“We Neglect Primary HIV Prevention at Our Peril”

Inspired by a steady decline in new HIV infections and AIDS-related deaths, the sustainable development goals call for ending the AIDS epidemic as a public health threat by 2030. However, the world is not on track to end the epidemic. – “We neglect primary HIV prevention at our peril”, Lancet HIV

The July issue of The Lancet HIV, launched online earlier this week, focuses on the need to scale up prevention to reduce new infections—reiterating that achieving the UNAIDS’ 90-90-90 treatment targets is not possible otherwise.

As the editors note in the introduction to the issue, “We can do much with existing interventions, but as the papers in this issue show evolution of programmes and technology will be needed to have the greatest effect.”

The issue is made up of a series of papers that attempt to show what needs to happen in prevention to reduce incidence and reach global and national targets. The papers cover a range of topics, including:

  • How we might create, use and understand a “prevention cascade” to assess programming;
  • What modeling shows we might be able to achieve if available interventions are appropriately scaled;
  • A framework for how to achieve UNAIDS’ ambitious targets and the actions need to get there; and more.

For those attending AIDS 2016, please save the date for a special session that will focus on this issue and its call to action: What Will it Take to Reach the Fast Track Prevention Targets: What, Who and How, on Monday, July 18, 14:45–16:45, Session Room 5.

In addition, as many in the field prepare to head to Durban next month, we are pleased to see that the Second Durban Declaration, released today by the International AIDS Society for endorsement through the end of the AIDS 2016 conference, devoted significant ink to prevention, both the implementation of what’s currently available, the need for research into new options and the fundamental structural barriers that must be addressed.

Introducing Innovation: The Role of Devices in VMMC

One of the greatest opportunities for impact in prevention is to quicken the pace of scale-up for voluntary medical male circumcision (VMMC). VMMC devices are one of the recent innovations in delivery that could assist in reaching coverage goals.

Just this month, the Journal of AIDS (JAIDS) published a special supplement on devices for VMMC. Check out the full supplement here. The collection of articles examine safety, acceptability and operations research on implementation of two devices used to assist male circumcision in adults and adolescents, PrePex and ShangRing. All articles are available as open access.

And for those attending AIDS 2016, be sure to download the VMMC roadmap available as part of the online conference programme—and for details on a number of the sessions and ways to connect via social media at the conference visit: aidsfree.usaid.gov/news-events/aids-2016.

The Second Durban Declaration

Despite significant scientific advancements, we continue to encounter structural barriers that impede real world progress. Realizing the promise of scientific achievement requires a greater commitment to removing barriers between discovery and implementation. The 21st International AIDS Conference (AIDS 2016) must bring these pieces together – the key scientific advances needed to end the epidemic and the key structural barriers impeding progress – and secure greater political commitment including financial resources to get the job done. Read the declaration here.

Announcing the Call for 2017 Fellows

AVAC is pleased to announce the call for applications for 2017 Advocacy Fellows.
Consider applying to be an Advocacy Fellow and join the 50 Fellows and alumni of the program!

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 Thursday, 7 July 2016.

The submission deadline for Advocacy Fellows applications is Monday, 15 August 2016.

Download application materials at www.avac.org/fellows-application-materials.

About the Program

The goal of AVAC’s Advocacy Fellows program is to expand the capacity of advocates and organizations to monitor, support and help shape biomedical HIV prevention research and implementation of proven interventions 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/AIDS 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 HIV vaccines, microbicides, multi-purpose prevention technologies and cure is planned or ongoing and/or where there is implementation or plans for rollout for newer proven interventions such as voluntary medical male circumcision, PrEP, early treatment, rings, high impact combination prevention packages that combine biomedical strategies for population impact, and where the links between sexual and reproductive health and HIV risk for women are being studied.

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 and transgender 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 combination 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.

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 MONDAY, 15 AUGUST 2016.

