AIDS 2018: The Story is Vulnerable

Emily Bass is the Director: Strategy & Content at AVAC.

“Making yourself vulnerable means looking in the mirror,” said David Malebranche in his plenary speech today (July 26) at the International AIDS Conference in Amsterdam. His talk was pure power and poetry, and I (yes, it’s Emily Bass here again) would probably be well-advised to get out of the way and just transcribe it, but instead I’ll urge everyone to view it in its entirety (what do you think comes up with a Google image search for idiot?!) and, in the meantime, look in the funhouse mirror of the conference a bit more.

What do I see when I look at myself? A white, American, feminist, writer, mother and rights-based social justice activist with a passion for queer and women’s issues who has focused her work on HIV in biomedical issues for much of her career. Rights is in that list, but it’s more context than primary subject—until this week, when, as lead rapporteur for Track D, which focuses on human rights, I’ve looked at the conference, combination prevention, and myself differently. (Check out daily summaries here.)

Here’s what I see at the conference: The biomedical prevention field that is one of my professional homes has both an obligation and an opportunity to merge science and rights. So do I. The field, with historic and ongoing acknowledgment of the human rights issues that affect whether a program works or a product gets used, has laid a fair foundation. But in many parts of the world, foundations stay bare for years. Especially if money is lacking. We need to build, together, a deeper, more systematic, detailed and intentionally-designed approach to a hybrid rights-and-science agenda. The anti-HIV criminalization movement says it perfectly: human rights plus science equals HIV justice.

The signpost at this intersection of rights and science? Combination prevention. It’s a destination we haven’t arrived at yet. Not me, not the biomedical prevention field, not the broader AIDS response.

From both the human rights and biomedical perspective, the AIDS response is largely missing the boat on combination prevention, with sloppy definitions, inadequate funding and poor adaptation of evidence. Fortunately, Wednesday’s plenary speaker Nduku Kilonzo, director of Kenya’s National AIDS Control Council, said as much in her tremendous presentation, highlighting a “prevention crisis” and calling for reinvigorating primary HIV prevention and delivering differentiated prevention programs. Peter Piot, another Thursday plenary speaker, said much the same thing, pointing out diminishing prevention funding and that the quality of funding matters as much as the quantity—and dollars dedicated to censorious programs that prevent discussion of comprehensive sexual and reproductive health are not high quality.

Yesterday also brought the release of data from several trials that were, when launched, billed as “combination prevention” trials. The Botswana Combination Prevention Project (BCPP) and the SEARCH study both claimed that moniker—and then defined the approach quite differently, as did PopART (HPTN 071), a study in Zambia and South Africa that has not yet released data. In Hall 12, the largest room in the conference center, BCPP reported a 30 percent incidence reduction in communities where individuals with HIV were initiated on ART compared to those who were treated according to national guidelines. While BCPP included that buzz-phrase “combination prevention” in its name, the other element in the combo package was HIV testing, which is not, in itself a prevention tool, unless all people who receive a test result, positive or negative, also get linked to evidence-based prevention or treatment.

SEARCH went much further, defining its package to include same-day ART, treatment for diabetes and hypertension, and testing for malaria and TB. This trial, which ran in Uganda and Kenya, did not find evidence of greater incidence reduction in those who received the package, though it did see significant reduction in viral load, TB diagnoses, hypertension, knowledge of status and linkage to treatment in the intervention arms compared to the control. Why no incidence reduction? One answer, offered by SEARCH principal investigator Diane Havlir, is that SEARCH had an “active control” arm insofar as all communities had access to ART under government programs, and the control arm also had health fairs at the beginning and end of the three-year trial.

There is much to say about what the studies did and didn’t find—and why. In this particular note, I want to call attention to the results but also to a broader issue, which is that neither defined combination prevention in ways that reflected the evidence available at the time that they were launched. For example, in the context of study countries, they could have but did not include data on the number of infections averted when voluntary medical male circumcision is taken to saturation coverage (80 percent) among target male populations. Data on oral PrEP arrived later in the trial periods; data from the DREAMS Initiative programs on the impact of layered structural interventions for adolescent girls and young women must be integrated in any meaningful examination of combination prevention.

