Lisa Diane White, MPH is the Deputy Director at SisterLove, Incorporated. She has over 25 years of experience in Black Women’s Health issues and other health education programs and services. Lisa Diane is an accomplished and recognized speaker, facilitator, trainer and consultant, who expertly intersects many social justice issues, including feminism, women’s and LGBTQ health and rights, reproductive justice, lesbian intimate partner violence, substance abuse, HIV/AIDS, intergenerational relationships, aging and human rights.

I came to the 2015 United States Conference on AIDS (USCA) to learn, and I was not disappointed. Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases (NIAID) provided the audience with a historical timeline about HIV/AIDS during the opening plenary luncheon and I was taken back to my own historical timeline.

Twenty-five years ago I facilitated my first group of women who were HIV positive. I was asked to conduct a self-help group with a newly formed support group for women diagnosed with AIDS. I knew self-help, I knew grief, I knew healing and I knew how to help women access their grief and trauma to heal. I didn’t know anything about HIV. How could I help these women? What did they need from me? I eventually learned. They needed to express their fears about living and dying with HIV/AIDS. They were worried about their children and families. They needed to be held. They needed to cry. They needed my support. I was afraid. I didn’t know how HIV was transmitted. Would I get HIV from their tears? One woman leaned on me while we were talking and began to cry. She soaked my shoulder with her tears. I encouraged her to release her grief and held her while she sobbed on my shoulder? I kept rubbing my shoulder. Did I have a cut I was unaware of? I hurried home and showered after the group. I worried for months about that encounter. I finally got an HIV test. I was sick with worry and fear as I waited for my results. Two weeks later I got my results. I was negative. I vowed never to work with HIV positive women again.

Fast forward to USCA 2015. I attended a session on HIV and trauma. The panelist stressed the importance of recognizing trauma and its impact on clients when accessing and staying in treatment and care. Stigma plays a big part in traumatizing HIV positive women. Sometimes the source of trauma starts with the first medical visit. Many HIV positive women suffer from Post-Traumatic Stress Disorder (PTSD). One panelist reminded us that some trauma was ongoing. There is no post trauma for some. It is all current. That is true about stigma and racism. Its damaging repercussions are ongoing. After the session I engaged in conversation with a woman who shared with me she was HIV positive. We sat down to eat our lunch and she continued to share with me about living with HIV. When she disclosed to a family member they covered their face and mouth with their shirt. Really? In 2015? She began to cry as she shared many of the indignities she faced when disclosing to family and friends her HIV positive status. They all asked her to keep that information in the family and not to share any further. I stood up and took her into my arms. She cried and cried and soaked my shirt with her tears. I enfolded her more deeply into my arms in a full body hug and she began to sob. Her words were muffled in my tight embrace. She hadn’t been held in a while. I could feel the wetness from her tears on my skin. I had a flashback to the moment I supported the woman living with HIV 25 years ago. I now know you cannot transmit HIV with tears. The body fluids were blood, semen, vaginal fluids and breast milk. Not tears. Not saliva. Not by breathing. You cannot get HIV just by sitting next to someone with HIV. I could not get it no matter how closely I held the beautiful woman. She couldn’t cry enough tears to transmit HIV to me. No matter how deep her grief.

I was outraged that she was harmed again by disclosing her status. I was outraged that her family shunned her and covered their faces. But then I remembered. I know a great deal about HIV. I have worked in the field for 12 years. I have learned a great deal. I had forgotten my vow never to work with HIV positive women. I am glad. I live and work with clients living with HIV everyday single day. I LOVE my life’s work. Knowledge about HIV prevention, transmission and treatment (FACTS) can offset the stigma that is caused by misinformation and ignorance (MYTHS). The lack of knowledge breeds fear. The lack of knowledge breeds stigma. I am working every single day to educate the community about HIV to eliminate fear, stigma and HIV criminalization.

I held this beautiful grieving woman until her sobs subsided. She apologized for soaking my shirt with her tears. I encouraged her to seek support around living with HIV. I encouraged her to be in community with people who could hold her and help her heal from trauma inflicted after being diagnosed by HIV. I thanked her after one final hug. She asked why I was thanking her. I told her she was a gift I needed that day. What I didn’t share was the gift she offered me. The gift of the memory and the release of fear and shame about my behavior 25 years ago. I know better. Now I can do better.