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

Stakeholder Engagement Community of Practice June Round Up

AIDS 2016 is quickly approaching and the virtual network has been filled with webinars and resources preparing advocates and educators for the conference! This year the Global Village will feature a Research Literacy Networking Zone! AVAC is helping to coordinate the zone, and we would love to highlight the informational-educational-communication materials you use for your research literacy work! Please consider sharing any tools you use to educate your communities about HIV clinical trials.

And if you will be in Durban, please let us know and be sure to come by the Zone! Email Jessica Salzwedel ([email protected]) with your materials and questions!

Keep reading to see what you may have missed on the virtual network!

Community of Practice Logo

Resources

The Lancet
Preparing for AIDS 2016 the Lancet HIV has just released a special issue focused on HIV prevention. A line from the editorial article summarizes the tone of the whole issue. “As we continue to scale up treatment to achieve the 90-90-90 targets, other approaches to reducing new infections must not be forgotten. We can do much with existing interventions, but as the papers in this issue show evolution of programmes and technology will be needed to have the greatest effect.”
Access all of the articles here.

A Gender Responsive Toolkit for HIV Prevention
The Office on Women’s Health and the Office of HIV/AIDS and Infectious Disease Policy have designed a new gender responsive toolkit for HIV prevention. Designed to be used by health departments, clinical staff, program planners, managers and community providers so they can address gender issues and inequalities within existing prevention programs.
To learn more and download the toolkit click here!

Webinars

CUREiculum Webinar Series
Whether you’re going to Durban or not this webinar series will introduce you to the essential information of HIV cure research. Join Wednesday, June 29th at 10am ET||4pm SA to discuss the ethical questions concerning the HIV cure field.
Register here!

HealthHIV Webinar: Social Determinants of Health Impacting Women of Color
The webinar is designed for current and emerging leaders in AIDS service organizations to learn practical strategies to address the impact of HIV and improve health outcomes for women of color.
June 30th at 12:30-1:30pm
To learn more and register click here!

Spotlight

Public/community engagement in health research with men who have sex with men in sub-Saharan Africa: challenges and opportunities
A new article from CoP members in Kenya on the role community engagement can and should play in overcoming the challenges of stigma and discrimination faced by key populations.
Access the article here!

If you’re not part of the Stakeholder Engagement virtual network please email [email protected] to sign up!

High Level Disappointment

Today as the UN High Level Meeting on HIV/AIDS comes to a close, AVAC joins our colleagues and collaborators from civil society in expressing disappointment in the final Political Declaration on HIV and AIDS: On the Fast-Track to Accelerate the Fight against HIV and to End the AIDS Epidemic By 2030 that was issued, noting in particular the failure to produce language that elevates gay men and other men who have sex with men, transgender people and sex workers to equal status with all other people at risk of and living with HIV in the world today.

There were significant strides for women and girls and a new goal of achieving 30 million people on treatment by 2020, but in its approach to key populations, the Declaration was largely unchanged from 2011. Without this recognition and commensurate action to decriminalize and destigmatize specific identities and the virus itself, new cases of HIV will continue to rise—a trend reported by UNAIDS earlier this week.

A weak Political Declaration is never helpful, but it is crippling, poised as we are at a moment in the epidemic where strategy, acceptance, political will and financing have the potential together to make great progress we must make to achieve the Fast Track goals. In response to these developments, AVAC joined with 162 global civil society organizations to issue a more ambitious, rights-based and inclusive 2016 Political Declaration on Ending AIDS. This call to action led to the announcement of a welcome and much needed initiative by the United States President’s Emergency Plan for AIDS Relief (PEPFAR) of a new $100 million investment fund to expand access to proven HIV prevention and treatment services for key populations.

We share with allies our concerns with the emphasis on country-led decision-making based on national context. Like so many phrases in this epidemic, this one also carries multiple meanings. AVAC strongly advocates gathering epidemiological information and using it to guide responses that are developed and monitored by those most at risk and most in need. But the same concept can also be used by governments that see context selectively—erasing certain groups from their programs by failing to collect or release data on them.