Combination prevention also, per this conference, must address rights infringements. In a powerful, information-packed session (WEPDD01), researchers from Kenya, Canada and Russia described how food insecurity, gentrification and housing insecurity respectively were independently associated with having a detectable viral load (Kenya). The same was noted for lack of access to health services (Canada) and risk of sharing injection equipment or using a syringe after someone else (Russia). Given the emphasis on U=U (undetectable equals untransmittable) as a prevention tool (the co-chairs choice session also saw data showing U=U is true for men who have sex with men!), integration of methadone maintenance treatment, policies and practices supportive of housing and food security and decriminalization of sex work and drug use are all evidence-based components of true combination.

Do these things need to be evaluated in trials? Not necessarily. In pointed remarks from the floor of a session on PEPFAR engagement on different thorny issues, Ambassador-at-Large and PEPFAR head Debbi Birx compared the investment in combination trials with investment in national-level programs taking key interventions to scale. “My opinion on this, not the US government’s, is if I look at what Namibia did, they got the same results as PopART, SEARCH and BCPP—these three studies cost more than all the PHIAs (Population-level HIV Impact Analyses) put together. We have to relook at how we invest and what we invest in.”

To date, the PHIAs have captured a remarkable level of incidence reduction accomplished mainly through scale-up of testing, treatment and achievement of virologic suppression in people living with HIV. That’s significant but not adequate to dropping incidence to the levels that would be classified as epidemic control. What gets us all the way? Scale up at a level not yet attempted, or even funded, of the elements of true combination prevention. And, as David Malebranche told his fellow Black same-gender loving comrades, “Let’s love on ourselves.” He wasn’t talking to me, nor should he have been. But he offered an invitation, as I heard it, to pose these questions: When you look in the mirror do you love what you see? Do you love it if you admit what you don’t know, if you cease to be the expert? Does the definition of combination prevention look different? I know I will be checking myself on these questions more frequently in the months and years to come.

AIDS 2018: The Story is Messy

Emily Bass is the Director: Strategy & Content at AVAC.

As the International AIDS Conference gets underway, AVAC is here with a look at what’s happened so far, what’s ahead and a reminder of the ways you can track the developments whether you are in Amsterdam or following from afar.

Actually, it’s one AVACer here, writing this initial update—Emily Bass—and in a departure from our usual update style, I am going to step out from behind the organizational “we”. Here’s why: On the eve of the official opening ceremony, it’s already clear that the story from Amsterdam is that ending epidemic levels of new HIV diagnoses depends on building services and societies that recognize individuals as wonderful, wild, weird, whole people, with more specificity, respect and rigor than ever before. It also depends on activism, nasty women and their male allies, everyone demanding change, refusing to play nice. We’ll feature further updates here and on Twitter throughout the week—but here’s one woman’s view of the meeting so far.

The most obvious messiness concerns the safety signal with dolutegravir (DTG), an antiretroviral with a magnificent resistance profile and minimal side effects that was and still is poised to be rolled out across sub-Saharan Africa. One of the conference’s first protests today—with a strong presence from AVAC’s COMPASS partners—centered on women’s right to access dolutegravir, even though a study in Botswana identified a possible relationship between the drug and a risk of a fetal abnormality known as neural tube defects.

The advocacy agenda for DTG exemplifies today’s complexity: women need to be given full information about the risks and benefits of DTG and alternative regimens; they need access to long-acting contraception if they desire it; they need to be able to set their priorities and have those matched by their health provider. Initial information about possible safety concerns with DTG led WHO to state that the drug was not recommended for women of reproductive age, a blanket statement that caused great concern about women’s right to choose their treatment options—at any age. At a satellite session today, WHO released updated ART recommendations that specify dolutegravir as first-line for women and adolescent girls with effective contraception or not of childbearing potential as well as pregnant women, from eight weeks after conception, breastfeeding and adolescent girls. The shift to language around “childbearing potential” versus “of reproductive age” was welcomed by advocates, as was the recognition of the need to give all women, as well as men, the choice to use this drug that is implicit in this recommendation.

That’s a promising shift towards a woman-centered approach. It’s an approach that puts ART programs in the midst of the unfinished—perhaps not-even-started—business of integrating sexual and reproductive health and rights with HIV services. It is easy to say that DTG rollout can and should continue in the context of expanded contraceptive access—far harder to figure how this will happen. The challenges are serious: family planning and ART services are still frequently siloed; retrograde and misogynist US government policy is limiting what PEPFAR can provide or counsel; and unmarried women face tremendous stigma about accessing contraception in many countries, not to mention the enduring stigma associated with HIV.