Anna Miti is a broadcast journalist and 2015 AVAC Advocacy Fellow. This post first appeared on her personal blog.

That’s my new mantra after attending the recently held Zimbabwean feminists forum… my body my politics. Since time immemorial women’s bodies have been subject to governance by patriarchy. In biblical times women who were on their periods were deemed unclean and could not enter the temple. They were supposed to cover the hair in the temple. If they had make-up on they were deemed to be “harlots”. Women were taught to be embarrassed about their bodies, to “cover-up” and to not enjoy sex. In some places in Africa female genital mutilation is widely practised and we still teach our girls to be ashamed of their sexuality. In fact, there is a common notion that women never say yes to sex, and even if they mean yes they still say no. So any man worth his salt will still have sex with a woman even if she does not say yes.

All these issues have contributed to the hindrance of young women’s access to sexual and reproductive health and HIV services in general. Young women seeking sexual and reproductive health services are shamed at health centres, being asked or told to keep their legs closed rather than seek contraceptives. Or shamed for seeking treatment for sexually transmitted infections. Society fails to realise that if young women can barely admit to having sex, expecting them to be able to negotiate for safer sex is definately asking for too much. For those who do dare to say yes to sex, their male partners are reluctant to use condoms and often times flatly refuse to use them. The myths and misconceptions about the female condom, coupled with the same issues of male cooperation further complicates issues. In the mean time young women are twice as likely to become infected with HIV than their male counterparts. The implication of this is that the same young women will go on to have babies who will also end up with HIV. Even with the advances in treatment, HIV/AIDS still remains a huge public health concern. The National AIDS Council of Zimbabwe statistics puts ART coverage for paediatrics at less than 50 percent and at about 78 percent for adults. As our global goal of zero new infections by 2030 go, empowering young women is one of the best ways of getting to that zero.

Movement

We need a movement for young women to make them aware of themselves and to open up to the challenge of taking charge of their own health. We have seen these campaigns before and South Africa is already making strides with the ZAZI – know your strength campaign. We need to get to a situation where a young woman can say no to sex that puts her health at risk and we need to teach young men to be able to accept that. It would be a great world, ideal in fact, where a young woman can whip out a condom and demand that the male partner uses it, and the young men actually follow through and have safer sex. It might be a long shot though, rolling back centuries of patriarchy in one swift movement. We need something that can make them shout my- body my politics-and actually mean it and follow it through. In reality however, we need to tamper that strong push with practical ways of making an impact on young women’s lives.

Control

Whilst we are building confidence in our young women and bringing our young men up to speed we need practical ways, like crutches to use on our way to the ideal world. We have new prevention technologies that are in the pipeline and those that have been proven to work. For example pre-exposure prophylaxis (PrEP) has been proven to be effective if used correctly and consistently. This is a pill that can be taken daily to reduce chances of getting infected with HIV. The advantage of PrEP is that it can be used discreetly without the need for the young woman to negotiate with her partner. Other countries like the US and closer to home in South Africa are moving forward, given the scientific research around PrEP, to ensure its availability. In Zimbabwe we need to create awareness around PrEP with a view for creating demand for it.

In addition researches have just concluded a microbicides trial in Zimbabwe and results are expected by the end of the year, while the HIV vaccine is undergoing research. All these are useful tools that young women can use, to empower themselves for their own health. It can be done, considering that male medical circumcision was incorporated into the public health response, offering a 60 percent reduction in the chances of HIV infection whilst PrEP has been shown to be more than 80 percent efficacy in some trials. Granted circumcision is cheaper, but the benefits of empowering young women are immense, preventing HIV infection in young women closes the tap on paediatric HIV and eventually on HIV related deaths.

As a world we have been failing the young women, leaving them vulnerable through our attitudes, and turning a blind eye on some home truths about young people and sexuality. I feel it is high time we turn back the time and stem the flow of new infections by actively pursuing options for young women. No I am not saying lets tell our young women to go forth and have sex… but sex is happening in young people whether we like it or not. All I am saying is at least let it be safer and let them have options for prevention for their health. The ball is in our court…

While the US Conference on AIDS (USCA) only officially begins tomorrow, activities are well underway in Washington, DC, as providers, frontline workers, activists and others working on HIV/AIDS in the United States gear up for this annual event.

