Prevention on the “Slow Track”: What UNAIDS missed in its annual progress report

Last year at the Durban AIDS Conference, many of us donned big round stickers that said “Code Red” for HIV prevention. If you’ve got yours, perhaps on a conference bag or t-shirt, you’ve got the main message we’d like to convey regarding the new UNAIDS report on the state of the HIV epidemic.

code red for HIV prevention sticker image

One year later, we’re in a “code red” situation—with as much cause for alarm as celebration in the UNAIDS report on the global HIV epidemic released this week.

First, the good news: based on higher-quality data, UNAIDS has revised its 2016 estimates for rates of new HIV diagnoses in sub-Saharan Africa. This is great news, as is the overall progress reported towards achieving the 90-90-90 targets, which aim for 90 percent of people living with HIV knowing their status, 90 percent of those people linked to ART, and 90 percent of those individuals on ART achieving virologic suppression. These are essential targets for a rights-based response and sustainable end to the epidemic. This progress must be sustained and accelerated, picking up lessons from innovative, comprehensive service-delivery models like the SEARCH study, highlighted in the report.

Now, the reasons for the red alert. Rhetorically, UNAIDS has abandoned its comprehensive “Fast Track” framework in favor of exclusive emphasis on the 90-90-90 targets. These treatment targets are not enough. UNAIDS is a global thought leader and advocacy partner. Its messages matter. The message in this report—that 90-90-90 targets are the global HIV response—puts the field on the slow track.

mind the gap image

The UNAIDS report is misleading in its top-line messaging. It credits a global decline in incidence to “acceleration of HIV testing and treatment—within a comprehensive approach that includes condoms, voluntary medical male circumcision, pre-exposure prophylaxis (PrEP), and efforts to protect human rights and establish an enabling environment for service delivery”. Yet globally, condom procurement and distribution numbers are dipping (the report gives information on condom usage, but not overall supplies or funding for programming); PrEP access is highly limited; annual VMMC numbers are not on track to reach the UNAIDS Fast Track target of 27 million by 2020 (noted nearly 100 pages into the report); and the human rights of those most at risk are tenuous at best.

The good news is that people living with HIV are accessing treatment, living healthy lives with dignity and that rates of AIDS deaths and new diagnoses are dropping. The bad news is that UNAIDS is providing a misleading picture of the state of all other primary prevention globally. Imagine what the world would look like if the Fast Track targets for VMMC, PrEP and human rights were actually being met.

Bringing epidemic levels of new HIV diagnoses and AIDS deaths to a conclusive, sustainable end depends on seeing the details, not just the big picture. In many sub-Saharan African countries there are twice as many young people as there were at the beginning of the epidemic. The fact that the number of new HIV diagnoses is remaining constant—and even dropping in some age groups, in spite of a growing population, is testament to effective programming.

But, as the report finally acknowledges more than 20 pages in, the world is not on track for reaching key goals in the reduction of new HIV diagnoses. In 2016, new HIV diagnoses among 15- to 24-year-old young women were 44 percent higher than men in the same age group. Global demographics are clear: the total population of young people will continue to rise, as will the percentage of those who are at risk of or diagnosed with HIV.

Current HIV prevention isn’t adequate to prevent new epidemics among the young people—particularly adolescent girls and young women—in this sub-Saharan African “youth wave”. Nor is it adequate for the alarming and unconscionable rise in new diagnoses in east and central Asia, where grossly inadequate harm reduction, TB treatment and human rights frameworks for addressing the epidemic are driving explosive epidemics.

Perhaps the best news is that HIV prevention advocates and activists know what needs to be done and will not give up fighting for it, using the scant references in the UNAIDS report to bolster strong arguments for a truly comprehensive response that includes:

  • Adequate funding and smart programming leading to reliable achievement of ambitious targets (appropriate to the intervention) for VMMC, PrEP and condom promotion.
  • Development and use of prevention cascades and continuums that allow countries to track the quality and impact of primary prevention and harm reduction programs with as much accuracy as their treatment programs.
  • An all-hands-on-deck approach to meeting the prevention needs of the young people of sub-Saharan Africa, particularly girls and young women—as well as their male partners.
  • Investment in and recognition of the need for continued research for new prevention options, including the dapivirine vaginal ring, next-generation PrEP products and a vaccine.