“Let’s have an Integration Index,” said Helen Rees, Executive Director of the Wits Reproductive Health and HIV Institute and AVAC board member, at today’s satellite session on hormonal contraception and HIV. The session was itself a landmark example of integration in that AVAC co-convened this session with Family Planning 2020 (FP2020), a global initiative focused on expanding contraceptive access. Beth Schlachter, FP2020’s Executive Director, was part of the distinguished panel of activists and researchers. Her introductory presentation provided a more robust platform than ever before for these discussions at the International AIDS Conference. The conversation centered on sexual health and reproductive rights, using that lens to look at the ECHO trial, among other things. ECHO is evaluating the copper IUD, Jadelle Implant and DMPA (also known as Depo Provera), to understand whether any of these impact women’s risk of HIV. The trial is slated to release results in 2019. With less than a year to go, panelists agreed that women needed better information from people they trust and more choices on the shelves to back up those conversations, no matter what results come from the trial! These next steps are complex, personal and essential to effective programs.

That theme—keeping the focus on people who will use products and acknowledging differences within groups of adolescents, sex workers, men—echoed throughout other sessions. It was a central point in a Saturday pre-conference on demand creation organized by the OPTIONS Consortium, key to a Sunday women’s prevention session and front and center in Zeda Rosenberg’s (IPM) full-throated call for systemic and non-systemic prevention options at the Monday satellite on biomedical research.

This type of “human-centered design” isn’t nice-to-have, it’s need-to-have—and yesterday—if the world wants to get serious about the prevention crisis that’s been making pre-conference headlines. AVAC has been sounding the alarm about this issue for years and there is no pleasure at all in seeing the crisis reach such proportions that it is now at centerstage. What there is, instead, is a hope that the recognition of this emergency will lead, finally, to primary prevention programs that take evidence-based interventions to scale in the populations that need them. These programs necessarily include VMMC, oral PrEP, reduction of gender-based violence and stigma, and comprehensive harm reduction.

This is messy work because it’s not entirely, or even mostly, medical. It’s the work of communication, negotiation and social marketing that reaches people where they are with messages that affirm and do not frighten, and that make agency and action seem possible in societies where those things are not often granted to girls and young women, gay men, transgender people and so many others.

On the way to writing this update, I ran into two women who were, years ago, mentors, role models, guiding lights in how to write and work and fight for justice. They were both living with HIV and had been diagnosed well before antiretrovirals were a reality. We found each other serendipitously and sat for an hour in the still-calm conference center and talked about what had happened in each of our lives, how none of it matched the neat narratives of news stories and documentaries about the fight for AIDS treatment, the launch of PEPFAR, the course of the global AIDS pandemic. We talked for a long time, left nothing out. The stories were messy. They were the reasons that my two friends had survived.

Announcing the Call for 2019 AVAC Advocacy Fellows

AVAC is pleased to announce the call for applications for its Advocacy Fellows program, now in its tenth year!

Consider applying to be a 2019 Advocacy Fellow and join the 63 Fellows and alumni of the program! We are looking for innovative and bold people and ideas to influence and improve how HIV prevention research happens or how new biomedical interventions are rolled out.

This update provides information on the Advocacy Fellows program, the application process, link to a short informational video and details on an upcoming informational call for interested applicants to be held on Tuesday, 7 August 2018.

The submission deadline for Advocacy Fellows applications is Friday, 7 September 2018. Download application materials at www.avac.org/fellows-application-materials.

About the Program

AVAC’s Advocacy Fellows program was launched in 2009 with the goal to support and expand the capacity of advocates and organizations to monitor, support and help shape biomedical HIV prevention research and implementation worldwide. The program is guided by AVAC’s conviction that effective and sustainable advocacy grows out of work that reflects organizational and individual interests, priorities and partnerships.

The Advocacy Fellows program provides support to emerging and mid-career advocates to design and implement advocacy projects focused on biomedical HIV prevention research and implementation activities in their countries and communities. These projects are designed to address locally identified gaps and priorities. Fellows receive training, full-time financial support and technical assistance to plan and implement a targeted one-year project within host organizations working in HIV or related advocacy. Host organizations are critical partners in the program and Fellows’ projects can be an opportunity for an organization to further develop its own work in this field.