Today, over 200 people are gathered for the Black PrEP Summit, organized by the Black AIDS Institute in partnership with a dozen community partners, including AVAC and members of our PxROAR program. The goal of the summit is to increase knowledge and uptake of PrEP among Black people in the United States through interactive conversations with clinicians, community members and public health practitioners. Follow today’s conversation on social media at #BlackAIDS.

At the same time, advocates are taking to the halls of Congress as part of HIV Action Day, and meeting with elected officials to discuss HIV/AIDS funding, syringe exchange and protecting/preserving the Affordable Care Act.

Prevention advocacy will be in full effect at USCA 2015 with a range of sessions (see the USCA website for the full schedule). We highlight below a handful of sessions that AVAC and our PxROAR partners are leading at the conference. And follow the prevention conversation and more throughout the conference on social media at #USCA2015 and @hivpxresearch and on AVAC’s P-Values blog.

Thursday, September 10

Accelerating the Uptake of Daily Oral PrEP with Truvada While Integrating Treatment and Preparing for Additional PrEP Strategies
10:30am – 12:00pm; Shaw, Meeting Level 3
Evidence shows that daily oral PrEP can reduce risk of HIV by more than 90 percent and, that when effectively targeted to those at risk, can be cost-saving given the reduced levels of new infections. This workshop will address the importance of overcoming barriers to PrEP uptake as well as unpack recent research results and look to new data that are expected in the coming years. Session attendees will be able to cite the evidence and engage in cogent dialogue in support of uptake in their respective communities nationwide.

Decoding HIV Cure Science: A CUREiculum Seminar
2:30pm – 5:30pm; Howard University, Meeting Level 1
Learn about the science behind the headlines of “cure” and discuss the current strategies being pursued in the field. Explore key ethical considerations, like treatment interruption, as well as barriers and motivators of participation in current and future trials. Work with other advocates to develop skills to discuss and disseminate information about HIV cure research in your community.

Saturday, September 12

HIV Prevention and Women: Delivering What Works and Preparing for What’s Next in the Pipeline
8:30 – 11:30am; Chinatown, Meeting Level 3
HIV prevention options for women—pills, rings and more! Want to learn more? Come hear the latest on what’s available now and what may be available soon. Network with fellow advocates and activists and gain skills (and tools) that can help you disseminate this important information—and help with access for your local community.

Prevention, Treatment and Cure: Talking About Research in Your Community
1:30 – 3:00pm; Walter E. Washington Convention Center, Room 151, 801 Mt Vernon Place NW
Attend this Affinity Session to learn more about HIV prevention, treatment and cure research, ongoing studies, trial ethics and more! It will also be great for anyone looking for an informal setting during which you can ask all the questions you’ve had about research and never gotten to ask!

Transgender Women and PrEP Affinity Group Launch
6:00 – 8:30pm; Walter E. Washington Convention Center, Room 151, 801 Mt Vernon Place NW
This Affinity Session will summarize the issues raised in the webinar on Transgender Women and PrEP held in July. Most of the session will act as a kickoff to an affinity group (a sub-set of the full US Women & PrEP Working Group) that will focus on naming and creating an advocacy agenda for transgender women and PrEP. The Transgender Women’s Affinity Group is open to transwomen, people on the trans feminine spectrum and their allies. The WG strongly believes that the voices of transwomen should be centered in the leadership of the affinity group, and would like for the decisions and the direction of the group to be led by transwomen.

Sunday, September 13

Sex Worker Visibility and the US National HIV/AIDS Strategy
8:30 – 11:30am; Gallaudet University, Meeting Level 1
Currently, sex workers are not identified as a “key population” in a number of national funding and policy agendas, including the NHAS. This can be seen as a protective factor for individuals who may be vulnerable to criminalization and/or those who may not identify with the term sex worker of feel comfortable disclosing their work or experiences to medical providers. What is lost, however, is significant. This workshop will explore the ways that sex workers are systematically excluded from domestic and international policy—from surveillance data to funding priorities—in the context of stigma and criminalization.

As always, questions or comments are welcome, and we hope to see many of you in DC this week!

Angelo Kaggwa-Katumba is an AVAC staff member. A version of this blog post was recently re-printed in the New Vision.

