject cuts and #SaveHIVFunding by sending letters to your Congressional representatives.

The House bill also proposes to cut 53 percent of spending for the Minority HIV/AIDS Initiative, which seeks to eliminate racial and ethnic health disparities in HIV. The bill would also completely eliminate funding for the Minority AIDS Initiative within the Substance Abuse and Mental Health Administration.

Together, these funding cuts would eliminate all activities of the EHE, reverse recent progress in bringing down annual HIV rates, and leave state and local health departments and community-based organizations without critical funding to provide services to their communities. With 70 percent of the 1.2 million Americans living with HIV projected to be age 50 and older by 2030, the impact on the aging HIV community would be severe.

In contrast, the Senate bipartisan spending bill proposes to maintain HIV funding for Fiscal Year 2024 (FY24) and includes a proposed increase of $3 million dollars to continue the fight to end the epidemic and begin work toward a National PrEP Program. 

Please help us push Congress to pass a final FY24 spending bill that rejects cuts to HIV programs and instead would #SaveHIVFunding by sending letters to your Senators and Representative now! Please also review the #SaveHIVFunding social media toolkit that you and your organization can use to urge our leaders in Congress to #SaveHIVFunding.

Decolonizing Global Health in 2024 and Beyond

In the year ahead, staking out a course that will advance the HIV response and global health equity faces serious headwinds.

Several African countries are seeing historic attacks on civil rights aimed at persecuting the LGBTQIA+ community, and most notably, Uganda is embroiled in crises with the enactment of Anti-Homosexuality Act. PEPFAR Re-authorization has been stalled by utter dysfunction in the US House of Representatives, the same body that has proposed massive cuts in domestic HIV fundingNegotiations on the WHO’s Pandemic Accord have so far failed to prioritize meaningful commitments to equity—jeopardizing global preparedness against future health threats. And at least 43 countries are holding elections in 2024, with several countries, including the US, facing serious threats from authoritarian candidates.  

But in HIV prevention, there’s also momentum. The scale-up of PrEP began accelerating in 2021 and has kept apace, with more than 6.2 million people initiated oral PrEP, and another approximately 4000 people have initiated either injectable cabotegravir or the dapivirine vaginal ring. If planning, policies and programs get it right and offer choices in programs that are co-designed by communities that need prevention most, modeling indicates the world could reach UN targets of 10 million PrEP users by 2025. But what does it take to ensure choice, what priorities will ensure policies, programs will serve the communities burdened by HIV? 

Decolonizing global health can and must be a guide star for these efforts. In 2024, it’s time to double down. Decolonizing global health is not a dream. It’s not an “extra” to reach for only when it’s easy. It’s not wishful thinking. Decolonizing global health is a cornerstone in reaching global targets, making prevention a reality, ending the epidemic, and preparing for the next one. 

It demands changes across the field, from research to rollout. AVAC is tracking this progress, developing strategic resources, and supporting the advocates who know that global health will advance or decline depending on progress in key areas:

Empowering Community Leaders & Following Community Priorities

Models of leadership that center communities necessarily involve money but must go beyond the size of the check and whose name is on it. New structures are needed, based on collaboration, transparency, and trust. The COMPASS coalition is pioneering a model to do just that. Read more about this exciting work here.

Pursuing a People’s Research Agenda

A community driven agenda is needed to define research questions and recommendations for HIV prevention research, rollout and investments. With an active HIV pipeline in research and development that is increasing weighted toward early-phase science, a need for unstinting support for vaccine research, and momentum in cure research, it’s critical for informed and intensive community advocacy to shape the research enterprise. See the pipeline here. 

Program for Choice 

The promise of new options in HIV prevention must not be squandered in siloed programs, or by poorly planned supply chains, or because of disconnected policy decisions. People have diverse needs and face complex challenges; ending HIV depends on finding the option that works best for each individual. Read more about the choice initiatives and the Choice Manifesto and the Global HIV Prevention Roadmap for Key Populations.