Above all, we need leadership. If that isn’t forthcoming from UNAIDS, we know where it can be found: in the vibrant, energetic and unstoppable HIV prevention movement. We’re on alert and in action! We’ll be bringing these messages to the fore at next week’s IAS 2017 conference in Paris—a key gathering for framing the global conversation; we’ll be working in small groups to develop specific strategies at country and community levels; and we’ll be convening via webinars, in-person gatherings and social media to provide the messages and momentum needed now.

Stay tuned, and join us. Every voice matters, now more than ever.

New Report: Investment trends for HIV prevention and cure R&D

It is said success breeds success. 2016 was a year of encouraging progress, indeed success, on a number of HIV prevention fronts. Two trials of the dapivirine vaginal ring showed efficacy, a spate of new vaccine and antibody trials began, and a trial of long-acting injectable PrEP launched.

Those developments are successes by any measure, and yet this year’s funding report from the Resource Tracking for HIV Prevention Research & Development Working Group (Working Group) shows that prevention funding continues to slowly decline overall. Over the same time, cure research got a big bump from global funders. A separate cure-focused brief from the Working Group, developed in partnership with the International AIDS Society (IAS), showed investment in cure research tripled since 2012.

Global HIV Prevention R&D Investment by Technology Category

Released today, the Working Group’s latest annual report on global investment in biomedical HIV prevention shows that overall funding for HIV prevention research and development (R&D) has fallen to its lowest level in a decade.

The prevention research report notes that funding for preventive vaccine research constituted the bulk of all investments, followed by investments in cure, microbicides, prevention of mother-to child transmission (PMTCT), PrEP, medical male circumcision (VMMC), treatment as prevention (TasP) and female condoms. Over half of the HIV prevention option tracked by the working group experienced a decline. These trends are somewhat reflective of the cyclical nature of large-scale clinical trials—when trials end, funding drops off. Likewise, as some interventions enter full-scale rollout, like PrEP, VMMC and TasP, research in this area can be expected to slow down. Nevertheless, the overall trends bear close watching and strong advocacy to ensure that research continues. The progress of this research in the context of flat funding should not be misconstrued. Flat funding will not get us where we need to go next.

Taking stock of all that’s been accomplished with a decade of flat funding, it’s important to note that two million people continue to be infected each year. To achieve control of the epidemic, the field must also take stock of what could be achieved with the right priorities.

The right products need to be tested in the populations who need them most, and research does not always connect well to the people who are most at risk. The report explores the demographic breakdown of almost 700,000 participants in ongoing HIV prevention trials in 2016, with the majority of these volunteers residing in sub-Saharan Africa, most notably in treatment as prevention trials in Botswana, Uganda, Kenya and South Africa. Only one in eight trial participants in 2016 belonged to a population most affected by HIV, including MSM and transgender women, injection drug users and cisgender women.

An intensifying trend towards a small number of large investors is concerning. Together, the US public sector and the Bill & Melinda Gates Foundation (BMGF) represented 88 percent of the total global investment in 2016, compared to 81 percent in 2015. Simply put, for every dollar spent on HIV prevention R&D in 2016, 88 cents came from just two donors.

On a hopeful note, global investment in research toward an HIV cure increased to US$268 million, a 33 percent increase over 2015 levels, with a number of new funders, and an expanded research portfolio at the US National Institutes of Health. The majority of investments (US$253.2 million) came from the public sector with US$13.8 million invested by philanthropies such as Aids Fonds, amfAR, CANFAR, the Bill and Melinda Gates Foundation, Sidaction and Wellcome Trust.