The World Health Organization (WHO) defines civil society as “a social sphere separate from both the state and the market” and civil society organizations (CSOs) as “a wide range of organizations, networks, associations, groups and movements that are independent from government and that sometimes come together to advance their common interests through collective action.” There are probably dozens of other definitions out there, but what stands out as core is independence and collective action by the citizenry.

In the recent past, however, there are more and more developments the world over showing that the independence of and ability to mobilize for collective action by civil society in many places is being seriously threatened.

Take Uganda as one instance. The country has a relatively vibrant and thriving civil society, but a new bill, The Non-Governmental Organisations Bill 2015, is threatening the very foundation of civil society in Uganda. Among its many flaws, this new bill would grant the Minister of Internal Affairs and the National Board for NGOs, absolute powers to supervise, approve, inspect and dissolve all NGOs, community-based and faith-based organizations—in the blink of an eye. In addition to this, the minister and this board would have the power to slap severe penalties to these groups for any “violations”. So why would a government that is serious about promoting basic freedoms of expression, association and others come up with a bill that would subject its citizens to such unnecessary government control and interference? Your guess is as good as anyone’s.

Fortunately, Ugandan civil society refuses to just sit and look on as government cracks down on the basic rights that they (government) are meant to ensure and protect. In a July 2 press statement signed by several NGOs, civil society demanded that government frees this space that rightly belongs to civil society to operate.

“We should not face criminal sentences if our work—research, advocacy or service delivery—touches on subjects sensitive to people in power,” reads the statement from civil society in Uganda.

They rightfully claimed the rationale for their very existence by adding “… the existence of independent groups in Uganda is no more a threat to national security than respecting fundamental human rights is, and they should not be subject to control by intelligence agencies.”

Sadly, it’s not just Uganda where this is happening. There are countless examples of similar developments in China, Cuba, Egypt, The Gambia, India, Kenya, Russia and Zimbabwe among others. To see a comprehensive update on information on legal issues NGOs are facing in various countries, you may go to the International Center for Not-for-Profit Law—an organization dedicated to improving “the legal environment for civil society, philanthropy, and public participation around the world”.

There are countless accounts of infringement of citizens’ rights to assemble, organize and express themselves in these and many other places where new laws are being enacted or old ones updated, and human rights are being suffocated. The more such laws are enacted, the greater the government’s control increases, and on the other end, the faster the pace at which civil society space shrinks. Unfortunately, as citizens find new ways of organizing, assembly, and expression, particularly through use of new and social media, their governments are quickly reinventing themselves to keep up, thereby suppressing the citizenry even more. It’s a bonafide human rights crisis!

So, why is this important to HIV/AIDS?

Advocates, activists, doctors, scientists, nurses, counselors and other people working in this space wake up each day with the hope that they will be able prevent another infection or provide the opportunity for linkage to care and treatment as needed. They work with the most marginalized and disenfranchised, and in some cases, criminalized individuals and groups such as men who have sex with men, sex workers, people who inject drugs and others. Such individuals and groups already have limited access to the services they need for prevention, care and treatment, and bills such as these, which limit rights, make efforts to bridge gaps in service delivery even greater.

Unfortunately, funding for these human rights-based groups and individuals continues to decline. It makes their work hard, and in some cases, impossible! This decline is captured well in AVAC Report 2014/15 in a graphic that summarizes trends in funding for civil society organizations for human rights-related work. The graphic—derived from a UNAIDS report—shows that among the civil society groups queried by UNAIDS, 24 percent said that HIV and human rights funding stayed at the same level, 17 percent said that HIV and human rights funding increased and 59 percent said that HIV and human rights funding decreased. The trend is disturbing! And yet, as AVAC argued in the same report, for all of us collectively to achieve the UNAIDS Fast Track goals (or any other goals for that matter), prevention programs must respect human rights and the realities that communities face. UNAIDS was spot on in their Fast Track goals by saying that in order for these goals to be achieved, “much greater emphasis will be needed on community service delivery” and that there’s need for expanded funding for civil society. The trend of funding for civil society groups focusing on human rights has to change. It’s time to make our (again collective) actions speak louder than our words!

Ending AIDS will require bold action. Bold action requires confidence. Confidence requires safety. Yet civil society’s safety and independence in these countries and many others are being denied. This civil society space is needed. Collective action is needed. This space must be protected, not shredded. It should be a basic step to ensure that all citizens enjoy the basic rights that are provided for in constitutions and international statutes.