The Fellows program focuses on low- and middle-income countries where clinical research on new biomedical HIV prevention options or the HIV cure is planned or ongoing; or where there is implementation or plans for rollout for proven HIV biomedical interventions and where there is exploration of strategies for integration of HIV and sexual and reproductive health to reduce risk.

HIV Prevention Research Advocacy Fellows are:

  • Emerging or mid-career community leaders and advocates involved or interested in advocacy around biomedical HIV prevention research and implementation.
  • Individuals with some experience or education in the areas of HIV and AIDS, public health, international development, women’s rights, communications and/or advocacy with key populations, such as adolescent girls and young women, sex workers, gay men, other men who have sex with men, transgender men and women and people who inject drugs.
  • Based in low- and middle-income countries where biomedical HIV prevention clinical research is planned and/or where implementation of multi-intervention prevention packages is planned, ongoing or emerging.
  • Able to collaborate with English-speaking mentors.

Please visit www.avac.org/pxrd to identify countries where research and implementation is ongoing or planned and to learn more about the research. For a list of ongoing trials, visit www.avac.org/summary-tables.

Learn More

Prospective applicants or host organizations who want to learn more about this program or have questions about the application process are encouraged to:

Register for the call here.

If you have any questions about the Fellows program or the application process, please email [email protected].

Applications are due by FRIDAY, 7 SEPTEMBER 2018.

Please share this information with your partners, and we look forward to receiving your application!

Tracking HIV Prevention @ AIDS 2018

Welcome to the first in a series of AVAC updates ahead of and during the 22nd International AIDS Conference, which will be held in Amsterdam, The Netherlands, July 23–27.

In this update we highlight some events and activities AVAC and partners are leading on or active in (and hope to see you at!) as well as the sortable HIV Prevention Roadmap of relevant sessions and activities at the conference. To keep up with the latest, bookmark our AIDS 2018 page and check it often for updates from the conference!

HIV Prevention Roadmap

The International AIDS Conference includes hundreds of sessions, side events, marches and meetings—many focused on HIV prevention research and implementation. This Excel sheet allows you to sort by focus; the PDF version has everything mapped out day by day. If there are events that are not on the roadmap but should be, please email us.

Global Village Zones

Research Literacy Networking Zone and HIV Prevention Marketplace
AVAC, in partnership with AfNHi, EATG, NHVMAS, TAG, and Wits RHI, is excited to host the Research Literacy Networking Zone (Booth 523 in the Global Village) at AIDS 2018. The RLNZ brings together advocates, researchers, community educators and local community members to network and discuss ongoing and planned HIV prevention, cure, treatment and implementation research.

This year, the RLNZ is also partnering with the HIV Prevention Marketplace Zone, which is being hosted by a number of seasoned HIV prevention advocates from east and Southern Africa who are Alumni of or currently participants in AVAC’s HIV Prevention Advocacy Fellows program. This Marketplace Zone will be a space where HIV prevention advocates, delegates and community members can come together to network, strategize and have informal discussions on current and future HIV prevention strategies as well as rollout of new interventions. Join us at Booth 525 in the Global Village.

In addition to features like a Help Desk (come with all your questions about prevention research!) and recharging area (for mind, body and devices), there is a robust schedule of events at the Zones. We hope that you’ll include some of the Zone sessions in your plan for the week! Keep an eye on our AIDS 2018 page for the schedule of events.

Pre-Conferences and Satellite Sessions

Click for details on select pre-conferences and satellites that AVAC and partners are participating in!

Stay tuned for additional updates as the conference kicks off!

New Px Pulse is Up With Look at Cure Research

The June episode of Px Pulse is up!

In this episode, researchers and advocates debate the rationale, risks and ethics of interrupting treatment as part of cure research. This is known as analytic treatment interruption or ATI.

AVAC spoke with advocate Udom Likhitwonnawut about when and why treatment interruption might make sense. Two cure researchers—Dr. Steven Deeks and Dr. Dave Margolis—share their differing views on treatment interruption; Deeks is professor of medicine at the University of California, San Francisco, while Margolis leads the Collaboratory of AIDS Researchers for Eradication at the University of North Carolina at Chapel Hill. Finally, HIV advocates Flahvia Namwaya and Moses Supercharger Nsubuga talk about what a cure would mean for those living with HIV.

Listen to this episode to hear the hopes, scientific mysteries and doubts surrounding HIV cure research and ATI.

For the full podcast, highlights and resources, visit here. And subscribe on iTunes to catch every episode!

We Love the Jargon, We Hate the Jargon!

Angelo Kaggwa-Katumba is a Program Manager at AVAC and Kay Marshall is a Senior Communications Advisor.

Scientists spend most of their time in laboratories or classrooms, in clinics or at conferences, in front of computers or wherever their field of specialty takes them.

The two of us have worked in the biomedical HV prevention field for more than three decades combined. Over the years, we’ve seen how so many scientists we know prefer to remain far from the spotlight—especially the media spotlight.

“They don’t get it,” one researcher said to us of journalists at a recent conference. “They always misrepresent my facts so I stay away from them,” we heard from another.

For their part, journalists have shared their own complaints about dealing with scientists as sources.

“Scientists speak in tongues to sound smart. Why would anyone say ‘end-user’ when she can simply say ‘someone who takes aspirin’?”

But journalists and scientists need each other if the public is going to understand the importance of research and support it. Opportunities are rare for them to meaningfully interact with each other.

To bridge the gap between scientists and the media, and to enhance knowledge and appreciation of each group’s role in biomedical HIV prevention and rollout, we, along with other AVAC team members, have conducted workshops for editors, scientists and civil society. We have convened media trainings in Eastern and Southern Africa and at major conferences; provided support to global communications experts; and over the past four years, initiated the media science cafés program in key countries in Eastern and Southern Africa. These provide a less formal space for interactions among journalists, scientists, civil society and research communities.

These programs are a crucial link.

At a symposium in April, organized by AVAC and Internews in Gaborone, Botswana, we were reminded that advocates are instrumental to making these connections and helping them to thrive.

At the Avani Hotel on the outskirts of Gaborone, about 30 people gathered in the intimate dining room reserved for private dinners. Most of them were health journalists from one of seven Southern African countries where biomedical HIV prevention research or implementation is underway. Journalists were from Botswana, Malawi, Mozambique, South Africa, Tanzania, Zambia and Zimbabwe. Seasoned journalists from Kenya and Uganda also joined to share their experiences and expertise in covering the field. Also in attendance were a couple of scientists and policy makers, and a handful of HIV prevention advocates representing civil society organizations from these same countries.

The journalists were there to learn about the research taking place in their own backyard and how it was connected to sister studies across the region. It was also an opportunity for the journalists to interact with the scientists conducting the research and gain the kind of knowledge they need to share this amazing science in language that is clear and compelling to their audiences at home.

We know that failure to make these connections represents a risk in itself. If you asked us, we can’t think of a time when there was more biomedical HIV prevention research in the region, or even globally, and each of these countries is deeply immersed in different aspects of it. More than 573,000 research participants in Africa (representing about 82 percent of the global total) are involved in research on HIV vaccines, microbicides, pre-exposure prophylaxis, HIV cure, HIV treatment, multipurpose prevention options, antibody-mediated prevention and hormonal contraceptives and HIV risk, among other areas. Far too often, local and national health journalists may not even know this research is underway, or their editors don’t grasp the significance of these stories in their communities. The public cannot support this work if it doesn’t know it exists. Even worse, poorly reported pieces may lead to fear and misjudgment, or, as we’ve seen in some places, stop important research from starting or continuing.

Educating journalists about the value of research through accessible, accurate stories, that inform and provide context, is vital.

A trip to Botswana Harvard Partnership is a case in point. Generally, access to the spaces where scientists work is restricted. In part, this is to protect the privacy of research participants. As part of the April symposium, researchers opened their doors to their world-class laboratory and clinical trial site. Some of the journalists had never visited a clinical-site laboratory, or any laboratory for that matter. Peering into a state-of-the-art industrial freezer holding 20,000 samples of material such as blood, urine, tissue, cells, DNA and protein among others, at minus 100 degrees, the journalists learned about the scientific questions under investigation from the researchers working with these samples. Some of these questions included: whether a combination of HIV prevention measures could significantly reduce the number of new HIV infections within a community; whether antibody infusions are safe and could prevent HIV infection; and what is the burden of hepatitis B infection among pregnant women.

They journalists learned how this work will inform other studies going on throughout the region.

“It now makes sense,” said Malawian Journalist, Chimwemwe Padatha.

“For me, seeing this makes the science more credible, more real,” added Botswana journalist Mmapula Molapong.

But those terms listed above—microbicide, pre-exposure prophylaxis and the like—they represent one of the challenges. It’s both essential and difficult to break down the jargon. Journalists who understand the science, and the context around it, report more and better stories, deepening public trust and interest.

Gathered around several dining tables pushed together, notebooks out, PowerPoint slides up on the screen, the journalists struggled to follow one scientist as she gamely made a first attempt at explaining the basics of research on broadly neutralizing antibodies. Looking at the faces around the table, some distracted, some frowning, most curious, an advocate from Botswana, Kennedy Mupeli said, “Can I help?”.

Mupeli had just completed his one-year AVAC Advocacy Fellowship and had also just been to the 2018 Conference on Retroviruses and Opportunistic Infections (CROI) in Boston in March, and steeped himself in this research.

“You or maybe your children have probably received fluids for dehydration via a syringe or IV, right? Now, imagine receiving the same IV but with fighter cells that protect your body from any sub-type of HIV.”

That’s the handy metaphor Mupeli used to make sense of a key prevention concept, which transformed a few frowns. The scientist nodded. She added a few details and continued to build off of Mupeli’s contribution, adopting less technical language modeled by Mupeli. The journalists leaned in to learn more. Later in the week, a whole session on the agenda was dedicated to the use and misuse of jargon, hence the birth of the most famous phrase at the symposium, “We love jargon, we hate jargon!”

Later in the session, a Zambian advocate, Chilufya Kasanda, showed how advocates hold a broad and deep level of knowledge about the context of research. She summarized the HIV prevention research ongoing in her home country. She could tell them the status of access to PrEP at trial sites in Zambia. She also explained the issue surrounding questions of standard of care at trial sites and why it’s generating debate among advocates and the research community right now.

Researchers tend to focus on their own studies. It’s not their job to maintain a bird’s-eye view on the whole landscape of HIV prevention. But the advocates know the science, they know the scientists, and they know the community.

The policy makers, scientists and journalists in the room took notice.

As the meeting concluded, Mupeli found himself surrounded by a group of journalists from Botswana. They wanted to start a coalition of health reporters, inspired by their counterparts in Kenya, Uganda and Zambia. Through the media science cafés, these journalists meet with advocates and scientists to network, get updates on research and implementation and spur each other on to better reporting. They share sources, learn new scientific concepts and talk craft.

Could Mupeli help them get this launched, they wanted to know. “I’m all yours,” said Mupeli.

We’ve since learned that the group, with Mupeli’s stewardship, had their second meeting early in June at the Botswana Harvard Partnership laboratory, a venue Mupeli secured through his links to them. A coalition has been formed and they are working on a plan to secure funding. Mupeli said, “But as we wait for the funds to come, we’ll do what we can with the resources we have: ourselves.”

May Episode of Px Pulse Podcast: HIV vaccine science, research, updates and advocacy

Check out the newest episode of Px Pulse on iTunes or at www.avac.org/px-pulse!

With HIV Vaccine Awareness Day (HVAD) in the spotlight earlier this month, AVAC’s May episode of Px Pulse features four experts steeped in HIV vaccine research. Together they help set expectations for where the field is now and where it is going.

Dr. Larry Corey, who leads the HIV Vaccine Trials Network (HVTN), explains how the AMP studies, HVTN 702 and HVTN 705 will each, in different ways, advance what the field knows about how to develop a vaccine for HIV.

Then, IAVI’s Dr. Kundai Chinyenze talks about efforts to ready for possible success, so that new tools work in the real world as well as they do in a clinical trial.

And two deeply experienced advocates, Bill Snow and Matthew Rose, talk about engaging with the science and preparing for research results.

For the full podcast, highlights and resources (including AVAC’s newest HIV Vaccine Awareness Day toolkit), visit here. Subscribe on iTunes to catch every episode!

HIV Vaccine Awareness Day 2018: Tools & more

HIV Vaccine Awareness Day, May 18, commemorates the vital and ongoing work to develop a vaccine against HIV. This work advances because of the ingenuity, courage and commitment of trial participants, host communities, funders, scientists and advocates. AVAC salutes the collective trust and sustained dedication to end the epidemic.

2018 is marked by great advances in research and important opportunities for advocacy. In addition to a host of tools AVAC updates annually to keep you current on this front, The Rise of Broadly Neutralizing Antibodies by AVAC founder and former Global HIV Vaccine Enterprise executive director Bill Snow offers a comprehensive look at antibody mediated prevention and its connection to vaccine research.

In case you missed it, check out the recording and slides from the May 17 webinar featuring Dr. Sandhya Vasan’s discussion on the legacy of RV144 and vaccine advocate Mark Hubbard’s take on today’s agenda for HIV vaccine advocacy.

The complete set of AVAC’s HVAD resources includes:

And add to the conversation on social media at #HIVvaccineAware and #HVAD2018.

The Rise of Broadly Neutralizing Antibodies

Bill Snow founded AVAC and is the former Global HIV Vaccine Enterprise Executive Director.

Research on broadly neutralizing antibodies (bNAbs) is taking the field of HIV prevention science in new directions, with implications for new prevention interventions and vaccine development. There’s much to know and much to learn about these powerful instruments of the immune system.

Since 2016, more than 2,700 men in Brazil, Peru, Switzerland and the US, and 1,900 women in Southern Africa have begun to enroll in clinical trials looking at antibody-mediated prevention, or AMP (see Figure 1). A collaboration between the HIV Prevention Trials Network (HPTN) and HIV Vaccine Trials Network (HVTN) (both funded by the National Institutes of Health), the AMP studies test the safety and efficacy of the broadly neutralizing antibody (bNAb) VRC01 when it is given every 8 weeks to reduce the risk of HIV infection. But how did this approach come about, why is it important and what may happen next with bNAbs for HIV prevention?


Click to enlarge.

What’s an antibody?

Antibodies are Y-shaped proteins produced by B cells to clear infected cells and pathogens in the bloodstream. B cells are part of what is known as the adaptive immune system, which mounts defenses aimed at specific invaders—like a cold virus or chicken pox or HIV. The innate immune system also defends against invaders, but its defenses are not so finely tailored to a specific pathogen. When a virus encounters the right B cell, the B cell begins cloning itself and produces antibodies designed to battle that virus. These antibodies circulate throughout the body looking for the virus, and they evolve continuously, becoming ever more precise and numerous.

The Antibody Hierarchy

Here are some terms that will help you follow this ongoing story:

  • Antibody: Proteins produced by B cells as a major part of the adaptive human immune defense against specific invaders.
  • Binding antibody: An antibody that attaches to a virus but doesn’t necessarily render it ineffective; can be driven by the innate immune system.
  • Monoclonal antibody: A bioengineered antibody made in a manufacturing facility by copying (cloning) one original antibody—selected for its potency and other characteristics.
  • Neutralizing antibody: Antibody that disables virus.
  • Broadly neutralizing antibody: An antibody that neutralizes many different genetic variants of HIV.
  • Passive antibodies: A dose of monoclonal antibodies that are infused or injected, rather than made by one’s own immune system.

HIV Vaccine Awareness Day: In May 2018, the story is…

HIV Vaccine Awareness Day (HVAD), May 18, is just a week away. Today, we’re bringing you AVAC’s annual HVAD Toolkit, a new advocacy resource—The Story Is…, and our HVAD webinar announcement!

AVAC’s HVAD 2018 webinar, to be held on Thursday, May 17, 9am ET, will tell the current story of HIV vaccine research from two perspectives. Dr. Sandhya Vasan of the Military HIV Research Program in Thailand will give her take on the world of HIV vaccine research since RV144: from where have we come, and where are we going? Mark Hubbard, a seasoned vaccine advocate and community representative for HIV research in Nashville, Tennessee will tell the story from a community and advocacy perspective: what are today’s current successes and challenges, and how are community members pushing the HIV vaccine agenda? Register now.

We’re especially excited in this year’s HVAD Toolkit to bring you a set of infographics that explain key aspects of vaccine research—trial participant and enrollment numbers, global funding, trials timelines, and more. We also have updated versions of old favorites you’ve come to expect each year, all available online at www.avac.org/hvad.

So, what is the story this year for HVAD? The story is the science, with an unprecedented level of vaccine and antibody clinical activity underway. But it’s not only the science—there are other important stories to tell as well, about global support for vaccine research in a time when there are many priorities in HIV prevention, and about stakeholder engagement in the current trial context. AVAC is publishing a special advocacy document, The Story Is…, which explores all this with an eye on primary prevention and the central role that research must play in it. Download it here.

As always, AVAC hopes these tools prove useful for HVAD events in your communities around the world. We know many of you are hard at work for HVAD, and we can’t wait to hear your stories, too.