This is a vigorous period in research and development, reflecting a growing recognition from the global community that research has to be part of the long-term fight to end the HIV epidemic. Now is the time to support continued progress with additional, well-targeted resources.

The Resource Tracking Working Group hopes these reports will serve as tools for advocacy and be used to develop public policy that accelerates scientific progress. We thank all of the individuals who contributed data to the report and who gave time and effort as trial participants.

Check out the report, share it with your fellow advocates, and be sure to let us know if your organization is either a funder or recipient of HIV prevention grants or if you have further questions or information about resource tracking at all!

IAS 2017: A guide to navigating the conference on-site and online

This post contains information on the upcoming IAS 2017 conference taking place July 23–26 in Paris. Read on for details on AVAC satellite sessions, data to watch for, a prevention roadmap and all the ways to follow next week’s developments from the City of Light!

Held every two years, this year’s conference will include results from several HIV prevention trials, including data from HPTN’s Phase II long-acting injectable PrEP trial as well as Janssen’s Phase II vaccine trial, important findings from PrEP clinical trials, initial evidence of impact on confronting the epidemic in Swaziland, and more!

The full conference schedule is available on the conference website, and AVAC has pulled together an HIV prevention roadmap, sortable by timing, intervention and session type (also available as a PDF). The conference organizers have also engaged with partners to create additional roadmaps, which can be viewed here.

We also hope that you’ll mark your calendars for two Sunday satellite sessions that AVAC and partners are organizing:

The Next Wave of Prevention Options: An update and interactive discussion on the pipeline of injections, infusions and implants—who will use, who will deliver, who will pay
Sunday 23 July, 14:45 – 16:45, Maillot Room
(Download flyer)

Join advocates, researchers and implementers, including Ambassador Deborah Birx, in a discussion on HIV prevention R&D, what potential users want from this next wave of prevention options, what’s scientifically feasible, what trials might look like, the development pathways and how to work together to accelerate progress.

Future Perfect: Opportunities and Obstacles for HIV Vaccines
Sunday 23 July, 17:00 – 19:00, Maillot Room
(Download flyer)

This satellite will feature three state-of-the-art presentations on the vaccine pipeline, including passive immunization, promising vector-platforms, and the development of envelope proteins able to elicit broadly neutralizing antibodies. The presentations will be followed by a moderated discussion on the scientific priorities, challenges, and opportunities for next-generation vaccines.

Following on the Web

  • In addition to AVAC’s online commentary on Twitter and Facebook, you can follow the official conference hashtag—#IAS2017.
  • Aidsmap is the official scientific news reporter for IAS 2017 and will be updating its IAS 2017 page with regular news updates—check it out here.
  • FHI 360 is an official media sponsor and will be hosting a digital live coverage hub for IAS 2017 on its Crowd 360 platform.
  • IAS Live debuts this year with IAS 2017 offering access to live streaming of the opening and closing sessions as well as the plenary sessions and press conferences. All session content will be available through the online programme.

Stay tuned for additional updates, and we welcome questions and comments at [email protected]!

What’s Up HIV: Supporting young journalists to report on the science and the human face of HIV

At this year’s biennial Southern African AIDS Conference (SAAIDS) in June the media room was buzzing with five young journalists covering the conference, and their mentors from Community Media Trust (CMT), Internews and AVAC. The journalists started every day with an early-morning meeting with guest researchers and advocates who provided background and highlights of the day ahead. With notebooks and recorders in hand they fanned out each day to find their stories.

AVAC has partnered with CMT since 2013 to produce the What’sUpHIV blog to report on HIV conferences in South Africa, but for the first time we provided scholarships to journalists whose sole mission at the conference was to write for the blog.

Together, the five journalists published 25 posts that we are proud to share with you. Don’t miss the personal story from a young woman who uses PrEP, or the reports on controversies around the South African National Aids Council’s (SANAC) new strategic plan, or the provocative piece decrying public attitudes towards women’s vaginas.

These young journalists played a key role in broader coverage of the conference. And we’re not the only ones who think so. Many of their stories were picked up and promoted by AllAfrica.com and by several South African news sources.