Anna Miti is an AVAC 2015 Advocacy Fellow. This post first appeared on her personal blog.

That old adage about a glass… the half full half empty theory? It always gets me thinking whenever I am in a reflective mood. Such as today when I think of the my Fellowship, of which I am now right in the middle of, six months have passed and six are left to go. In this blog I reflect on the past six months, and also outline what I hope to achieve over the next six so here we go…

What I Have Achieved

1. Making the jump

   I have “always” been in media, broadcasting in particular. I had a weekly program on national radio by the time I was 21, still in college and studying Mass communication. It is pretty much all I have ever known. Making the jump from being a journalist to an advocate was a daunting task, no matter how prepared I said I was, it was a scary move. I did not know whether I would even make past a month, in spite of my bravado! With the exception of motherhood and marriage I can safely say it was the most challenging thing I had to do in my life. Now I am not just another reporter, but a go-to person for media and HIV prevention issues.

2. Creating civil society network with an agenda towards HIV prevention

   As a journalists the first thing that you learn is that people don’t really want you in their meetings, whether government, corporate or civil society organisations. It is fair because as a media person my role would be ferret out news, and unfortunately “bad” news sells better than “good news” so all the above mentioned entities have at one time fallen on the bad side of media. To convene a meeting with civil society, of which most of them knew me as Anna the journalist was no mean feat. It was hard to get them to trust that I was not inviting them to a meeting so that I could find a good story, but rather to talk issues close to their hearts.

   In a country where homosexuality is not just shunned but actually criminalised, and sex work is openly regarded as a shame, it was next to impossible to have the Gays and Lesbians Association of Zimbabwe and an organisation which supports sex workers to have a meeting where media was also invited and it actually turned out great. To date I can count over 23 organisations in my network, all of whom agree that PrEP is the way to go and are looking out for the Microbicide trials results. To have journalists who are keen to learn more, not just in order to get a good story, but write and broadcast HIV prevention stories with understanding. Not just local journalists, but to actually push for a regional organisation for journalists working in health all wanting to find out and write about new HIV prevention tools and see the organisation blooming was also a great experience for me. As a network we do not just talk about PreP and other options, but reach out to all our other networks as well.

   The end result has been that PrEP has become part of the Agenda in more forums. The aim of this is to increase awareness in order to create demand for Prep. Our call has been heeded such that PrEP has been inputted to the such as National AIDS Council, which is in the middle of coming up with the Zimbabwe National AIDS strategy policy (ZNASP3), which among other things highlight the importance of the inclusion of sex workers and the LGBTI community as key populations.

3. Increasing media coverage around new HIV prevention technologies

   Over the last six months I have seen colleagues in the media calling or texting me wanting to be linked to researchers or certain individuals because they were doing a story on the AIDS vaccine or just to find out about what exactly I do. It is even more heartening to see a full page feature on the vaccine trials in Zimbabwe. This was not part of everyday news stories before. It felt good to hear issues of Microbicides being discussed in programs broadcast in Shona and Ndebele, indigenous languages of Zimbabwe.

There are other fun things that happened along the way, my first trip to the United States, being seconded into the ICASA 2015 communications sub-committee, being interviewed on radio instead of being the interviewer, mentoring a journalist for the first time and very important—having my very own blog!

Of course it was not all fun and games, I have learnt quite a few lessons along the way, some painful some… I am still learning. I have had my fair share of disappointing moments, times when I actually felt like quitting. But I`m still here, counting the lessons…

Lessons Learnt

In journalism the means justifies the end, we do not care how you got the story, just get it. In civil society and advocacy the process is just as important. No matter how good the end result is, if the process has some missing elements which aid in transparency, it will be not a good end.

Politics, religion, cultural and environmental situations play big role in achieving targets and goals. They are make or break rules and should be considered all the time, no matter how right your advocacy seems. Failure to negotiate politics, not just of the land but politics of the office, of the mind even family will result in failure.

There is no Shona or Ndebele word for Microbicides—Shona and Ndebele are the most widely spoken local languages in Zimbabwe, trying to translate microbicides without offending anyone is like walking a tightrope!

Sometimes the people we try to teach can actually teach us. I have always been surprised when I try to talk to young women about HIV prevention. They may not have scientific knowledge of biomedical interventions, but they know what they want. The also know solutions to the issues the are facing. They speak with such confidence about their reproductive health that all our assumptions about young women are wrong, like young women can not adhere to PrEP, or that they do not have a clue about what they want. Given the right options young women can take charge of their health. I have actually learnt some things from them.