We are living in an era of unprecedented access to and focus on data. What gets counted is what gets attention—and we know in many many countries that the populations at highest risk, who are most marginalized, are not counted. Gay men and other men who have sex with men, sex workers, people who use drugs and young women at great risk have high rates of HIV and low access to services. We need to accept nothing less than a comprehensive research, data and monitoring agenda that tracks the needs, priorities and outcomes of these populations in all countries—including middle income nations. And where governments won’t do it, implementers and NGOs can and should lead the way.

Only then can we meet the goals in the civil society 2016 Political Declaration on Ending AIDS that “combination HIV programs… meaningfully involve communities at all levels, … be well-managed with necessary capacity, scaled up to reach at least 90 percent of those in need, and be aligned with global guidance developed and supported by the WHO and UNAIDS”—and only then will we have any chance at all to begin to end the epidemic.

One last thing: this week should also be a reminder that, despite the rhetoric, we don’t actually have “all the tools we need to end the epidemic”. Luckily, the final Political Declaration does recognize that research and development for additional prevention and treatment options must be accelerated—now we just need to be sure that financing, targets and programs commit to acting on it.

What Should the Next US President Do? Advice for Hillary and Donald.

On behalf of IFARA, thebodypro.com recently posted two videos. In the first, Jim Pickett, director of Prevention Advocacy and Gay Men’s Health at the AIDS Foundation of Chicago, spoke with Robert Grant, MD, MPH, Mike Cohen, MD, Ian McGowan, MD, PhD, FRCP, and Mitchell Warren about HIV prevention research presented at this year’s Conference on Retroviruses and Opportunistic Infections (CROI).

New prevention tools, such as a safe and effective vaginal ring and the prospect of long-acting injectable agents are exciting news, panelists agreed. However, these tools are only as good as their implementation — as is the case with already approved methods, such as oral pre-exposure prophylaxis (PrEP). This includes finding and effectively treating people living with HIV, because those with an undetectable viral load do not transmit the virus.

Panelists would advise the next US President to invest in long-term research, including the search for a vaccine, cure, fund open-label studies of the vaginal ring, and provide treatment and prevention services to as many people as possible — especially women and men of color.

Watch the video on thebodypro.com.

In the second video, AVAC Policy Director Kevin Fisher spoke with Steven Wakefield and Ntando Yola about the development of a vaccine for HIV.

Wakefield called antibody-mediated prevention “the next holy grail.” Trials of broadly neutralizing antibodies that are infused every two months will start enrollment across the globe by mid-year, he said. However, a potential vaccine is just one component in a set of HIV prevention methods. Yola described HIV prevention as “a track field where products are racing each other.” Communities pin their hopes on each new prevention modality, but the focus needs to be moved from specific methods to overall prevention science, he believes. To that end, the science behind vaccine research needs to be explained in a way that people in the community can understand.

This video is also available at thebodypro.com.

Introducing PrEP Facts: Women’s Sexuality and HIV Prevention

Faith Landsman works for the CFAR Research Facilitation Core at the UCLA HIV Research Study Volunteer Project.

If women in the US want to start PrEP right now, most often they have to ask for it directly. The question is, how do women get PrEP if we don’t know that a pill to help prevent HIV even exists? While Planned Parenthood is rolling out PrEP services throughout the US, healthcare providers rarely offer PrEP to women, and even then often only if women disclose that their partner is HIV-positive. In a study published in the journal Contraception, (2016 May;93(5):463-9) researchers found that among family planning providers surveyed, most have limited knowledge about HIV PrEP and HIV testing, and report lack of provider training as the main barrier to PrEP provision.

In the Facebook group “PrEP Facts: Rethinking HIV Prevention”, founded by Damon Jacobs in 2013, its over 14,000 members have been promoting PrEP education and advocacy worldwide. Members advocate for one another with under-informed physicians, insurance companies, health departments and in interpersonal relationships. However, the membership is overwhelmingly men who have sex with men. “PrEP Facts: Women’s Sexuality and HIV Prevention”, a spin-off of the original PrEP Facts group, intends to do the same for women looking to take control of their sexuality and health. We want to empower women to be able to say, “I’m taking control over my risk for HIV infection.”

Join the conversation at www.facebook.com/groups/PrEP4Women!

Register Now for June 6 Webinar on Basics of HIV Cure Research!

In July, thousands of advocates, researchers and educators will arrive in Durban excited to hear the latest news in the HIV field. To get ready for the upcoming developments in HIV cure research, AVAC is thrilled to announce the first webinar in a six-part series preparing advocates and cure-enthusiasts alike for the HIV cure research agenda being presented at Durban. The webinar series will provide accessible, essential information for advocates who want to understand the HIV cure research updates being presented in Durban, and provide a space to engage with leading researchers and advocates before AIDS 2016.

CUREiculum Webinar: HIV – The Basics What You Need To Know, And Want to Know About HIV Cure Research led by Nicolas Chomont, a leading researcher at the University of Montreal.

Join us Monday, June 6 at 9am ET (see www.timeanddate.com for the time in your area).

  • What are researchers talking about when they say “cure”?
  • What kind of progress is being made toward a cure for HIV?
  • How can we talk about HIV cure to our communities?
  • What do we need to know before AIDS 2016?

Register here.

We Told You So—New UNAIDS report shows missing focus on rights and evidence-based responses hurting prevention

Earlier today UNAIDS released its Global AIDS Update ahead of next week’s UN High-Level Meeting on Ending AIDS in New York. The highlight of this year’s update was the news that across the globe 17 million people who are living with HIV are on antiretroviral treatment (ART), an increase of two million from 2014 to 2015. While there is clearly still work to do in closing the treatment gap (17 million is still a little less than half of the total number of people living with HIV all of whom are eligible for treatment per updated WHO guidelines), this recent accomplishment is ahead of the 15 million target set within the 2011 UN Political Declaration on HIV and AIDS.

This is welcome news, but unfortunately the news is not all good. The report also reveals that declines in rates of HIV acquisition have “slowed alarmingly” with the overall rates of new infections largely unchanged. These rates continue to be disproportionately high among young women, and key populations and their sexual partners.

While the annual number of new infections has changed little from the previous year, the data that make up that total have changed. Rates are on the decline in eastern and southern Africa—4 percent since 2010—while new infections in eastern Europe and central Asia are up 57 percent over the same period. Any decline, even a modest one, indicates progress, but prevention advocates are left to wonder what could have been had countries reached the 80 percent coverage of voluntary medical male circumcision (VMMC) targets. Some models predicted 10–15, even 25, percent declines if VMMC targets were reached. So yes, overall decline is good but this modest number represents a missed opportunity to do much much better.

And speaking of VMMC, the report didn’t speak to it much at all, or any of the prevention targets outlined in UNAIDS’ 2016 – 2021 Strategy, released last October. There is a section of the 12-page update on prevention, the title of which points to the need for a “reinvigoration of HIV prevention” but the update misses the mark, leaving out the targets completely and reporting only on successes in ART coverage.

And prevention was dealt another setback today with the National Health Service England confirming its decision not to fund PrEP—and somehow it’s still a surprise when reports like the one released today show that global HIV rates aren’t declining.

UNAIDS comments that “Fast-Track approach to HIV treatment is working. Global consensus and leadership have driven greater investment of financial and human capital, and mounting clinical experience and research, improved treatment regimens and diagnostics and reductions in the price of medicines have created gains in efficiency and effectiveness.” This is certainly true, but AVAC calls for—and looks forward to—future reporting where the “Fast-Track” approach to treatment AND prevention is the global success we all know it can—and has to—be.