To read more news and views from the conference head to whatsuphiv.blogspot.co.za and look for more from these enterprising young journalists in years to come!

Honoring Prudence Mabele – Her light will shine bright forever

We want to take a moment to pause with you and pay our respects to a revolutionary colleague and friend, Prudence Mabele, who passed away on July, 10 2017. AVAC joins advocates across the globe to honor Prudence and her impact on us all.

Pru, as many called her, was a fierce South African activist and leader in the HIV/AIDS, TB and human rights movements and, always, a defender for women’s rights. She was the founder of the Positive Women’s Network and a co-founder of Treatment Action Campaign (TAC) and the National Association of People Living with HIV and AIDS of South Africa (NAPWA). She was part of several other international, regional and national initiatives and, as one of the first South African women to disclose her HIV status in the 1990s, an inspiration to a generation of activists from across the world.

You could not miss Pru, even in the most crowded space, with her wide smile, booming laugh and an authenticity that was always evident. Pru lived her truth. She defended the rights of people living with HIV aggressively and unapologetically. She was the first to the microphone to speak truth; the first to belt out just the right song at the right moment; and she was never afraid to be at the front of the room or protest or podium to call out injustice wherever she saw it.

She was a force of nature and a courageous leader, mentor and activist. The work she did and her fighting spirit will live on in the many people she made a mark on. Prudence was a light that shone bright and her light will stay with the many of us she touched, and those of us privileged to be in her circle and walking along the path she helped to pave.

Go in peace and power, Prudence – we will keep your legacy alive! We extend our heartfelt thoughts and condolences to Prudence’s family, colleagues, friends and loved ones.

Use AVAC Materials? Take Our Survey!

AVAC is undertaking a communications and research literacy survey to learn all we can about how to best serve the field of HIV prevention.

Take the survey.

As HIV prevention advances and evolves, AVAC strives to bring clarity, and spur needed action that is firmly grounded in the real-world. To keep AVAC’s materials and website aligned with the needs of the field, we need to hear from you.

The survey should take no more than 5-10 minutes to complete, and if you haven’t filled it out yet, please take a moment to fill it out. Your feedback is invaluable. And to sweeten the ask, we’re entering survey takers into a lottery to receive one of three $100 Amazon gift cards.

Many thanks in advance for your help!

NIH Announces June 2017 “Concepts”

See the new Council-approved concepts at Concepts: Potential Opportunities for the National Institute of Allergy and Infectious Diseases (NIAID) Division of AIDS (DAIDS) at: https://www.niaid.nih.gov/grants-contracts/june-2017-daids-council-approved-concepts. Concepts represent early planning stages for program announcements, requests for applications, or solicitations for Council’s input.

Support Groups a Driver to PrEP Rollout in Kenya

Contributed by Alfred Itunga, Technical Communications Officer at LVCT Health. This post first appeared on PrEPWatch.org.

Kenya passed a major milestone in the fight against HIV on May 4, 2017 when it launched a nation-wide initiative to bring oral PrEP (pre-exposure prophylaxis), antiretroviral drugs for preventing HIV, to the people who need it. The hope that oral PrEP will help defeat HIV comes after important clinical studies, which showed the safety of the drugs and their ability to prevent infection if taken correctly and consistently. But what works in the lab has to work in the real world too. A number of demonstration projects, aiming to answer the outstanding questions of how best to deliver oral PrEP, started offering PrEP before the launch of a national scale-up. The larger rollout will look to those projects to learn what worked well and what didn’t, and design a successful program. LVCT Health led a demonstration project called Introducing PrEP into HIV Combination, or IPCP, at multiples sites.

The three-year IPCP project focused on reaching populations at risk of being exposed to HIV in counties where HIV rates are high. Young women, female sex workers and men who have sex with men in Kisumu, Homa Bay and Nairobi counties of Kenya were enrolled in programs that offered daily oral PrEP. Program implementers answered their questions, counseled them through the effort to adhere to a daily regime, and collected evidence that would inform others about how to deliver PrEP as part of an HIV combination prevention package in Kenya.

A team made up of LVCT Health staff and AVAC staff recently visited the implementing sites to gather stories and collect lessons learnt as part of the OPTIONS project. We interviewed providers, adherence counselors and people using PrEP who shared their journeys of PrEP uptake and adherence.

People using PrEP pointed to support groups as one of the most important resources they depend on to help them maintain good adherence. The groups consist of 10-15 people who are self-led and meet regularly to share their experiences and challenges in using PrEP. I had an opportunity to attend a female sex worker support group in Kisumu and witnessed what happens during the meetings.

Monica, a PrEP peer leader, started the meeting by welcoming twelve others attending this support group. After each participant shared something about themselves, the group took up the subject of adherence while a note taker kept track of the discussion.

Lucy was among the first speakers. She has been able to keep up with a daily dose of PrEP, something many others struggle with. She said that she has been a female sex worker for 5 years and has been taking PrEP for the last year, catching the attention of those who have been using PrEP for a shorter period. Lucy continued to share her experience of using PrEP in the first two weeks which she confessed were the most challenging.

“I would feel nauseated, headaches and stomachaches, but after visiting the clinic and talking to the nurse, I was informed that these feelings would stop as soon as the body got used to the drugs and this surely did happen, after two weeks these side effects disappeared.”

Lucy said that during that time she almost gave up on PrEP taking, but what kept her going was the fact that she had lost her mother to HIV and could not imagine getting infected. She wants to remain healthy and HIV negative for her daughter. She also said that meeting with her peers during the support groups and hearing the same challenges she experienced made her grow stronger.

Her story generated some discussion as members loosened up and began to share their own experiences. “One time I forgot to take my pill since I was late from visiting a client. The following day I took two pills to compensate” one person said. This raised an argument as some thought it is not right while others said it was.

The service provider was at hand and advised that it is wrong to take two pills at a go and said that it’s too big of a dose. This reaffirmed those who felt it was wrong and users were advised that if for any reason they forgot to take their daily dose, they should continue with their dosage the following day.

I can see the support group meetings not only help people feel supported but also gives them an opportunity to get information and professional guidance on the challenges they face. Considering PrEP is a new prevention option in Kenya and the significant stigma associated with HIV in Kenya, the support groups give assurance to people and a platform to identify solutions to some of the challenges that they face.

It shouldn’t surprise anyone familiar with the HIV response that support groups have emerged as an important resource for a successful PrEP program. For years now, support groups have been pivotal for those on treatment, helping people living with HIV to adhere to the demanding regime of antiretroviral treatment. Providing a protected space for peers to discuss their challenges, such as managing medication or the stigma associated with HIV, is now a time-tested model.

At these LVCT demonstration sites, providers say the support groups have been invaluable. Maryanne, an LVCT Health PrEP service provider from Homa Bay, says at first only a few expressed an interest in the support groups. But those few kept coming and they kept telling others how much it helped. The support group got larger as young women confronted obstacles to adherence, which they wanted to overcome.

“One of the challenges that the users had was the rattling of the pills in the bottles, which made them feel uncomfortable while traveling with the drugs. This affected adherence. They would not carry the drugs when they travelled,” shared Maryanne.

Together they devised a way to keep the pills discrete. Maryanne began supplying cotton to stuff in the pill bottle. No more rattling. No more leaving the pills behind.

Whether it’s managing side effects, stigma or adherence, these group discussions offer personal, consistent support—something the IPCP programs developed in a number of ways. In the coming weeks and months, OPTIONS will be sharing a series of lessons learned from our visits to the LVCT demonstration projects. As a whole, these lessons will touch on a range of issues, but several will underscore what these support groups show. The challenges to good PrEP adherence are both individual and societal, both practical and complex. Enduring solutions often involved ready access to a trusted person who can offer guidance when the going is hard until the way gets clear again.

HIV Testing: A portal for treatment and prevention

Mitchell Warren is the Executive Director of AVAC. This post first appeared on TheBody.com.

For years, HIV testing has been the cornerstone of plans to end the HIV/AIDS epidemic. Widespread testing programs have helped connect millions of people to HIV treatment and care and have been the first step in saving lives. However, an estimated 14 million more people who are living with HIV still haven’t been tested and remain unaware of their status and unconnected to the treatment and care they need, according to the World Health Organization.

As those of us in the US gear up to celebrate National HIV Testing Day — a day intended to remind us all of the importance of knowing our HIV status — it’s important to look at ways to leverage HIV testing, whatever the result, to link more people to the services they need.

The benefits of immediately linking people who test HIV positive to care and treatment are clear. With evidence and guidelines pointing to the benefits of “test and start,” should an individual want it, more people are being linked directly to antiretroviral treatment (ART) programs — ideally, the same day they get test results. This has a positive impact on the health of the individual being treated and an added effect of preventing onward transmission once an individual on treatment achieves viral suppression, a concept also known as Undetectable = Untransmittable, or U=U.

But what about those who test negative? HIV testing is not, in and of itself, a prevention service. However, HIV testing linked to comprehensive prevention services is — or at least it should be.

Comprehensive prevention is not just condoms, referrals for sexually transmitted infection (STI) treatment and — depending on where an individual lives in the world — possible counseling about voluntary medical male circumcision (VMMC) or pre-exposure prophylaxis (PrEP). It includes male and female condoms, condom-compatible lubricant, daily oral PrEP, STI treatment and linkages to the most appropriate and needed services, including VMMC, ART for partners living with HIV, opportunities to build social capital, financial support, harm reduction and much more.

In fact, if programs could leverage HIV testing expansion as an entry point for effective prevention, HIV prevention could be transformed and many of those most at risk of HIV could be reached with effective prevention options to protect themselves.

The key to this is regular and ongoing HIV testing for those most at risk. Many people in the US will hopefully heed the call for HIV testing on June 27th and take advantage of programs that make it easy to test on that day. But, will they be linked to effective prevention that is also right for them? Will they commit to ongoing testing as part of that prevention package?

The era of PrEP is also the era of regular HIV testing, since safe and effective PrEP use requires HIV testing on a regular basis to ensure that the mono- or dual-therapy is not being used by someone who has acquired HIV. As PrEP use is increasingly seen as an important and empowering act of self-protection for anyone who uses it, how can that same empowerment principle be extended to regular HIV testing for all who are at risk, regardless of the prevention options they access?

HIV testing programs have come a long way in the last three decades in cutting down stigma, making testing more accessible and linking people who test positive to care and treatment. But programs, policies and funding have not moved where they need to be to link HIV-negative individuals to the prevention options they need. Everyone who tests for HIV — no matter the result — needs to be linked to comprehensive, integrated and sustained services that are culturally appropriate.

Is this happening? How often is it happening? No one knows. Data on services offered to people who test HIV negative are inadequate. Outside of the US, countries, funders and implementers report on “people reached” by simply counting referrals and condoms distributed, yet data on who is being reached — particularly among populations at greatest risk — are insufficient. In the US, these linkages vary widely based on the availability of funding and other support to often overstretched clinics and local AIDS service organizations that run testing programs.

What is the solution to linking HIV-negative people to effective prevention services? Data show that connecting people to services immediately after testing can help keep them negative. There are global guidelines in place from the World Health Organization, and national guidelines exist in several countries, including from the Centers for Disease Control and Prevention for the U.S. But experience shows that guidelines and policies do not always reflect the reality of programs and, most importantly, people’s lives.

Moreover, funding plays a critical role in the realities of programs. Even as test-and-start treatment has become the standard that testing programs aim for in the U.S. and around the world, budget cuts and health care “reform” threaten to derail these evidence-based and policy-supported programs. Linking HIV-negative people to the services and care they need is likely to suffer even more with health care changes in the U.S. and domestic and global HIV budget cuts.