HIV advocacy can be really frustrating-HIV/AIDS is far from over. We want to end AIDS by 2030 but we have HIV positive people who fail to access mediation. Young people are still being infected with HIV, babies are still being born with HIV and less than half of them get medication in time. Hospitals do not have basics such as paracetamol and relatives of patients are asked to buy their own items such medical sutures in order to get treated. Young women are so vulnerable to HIV infection.

In my work I have heard stories that left me emotionally drained. Like when I met a young woman, all 16 years of age, “married” with two children, one of whom is HIV positive. The young girl was raped by a neighbour and her family forced the rapist to marry the girl when they realised she was pregnant. The stories of stigma, perpetrated by siblings of a 17 year old teenager, born positive, both parents late having succumbed to complications of AIDS, now she is in the care of HIV negative siblings. Some issues just made me angry – like news headlines that read “hooker infects man with AIDS” — in 2015 someone media houses still use such negative words. And what is “AIDS infection”? I have also been frustrated by the response to my advocacy from some civil society players — their negative attitude to PrEP and a been-there-done-that attitude, basically telling me I should stop wasting time.

The Rest of the Glass

In spite of my challenges and taking stock of all that has been, I can only look forward to the next half year. For the next six months of my fellowship I want scale up my advocacy. I want to use my voice for what I believe in. The glass is half full, I just need to drink it… bottoms up!

John Mutsambi is a 2015 AVAC Fellow, hosted by TB/HIV Care in Cape Town. He is a community engagement specialist whose experience spans two decades working on HIV prevention and implementation. John has developed and managed community engagement programmes at clinical trial sites in six countries in eastern and southern Africa, including IPM’s Ring Study, HPTN 052 and BufferGel and PRO 2000 microbicide studies. As a 2015 Fellow, he’s working to speed up regulatory approval of Truvada as PrEP, codify the Southern African guidelines for PrEP into policy and create demand for PrEP.

“Who knows my HIV prevention needs, fears and experiences better than myself?” asked a young woman at a recent community event in Cape Town. She considers herself at high risk of HIV infection. And I agree with her and others at risk that they know their sexual situation better than anyone. It is only when we mentally put ourselves in their shoes that we gain a sense of what they are going through. Our ears need to be awakened to hear what people are saying. This awakening should move our hearts to action. But what prompts me to make this statement?

As an HIV prevention advocate who works closely with a host of people from different walks of life, it touches the deepest part of my life to hear those at high risk of HIV calling for access to scientifically proven HIV prevention options. One of these options is pre-exposure prophylaxis (PrEP), an evidence-based biomedical intervention to prevent HIV infection. PrEP is an exciting new HIV prevention tool, which if taken correctly and consistently, can prevent HIV infection by more than 90 percent.

For most of the voices demanding PrEP, the existing interventions aren’t sufficient. Even though they may not be heard at the moment in South Africa, these voices are very clear and they carry an emotional urgency – one that calls for attention. Their demand is expressed in different forums such as community meetings, informal dialogues and in conferences, to name a few.

On 8 August, for instance, I jointly organized a large community event with other civil society partners to celebrate Women’s Month in Cape Town. Here, women expressed a great demand for PrEP. “How and where can we get PrEP?” asked some of the young women. The demand for PrEP, as I have seen, increases proportionally with the level of awareness created.

Also at the 7th South African AIDS Conference held in Durban in June, young women demanded that PrEP be made available without any further delays because it is the only HIV prevention tool that they could initiate without a partner’s consent. They emphasized the need to be involved in decision-making when planning for the rollout of PrEP and asserted “Nothing for Us without Us”.

To effectively access PrEP, the young women pointed out that health workers’ negative and judgemental attitudes towards them should change. “We recommend that youth-friendly clinics be established and that health staff be sensitized about the unique needs and problems that young people face,” said one of the young women at the conference.

Sex workers have also expressed a high demand for PrEP. Some have even stated their support for the possibility of a long-acting injectable PrEP option and the ongoing clinical trials. It is this expressed demand for PrEP that collectively spurs prevention advocates into action.