Create a New Global Architecture Founded in Equity for Pandemic Readiness

When the next pandemic hits, allocating tools to the most vulnerable is the most effective and efficient way to fight it. County commitments, engagement with civil society, funding levels, and how well planning incorporates equity as a principle has yet to be secured in the Pandemic Accord or other agreements related pandemic planning. Advocates have a role to play in demanding engagement and ensuring equity. Find resources to keep you up to date on the issue here. 

Embrace the Role of Prevention in Global Targets

To end AIDS as a public health threat by 2030, prevention efforts must make dramatic strides to reach fewer than 370,000 new infections by 2025. As the UNAIDS HIV Prevention Roadmap documents, the most successful HIV responses have come from countries who “have directed resources towards high-impact combination HIV prevention programs and supported and worked with community-led responses that reach the populations and places most in need”. UNAIDS targets will continue to falter at the global level if the field fails to learn the lessons of countries such as El Salvador, Kenya or Thailand where incidence saw steep reductions by centering prevention programs around the needs of key populations.   

In the months to come, AVAC will be following progress toward these goals and reaching out to you to discuss, debate, collaborate and unite.

What is PrEP Access Right Now and What’s Next in 2024?

AVAC is thrilled to see the launch last week of injectable cabotegravir for PrEP (injectable CAB) in Zambia—the first program outside of the US to do so. And earlier this week the Desmond Tutu Health Foundation in South Africa also announced “the first jab” of injectable CAB administered in its FASTPrEP study. This news comes on the heels of another important gain—the announcement of a new licensing agreement that will double the supplies of the dapivirine vaginal ring (DVR) across Africa. 

All represent significant milestones that we hope will be the first of many in 2024. Leveraging these achievements so that people who need and want HIV prevention can access choice is the prevailing question on our minds at AVAC. Choice is the key: it requires robust investment in the policies, planning and programs that ensure every proven product—oral PrEP, injectable CAB and the DVR—are included in the package of HIV prevention options, along with sustained research and development of new interventions.

So what is the status of access among PrEP options as 2024 begins?

As it stands, oral PrEP is offered in 122 countries with cumulative initiations reaching more than 6 million (2012 – December 2023). (Check out the Global PrEP Tracker for details.) Trends in initiations saw great progress over the last two years, but to reach UNAIDS targets of 10 million PrEP users by 2025, initiations of oral PrEP alone will not be enough. People will need to find an option they can use for as long as they need it. PrEP coverage, seeing the most people possible using an option that works as long as they need it, regardless of product type, is the goal—with programs and products to support them.  

Injectable CAB supplies are an important factor. Late in October 2023, Injectable CAB’s developer, ViiV, forecasted a 40% increase in available doses to low- and middle-income countries, reaching 1.2 million doses through 2025. These doses are headed to implementation science (IS) studies that are evaluating how to scale up delivery and to national programs supported by PEPFAR and Global Fund, including Zambia’s. 

Zambia is now the second country in the world, after the USA, to roll out injectable CAB outside the planned and ongoing IS studies. And more countries are expected to follow in Zambia’s path, including Malawi and Zimbabwe. Check out our Country Planning Matrithat tracks this progress of injectable CAB as well DVR. 

In addition, 11 countries have approved the DVR, and 38 implementation science studies are delivering or planning to deliver injectable CAB and/or the DVR. Check out our Integrated Study Tracker that catalogues these projects. 

As these products start arriving in country, key issues must be addressed:

  • increasing supplies and obtaining lower prices for both products;
  • ensuring the delivery mechanisms for rolling out injectable CAB and DVR are integrated into prevention programs that are well-designed to reach those who could benefit from PrEP products;
  • establishing how to deliver acceptable HIV prevention services to a wide range of populations, including adolescents, pregnant and lactating people, sex workers, LGBTQ+ communities and people who inject drugs; and
  • advancing a learning agenda across programs that are delivering HIV prevention—inclusive of injectable CAB and DVR—to ensure information, lessons and insights are shared.

But above all, effective delivery must be defined by delivering choice through programs where end-users are supported to select the option that best fits their lives. AVAC’s Wawira Nyagah and Mitchell Warren outlined these issues—and the lessons from oral PrEP that need to be leveraged—in a recent commentary in BhekisisaBending the curve: What a decade-long roll-out of the anti-HIV pill can teach the world

As 2024 begins, at AVAC we see possibility. PrEP initiation trends, country approvals for new products, program launches, and efforts at transparency and coordination could pay enormous dividends. But fulfilling this promise is not certain. It depends on overcoming systemic challenges around access and choice.

Let’s not waste 2024.

Now accepting applications for the 2024 Advocacy Navigator program

Advocacy Navigator program accepting applications

Dear Advocate,  

Following a successful 2023 program, AVAC is delighted to launch the 2024 Advocacy Navigator program and invites applications from emerging advocates from Eastern and Southern Africa interested in strengthening their skills in HIV prevention advocacy. Applications for the Advocacy Navigator program are now being accepted through 8 March 2024. 

Find details about the Advocacy Navigator program and application process here. And join us for an informational webinar on Tuesday, 13 February

The Advocacy Navigator combines training and mentorship for young and emerging advocates in the field of HIV prevention advocacy. The program brings together a small group of individuals for online knowledge- and skills-sharing sessions and pairs them with a mentor from AVAC’s alumni Fellows’ network to apply their learning to a community advocacy project. The program begins with three months of coursework and project development, followed by three months of implementation, when advocates work on their plans. 

Twelve advocates from nine countries across Africa completed the Advocacy Navigator program in 2023. Their community projects ranged from advocacy for the introduction of and access to new prevention methods including the dapivirine vaginal ring and injectable PrEP, to the need for more available data for key populations, to a call for expanding choice in HIV prevention. Read testimonials from their experience here

“It’s not a one-size-fits-all approach; rather, it’s about recognizing the diversity of needs and implementing interventions that truly make a difference. It’s been eye-opening to witness how empowering individuals with the knowledge and skills to advocate for their rights and educate their peers can be a catalyst for change. This project has instilled in me the belief that advocacy is not just about speaking up; it’s about equipping those affected by an issue with the tools they need to be the agents of change themselves.”  

– Doreen Moraa Moracha, Advocacy Navigator 2023 (Kenya) 

Since launching the AVAC Fellows program in 2009, AVAC has recognized the imperative to invest in mobilizing a growing cadre of HIV prevention advocates. The Advocacy Navigator program is leveraging the strength of this extraordinary alumni community to sustainably expand this model through a short online learning and mentorship program to a larger number of people. 

Find the application and additional information at AVAC.org/navigator

New COMPASS Governance Structure to Accelerate HIV Policy and Advocacy

Pangaea Zimbabwe selected as new Secretariat

AVAC and Pangaea Zimbabwe are thrilled to announce Pangaea Zimbabwe’s new leadership of the Coalition to build Momentum, Power, Activism, Strategy & Solidarity (COMPASS) Africa, a historic milestone in the development of innovative models for power-sharing in coalition and an important step toward decolonizing global health.

Launched in 2017, COMPASS Africa is a civil society coalition with 29 organizations working in three countries as well as regionally and globally, using data-driven advocacy to improve the HIV response with high-impact campaigns. Its achievements to date have set new standards for mobilization and advocacy, improving laws and policies, increasing investment in programs, elevating the leadership of affected communities in the HIV response, and holding all stakeholders to account for targets, commitments and impact.

In December 2023, Pangaea Zimbabwe signed a new two-year, $4.9 million grant agreement with the Bill & Melinda Gates Foundation as the new secretariat of COMPASS Africa. For the first 6 years, AVAC served in this role, and worked with a coalition-wide governance committee to develop a clear transition plan for COMPASS to be led by African civil society organizations.

“Since 2017, we’ve been breaking new ground under COMPASS Africa. We’ve expanded our networks and brought together the superpowers of new and seasoned advocates who have diverse strengths and have joined together to develop and share technical expertise and winning strategies,” said Imelda Mahaka, executive director of Pangaea Zimbabwe. “This is a foundation of collaboration, knowledge-exchange and trust that can and will accelerate innovative advocacy under African leadership. We are so proud to take this step with AVAC and with support and collaboration of the entire consortium.”

COMPASS Africa supports coalitions and organizations based in Malawi, Tanzania, the United States and Zimbabwe, and COMPASS Africa members are currently leading more than two dozen active campaigns to advance HIV prevention and treatment. 

“From its founding, COMPASS Africa pursued a vision of collective power and shared decision-making that planned for a future in which an African-based organization would assume leadership as a vital step to sustaining this essential work,” said Mitchell Warren, executive director of AVAC. “The communities who are most affected by HIV uniquely understand their context, challenges and opportunities—their leadership is essential to developing solutions that work. With inclusive governance structures formalized, including Pangaea Zimbabwe as the new secretariat, that leadership is in place, and we are excited that AVAC will continue to be part of the coalition in its new form.”

“As planned from the inception of COMPASS Africa, coalition members are taking their highly successful model to the next level. We are jointly investing in the long-term success of African leadership because it is absolutely essential to breaking cycles that perpetuate inequity and that stall progress in the HIV response,” said Justine MacWilliam, senior program manager and COMPASS Africa partner at AVAC. 

Along with the handover of the secretariat from AVAC to Pangaea Zimbabwe, COMPASS Africa has developed a new governance manual strengthening operating structures for the growing coalition. AVAC will continue as a COMPASS Africa sub-grantee and technical partner focused on advocacy strategy and tactics, including ensuring community priorities are influencing global-level HIV policies, funders and programs.

“This effort put a premium on creating structures to deepen and sustain transparency, accountability, effectiveness and continuing growth within the coalition. COMPASS has a track record of remarkable achievements, this new leadership structure ensures we leverage lessons learned, scale up our advocacy, strengthen each other, and set ambitious goals for impacting the HIV response,” said Dr. Lilian Benjamin Mwakyosi, executive director of DARE Organization in United Republic of Tanzania and co-chair of the COMPASS Governance Working Group.

COMPASS Africa has been unparalleled in testing and succeeding with new models for transnational collaboration. The results have brought campaign after campaign that have marshalled the power of data-driven advocacy to advance community priorities and have convinced policymakers to do the right thing. With these latest innovations, COMPASS Africa is now pioneering a leadership structure that offers the field a sustainable model for decolonizing global health.

New Resources to Support Understanding of Scientific Research

We are delighted to share our new Translation Index, a resource for journalists and advocates, to help bridge the gap between scientific research and community understanding. The Translation Index offers health journalists and advocates accurate translations of commonly used and essential scientific and medical terms in 10 African languages.

Journalists and community health workers are often at the forefront of helping people understand complicated science and health terms in their own languages. Providing information in the language it will be reported minimizes errors and helps journalists reach a wider audience. AVAC is grateful for the Sabin Vaccine Institute‘s support in the development of the Translation Index.

“Since many journalists in community radios may not be highly specialized, the translation of technical science terms into vernacular languages is essential for audience comprehension. This becomes particularly relevant during crises, as witnessed during the pandemic when different radio stations provided varying names for COVID-19 in the same language.”

—Esther Nakkazi, founder of the Health Journalists Network in Uganda

Since 2012, AVAC has collaborated with health journalist associations in East and Southern Africa through its Media Science Café Program to strengthen the capacity of journalists to report on HIV prevention research. In 2020, AVAC and partners  expanded this work to include COVID-19 science. Today, AVAC partners with health media associations in Kenya, Malawi, Tanzania, Uganda, Zambia and Zimbabwe to bring journalists together with researchers, implementers, civil society, policy makers, regulators and policy makers to build relationships that will foster accurate reporting of HIV, COVID-19 and other science or health stories in those countries.
 
Join us, Tuesday, January 23 for a webinar, Reporting the African Science Story: Decoding scientific research to support public health in Africa where we will share highlights from our Media Science Café Program. Click here to register.

“Having a platform in Malawi for communicating science in local languages is a great innovation that will also enable more of the population to be able to follow science, research and other innovation in global and public health from a scientific perspective and participate in the discourse.”

– Dingaan Mithi, journalist and JournAIDS program manager

We hope you will visit the Translation Index and join us on the 23rd.

The Search for an HIV Vaccine Must Continue

Field Will Learn for Halted PrEPVacc Arm

By Jeanne Baron

Today the PrEPVacc trial team announced at a special session at the International Conference on AIDS and STIs in Africa (ICASA) in Harare, Zimbabwe, that they were stopping vaccinations in the study following a review by an independent data safety committee that determined there was little chance the vaccines being tested could stop HIV acquisition. The oral PrEP arms of the study will continue. 

PrEPVacc was testing two different vaccine strategies against a placebo: one regimen combining a DNA vaccine with a protein-based vaccine (AIDSVAX), and another regimen combining DNA, MVA and a protein-based vaccine (CN54gp140). 

“We always hope for a positive outcome in HIV prevention trials, and this news is disappointing,” said Mitchell Warren, AVAC executive director. “We look forward to seeing the full PrEPVacc data in 2024 and hope it will add to the body of evidence that is helping scientists understand how to develop better vaccine candidates that will one day protect against HIV.”  

“The PrEPVacc outcome underscores yet again that the science of HIV vaccine development is extremely challenging,” he added. “Now is not the time to step back from vaccine research. There are several promising strategies in early-stage research that must continue, along with research for other HIV prevention options. We will not end HIV without ensuring that everyone who is vulnerable to HIV infection has a choice of effective and desirable prevention options.”  

Importantly, PrEPVacc’s PrEP arms will continue. The study is testing two different formulations of daily oral PrEP, looking to see if a new formulation – F/TAF (also known as Descovy) – is at least as good in the trial population at protecting against HIV acquisition as F/TDF (also known as Truvada and the most widely used version of PrEP). The trial will provide the first data for F/TAF among cisgender women (who make up 87% of the just over 1,500 PrEPVacc trial participants). F/TAF is approved for use in the US and UK, but not for those individuals who have receptive vaginal sex, since previous trials regrettably did not enroll cisgender women. 

The PrEPVacc study is scheduled to conclude in 2024 and data from all arms of the study are expected to be reported in the last half of 2024. 

“The PrEP arms of PrEPVacc will provide important insights into the potential of expanding access of F/TAF for PrEP to women in East and Southern Africa who need additional options to protect themselves from HIV. Equitable access to new interventions should be a goal of every research program,” said Stacey Hannah, AVAC’s director of Research Engagement. 

“PrEPVacc is a complex, innovative trial design, and, while the vaccine result today is disappointing, the trial team has worked from the outset to implement the Good Participatory Practice (GPP) Guidelines. The team’s hard work on the front-end to apply GPP to this trial is paying off especially now in the ability to deliver complex, disappointing results to trial participants, advocates, policymakers and other key supporters of PrEPVacc and of HIV prevention broadly.” 

ICASA 2023: Demands for equity and investment in the HIV response

By Jeanne Baron

At the ongoing International Conference on AIDS and STIs in Africa (ICASA), the struggle to sustain an evidence- and rights-based HIV response is heating up. HIV prevention and global health equity depend on continuing to build on the gains to date, to learn from mistakes, and to invest in scaling up now-proven solutions while developing additional ones. But all these principles are increasingly threatened by political reaction and short-sighted investment. AVAC and partners released four major calls to action at ICASA to confront these urgent challenges, which are imperiling the communities most burdened by HIV and other health inequities. Each of these resources set an agenda to address critical gaps. 

Upholding Civil Society Voices in Health International Conferences: A response to the suppression and cancellation of community voices at ICASA 2023

A permitted People’s March scheduled for December 5 in Harare was cancelled due to acute safety concerns following the arrest of conference attendees at a demonstration, and other intimidating police actions against civil society and key populations at the conference. AVAC is part of coalition that issued an open letter to the conference secretariat condemning the suppression of community voices and calling for the People’s March to go forward and future guarantees that ICASA host countries commit to allowing community voices to be heard and ensuring their activities are unhindered. 

The Global HIV Prevention Roadmap for Key Populations

This roadmap outlines a strategy for the equitable expansion and delivery of HIV prevention services to key populations (KPs) globally and regionally. It introduces a critical, coordinated approach led by KPs to accelerate the implementation of existing and new HIV prevention interventions. Developed by the Global KP HIV Prevention Advisory Group (KPAG) and allied stakeholders, this roadmap represents near-term priorities for funding, U=U, PrEP targets, the advancement of rights— particularly decriminalization of key populations and more for key stakeholders and regions to achieve by mid 2025. This roadmap is a terrific complement to the recently-released Choice Manifesto, led by women advocates throughout Eastern and Southern Africa.

“This is nothing new, we’ve been saying this for years, but now it is more urgent than ever: Funding to key populations must go beyond services to support our advocacy and our activism.  Decriminalization is imperative. We are not criminals, and with a stroke of the pen decriminalizing key populations could lead to lower incidence of HIV,” said KPAG member and former AVAC Fellow, Josephine Aseme at a press conference promoting the importance of this roadmap.

Mobilizing People of Faith to Build Networks to Protect Human Rights and Overcome Homophobia

Faith leaders from across the region convened by African Services Committee, AVAC, GALZ & Inerela joined in solidarity in defense of human rights and evidence-based HIV prevention, including for vulnerable populations. Among the pledges, participating faith leaders are committing to engage in cultural and legislative initiatives related to LGBTQIA+ issues that promote love, grace, compassion, equity and justice for all. 

Call to Action for Voluntary Medical Male Circumcision: The job is not done yet

Despite impressive achievements in bringing voluntary medical male circumcision (VMMC) to scale, the pace of funding and the expansion of programs delivering VMMC must intensify to reach 2030 global targets for HIV prevention. Modeling studies suggest the approximately 30 million VMMC’s conducted between 2008-2020 averted 615,000 new HIV infections. By 2030 that number could be 1.6 million infections averted, if the HIV response sustains and expands VMMC. This joint report was prepared by AVAC, Azali Healthcare, Bill & Melinda Gates FoundationJhpiego, the Coalition for Health Promotion and Social Development (HEPS-Uganda), Treatment Advocacy and Literacy Campaign (TALC), the Joint United Nations Program on HIV/AIDS(UNAIDS) and the World Health Organization (WHO). Find a two-page summary here and the full report here

“VMMC offers us an exceptional opportunity to get men into the healthcare system but we have gone off track. We can’t afford to lose momentum. The job is not yet done. New funding is needed now. Integration is needed now. Sustained commitment is needed now.” – Chilufya Kasanda Hampongo, TALC Zambi

All four initiatives launched at ICASA take aim at critical gaps in the HIV response. Each provide resources that outline next steps and roles for stakeholders across the field to advance equity, and in turn help the world reach global targets to end the epidemic.  

AVAC Commemorates World AIDS Day

This World AIDS Day we at AVAC are reflecting on remarkable gains and increasing threats to progress against AIDS. Our latest issue of PxWire, tracking trends in research, development and delivery of HIV prevention options, speaks to this important progress: 

However, as we look to 2024, all these gains could be imperiled by political and financial choices facing leaders today.

The answers to these questions will require donors and political leaders to do the right thing, and it will depend on us, a global movement of advocates with a track record of world-changing achievements, to stay the course and build the road to reach everyone one of these goals. Below are a few key resources to support your work. 

From the Lab to the Jab

A series of advocates guides on key issues to ensure equitable access to safe, effective, and affordable vaccines.

Learn more.

Call to Action for Voluntary Medical Male Circumcision

A report on next steps to advance the role of VMMC in ending the epidemic.

Learn more.

Good Participatory Practice: Body of Evidence

An online package of resources to support advocacy for GPP as an international standard for clinical trials.

Learn more.

The HIV Prevention Choice Manifesto

A historic milestone in the power of community-led leadership and prioritization of choice in HIV prevention.  

Learn more.

Progress Against HIV and AIDS is Fragile

POZ Magazine’s interview with Mitchell Warren, with a comprehensive look at the status of the fight against HIV/AIDS and the scientific breakthroughs to date and still needed to end the epidemic.

Read more.

The Anti-HIV Jab is Coming to South Africa

Bhekisisa’s Mia Malan and AVAC’s Mitchell Warren breakdown what it will take to get injectable CAB for PrEP to everyone who needs it.

Listen here.

A Call to Action: Scale Up HPV Vaccination in People Living with HIV

In a new call to action, Mitchell Warren and Heather White, executive director of TogetHER for Health, argue that the time is now to invest in efforts to ensure that people living with HIV can live their lives without the threat of cervical cancer.

Read more.


At AVAC, we believe it’s up to all of us to make sure the world does not squander another decade in slow, fragmented rollout of life-saving innovation in HIV prevention or risk underfunding research and development. If we work together to build equity into the rollout of options that exist already and support the promise of expanding choices in the near future, the world will at long last bend the curve of HIV.  

Scale Up HPV Vaccination in People Living With HIV 

A Call to Action

By Mitchell Warren, Executive Director of AVAC, and Heather White, Executive Director of TogetHER for Health. This post first appeared at togetherforhealth.org.

HIV/AIDS and cervical cancer are two global health emergencies that impact millions around the world – and unfortunately, the relationship does not end there. The dire synergy between HIV/AIDS and cervical cancer can be expressed in some startling statistics: 

  • Cervical cancer is on the relatively short list of “AIDS-defining illnesses”—cancers and opportunistic infections that can be life-threatening to people living with HIV. 
  • Women living with HIV are up to six times more likely to develop invasive cervical cancer than their HIV-negative peers. 
  • Women testing positive for infection with the human papillomavirus (HPV) that causes almost all cervical cancers are twice as likely to be infected with HIV.  
  • The proportion of cervical cancer cases attributable to HIV is greater than 40% among the eight countries with highest HIV prevalence in sub-Saharan Africa, compared to less than 5% in 127 countries with lower HIV prevalence, highlighting major disparities in the global burden.

Additionally, HIV/AIDS and cervical cancer share many barriers to effective prevention, treatment, and care. Efforts to provide services to address both diseases are beset with social stigma and misinformation. 

Due to their elevated risk of disease, women living with HIV, and those at risk of HIV are considered priority populations for cervical screening. The US President’s Emergency Plan for AIDS Relief (PEPFAR) invests more in cervical cancer screening and treatment in low- and lower middle-income countries than any other funder. The Global Fund to Fight AIDS, TB, and Malaria will also fund requests for cervical cancer prevention aligning with HIV prevention programs. The SUCCESS collaboration funded through Unitaid and implemented by Expertise France, Jhpiego, and the Union for International Cancer Control (UICC) is introducing and promoting the best available screen-and-treat tools to prevent cancer in women most at risk, especially those living with HIV.

But these lifesaving efforts are only reaching a fraction of those in need. 

While efforts to develop a preventive vaccine against HIV are underway, vaccines against HPV have proven to be safe and effective for people already living with HIV—greatly reducing their chance of developing cervical cancer. Given their enhanced likelihood of developing cervical cancer, it is critical to focus additional attention on vaccinating people living with HIV, as well as young people vulnerable to both HIV and HPV infections. Unfortunately, few targeted efforts to ensure widescale uptake of HPV vaccination in people living with HIV have been made. 

According to data from the  World Health Organization (WHO), only around 25 percent of women living in the Africa Region – the region with the highest burden of HIV/AIDS—are currently vaccinated against HPVCurrent WHO guidance recommends at least two doses of HPV vaccine for people living with HIV, requiring not just effective implementation of initial vaccination but also efforts to ensure subsequent follow-up to complete the recommended regimen. A lack of disaggregated data on the proportion of people living with HIV who remain unvaccinated against HPV hampers the creation and implementation of targeted HPV vaccination strategies in populations with increased chance of acquiring HIV.

It’s well past time to build an evidence-based plan to ensure access to critical comprehensive health services for adolescent girls and young women at risk for HIV, or those living with the disease, using a lifecourse approach. Specifically, to improve coverage of HPV vaccination, we call on global bodies to take urgent steps to: 

  1. Assess the current status of HPV vaccination among girls and women living with HIV. A dearth of reliable global and regional data must be addressed if we are to ensure wider uptake of HPV vaccination in populations of people living with HIV. Effective monitoring of is a critical first step toward addressing the gap in HPV vaccination coverage for people living with HIV. 
  1. Create evidence-based HPV vaccination strategies for people living with HIV. Programs should take advantage of opportunities to integrate HPV vaccination alongside HIV prevention, treatment, and care services, alongside outreach and awareness activities to break down stigma and combat misinformation. 
  2.  Build the evidence base supporting HPV dosing schedules for people living with HIV. Current WHO guidance has shifted to a single-dose regimen for HIV-negative populations. Clinical research can affirm the need for multi-dose regimens for people living with HIV, but may also support a shift to single-dose schedules that can ensure wider access to more individuals. 

This call to action couldn’t be more timely, as one lingering constraint to accelerating access to HPV vaccination for people living with HIV—limited vaccine supply—is expected to be all but removed in the near future. UNICEF projects that by 2024 the supply of HPV vaccines will for the first time align with the demands of the programs UNICEF services, most notably Gavi, the Vaccine Alliance, the most prominent implementer of HPV vaccination services in low- and lower middle-income countries. Gavi’s ambitious goal of vaccinating 86 million adolescent girls in its focus countries against HPV by 2025 presents a unique opportunity to close a vaccination gap in people living with HIV. 

Today – December 1st – is World AIDS Day. Two weeks ago on November 17th, the world marked the third annual Cervical Cancer Elimination Day of Action. The proximity of these two days of advocacy provides an opportunity to highlight another connection shared by HIV/AIDS and cervical cancer: the opportunity to invest to end these dual health threats by scaling up effective services and meeting global targets – the 95-95-95 HIV treatment goals set by UNAIDS and the 90-70-90 cervical cancer prevention goals set forth by WHO. 

UNAIDS’ Global AIDS Strategy incorporates sub-goals for women and girls vulnerable to developing cervical cancer, representing a confluence of these two remarkable global health endeavors. The Strategy calls for: 

  • 90 percent of girls aged 9–14 in priority countries gaining access to HPV vaccination; 
  • 90 percent of women living with HIV being provided access to integrated or linked services for HIV treatment and cervical cancer; and
  • 90 percent of women, adolescent girls and young women accessing sexual and reproductive health services, including for HPV and cervical cancer, that integrate HIV prevention, testing and treatment services. 

The alignment of HIV/AIDS and cervical cancer targets reflects an evidence-based understanding that ending preventable deaths from these two diseases is best done in tandem.

We know that effective plans supported by sufficient political and financial support can achieve these goals—saving millions of lives. The time to invest to ensure that people living with HIV can live their lives without the threat of cervical cancer is now.