As advocates for evidence-based prevention, we at AVAC fight for policies that link all people who test to relevant, appropriate and user-friendly services. It’s the right thing to do for individual health and to end the epidemic — and it’s cost effective and cost saving.

So, on this National HIV Testing Day, we call on individuals to get tested, know their status and take appropriate steps to access treatment and prevention. And, we call on funders and policymakers in the US and around the world to support life-saving and cost-saving testing programs that are the cornerstone of a comprehensive, integrated and sustained response to HIV.

Now I Am Not Scared of Testing for HIV

This blog post, written by Thabo Molelekwa, first appeared on What’sUpHIV as part of a series covering the 8th South African AIDS Conference.

When Samkelisiwe Chiliza from Durban heard about Pre-Exposure Prophylaxis or PrEP, she did not hesitate to join the PrEP study through the Centre for Aids Programme and Research in South Africa (Caprisa).

PrEP is the use of anti-HIV medication to keep HIV negative people from becoming infected. PrEP has been shown to be safe and effective in clinical trials that have taken place in many countries, including South Africa, and is approved by the South African Medicines Control Council (MCC). Taken as a single pill once daily, it is highly effective against HIV when taken every day. The medication interferes with HIV’s ability to copy itself in one’s body after one has been exposed. This prevents HIV from establishing an infection and making one sick.

Samkelisiwe is one of the young women who are currently on PrEP in South Africa and she is encouraging other young women to participate in one of the PrEP projects taking place around the country so that they can help stop the spread of HIV and keep themselves safe.

“I have been taking one pill every night for the past 14 months and I am not willing to stop as I am saving my life,” said Samkelisiwe, adding that she is not scared of testing for HIV because she knows what results to expect since she is on PrEP.

According to Samkelisiwe, many young women are already infected and are not eligible for PrEP as it is only for HIV-negative people.

“Lots of people don’t know about these kind of studies but I do spread the word as much as I can,” she said.

She said that her grandmother was happy to hear that she is taking a pill to protect herself from contracting HIV.

According to Professor Linda-Gail Bekker of the Desmond Tutu HIV Centre, PrEP is a prevention option, not a treatment. It works properly when taken correctly and consistently, but that, currently, only 13,000 people who are receiving PrEP from the government. These are sex workers and men who have sex with men. And there are only 1,387 people who are taking PrEP through demonstration projects run by various organisations.

Prof Bekker said that, while PrEP is not yet widely available, “there is advocacy going on to make sure that the government rolls out PrEP to everyone who needs it.”

The high cost of PrEP is what stops the government from rolling it out to everyone who needs it. Currently, there are only two ways to access PrEP – “People can buy it at a chemist or they can join the demonstration projects that are taking place in the country,” added Bekker.

Bekker said that educating people in the communities about PrEP is important because that will give them knowledge of what the intervention is so that they can make decisions about protecting themselves from HIV and preventing the spread of the disease.

According to World Health Organisation guidelines, PrEP is rolled out to people at substantial risk of contracting HIV. Deborah Baron of Wits Reproductive Health and HIV Institute (WRHI), believes that in South Africa, PrEP should also be rolled out to young women because 7,000 young women become newly infected with HIV every week in Eastern and Southern Africa. “And a third of those women are right here in South Africa,” said Baron.

Baron said that in order to make PrEP interesting for young women there is a need for youth-friendly PrEP delivery models and tools. “We need to be responsive to realities of young women’s lives.”

In late 2015, the South African Department of Health developed policy and guidelines for oral PrEP as well as test-and-treat implementation to protect groups at high risk in line with World Health Organisation guidance. The ARV drug, TDF/FTC, was approved for use as PrEP by the Medicines Control Council.

The National Department of Health, together with the implementing partners, like Baron’s organization, continue to work together to move PrEP forward and get it to the people who most need it. Individuals like Chiliza who take PrEP and talk about it their peers are helping to expand an important HIV prevention option for South Africans.