By citing only a few key groups above, the reader should not assume that these are the only people demanding PrEP. It is in fact different people who perceive themselves to be at high risk of HIV infection whom we talk to during outreach who are eagerly waiting with anticipation for its availability.

In spite of all this, the people’s wishes have either been drowned out by voices of power or the politics of inaction and even complete silence. Nothing is more disheartening today than knowing that PrEP is here, and yet so far unavailable due to regulatory and other hurdles. We must heed the advice of Woodrow Wilson, the 28th President of the United States of America, who advised that, “The ear of the leader must ring with the voices of the people.”

Getting PrEP into people’s hands so that they can prevent themselves from HIV infection should be placed high on the HIV prevention agenda of African countries if we are to drive down the HIV incidence. Of course, PrEP won’t work in isolation of other options. It should be rolled out as part of combination prevention, along with male and female condoms, prevention of vertical transmission, syringe exchange and harm reduction, medical male circumcision and treatment, among others. Scientists, sponsors of PrEP trials and other stakeholders have already put substantial resources into this research to give us the evidence of its efficacy. What baffles me now is the delay in turning the research results into policies, and then policies into services – more so when the demand for the prevention tool is so apparent.

Oh! this reminds me of the other day when I heard people arguing that there aren’t enough resources to roll out PrEP. They said rolling out PrEP would divert scarce resources from ARVs, which are already in short supply in South Africa. Believe me, rolling out PrEP is not going to be easy in any country. It requires political will, advocacy, generation of domestic sources of funding, continued external resource mobilization, continued donor contributions and commitment, and more importantly, investment based on decisions that are not driven by sentiments but rather evidence.

Advocates and NGOs want to support the Department of Health (DoH) in planning and executing such a rollout. Some NGOs that are already providing comprehensive HIV prevention services to different key population groups in South Africa have suggested that the DoH could take advantage of these existing structures and services to understand how best to integrate PrEP into existing prevention packages. This technical assistance would support the DoH in putting in place structures in district and provincial hospitals to scale up PrEP rollout.

I do not see PrEP competing with, undermining or replacing the availability and promotion of other existing HIV prevention methods, including treatment. In fact, the introduction of PrEP would complement existing strategies and give people a wider choice of options. PrEP would also avert new infections and subsequently result in less need for treatment, putting countries on a more feasible path to UNAIDS targets of ending AIDS. Also, PrEP should not lead to drug shortages. As established by GroundUp, the South African community newspaper, drug stockouts in the country have predominantly been due to poor management not a lack of resources.

How can HIV prevention advocates help PrEP become a reality in South Africa? We need to continue supporting the people’s demand for PrEP. We must urge the Medicines Control Council (MCC) of South Africa to quickly approve the application for Truvada as PrEP. (Truvada is already approved as a treatment drug in South Africa.) And we must continue advocating for extended clinical guidelines for PrEP. This cannot be done without mobilizing resources internally and externally and by civil society working closely with national and provincial policy makers to map the landscape and PrEP agenda together. As we do this, we need to ensure communities are provided with adequate and accurate information about PrEP. What an opportunity we have to make prevention a reality for some of the most at-risk individuals and groups! We must seize it.

This article first appeared on thebodypro.com.

Fred Schaich of IFARA spoke with Mitchell Warren, executive director of the AIDS Vaccine Advocacy Coalition, about HIV prevention research presented at the 8th IAS Conference on HIV Pathogenesis, Treatment and Prevention in Vancouver, Canada. Much of that research confirms what we already know, Warren said. Treatment as prevention works when linked to a serodiscordant relationship, but more prevention services are needed outside such relationships. The Kenyan COUPLES study provides one avenue by combining treatment of the HIV-infected partner with pre-exposure prophylaxis (PrEP) for the uninfected partner to address transmission events not linked to that relationship.

Warren pronounced 2015 “a really important turning point” because research proved that treatment upon diagnosis, coupled with PrEP for anyone at high risk of infection, is the best way to prevent the spread of the virus. Another important development is the involvement of industry in vaccine studies, he said.

However, antiretrovirals alone cannot end the AIDS epidemic, Warren believes. Criminalization and stigmatization of HIV infection must end so that both prevention and treatment services can be implemented. “Even with the greatest antiretroviral, even with the greatest vaccine strategy, if we don’t address those fundamental issues, we do not end this epidemic,” he concluded.

Watch the video to learn more: