Five Must-Read Recent Blog Posts on the New AVAC.org

AVAC’s relaunched website, avac.org, includes a new blog, P-Values. It’s a place where AVAC, its partners and colleagues in the field of biomedical HIV prevention advocacy have their say about the latest findings, biggest challenges and most exciting successes in our collective work.

Posts include guest-authored pieces by leading scientists, AVAC’s “take” on emerging issues in real time and more.

We hope you’ll visit the page regularly and, to get you started, invite you to check out some recent highlights:

  • What Does PrEP Mean for Condom Use? — Nicholas Feustel, a documentary filmmaker specializing in films on health and human rights and a member of AVAC’s PxROAR program in Europe—a program that connects advocates and builds advocacy skills. In a July interview with the German magazine Männer, he talked about PrEP and the implications of its use.
  • No Turning Back in Fighting AIDS — The past decade of financial and political commitment has resulted in a major expansion of access to HIV prevention and treatment services around the world but these gains remain fragile. In this piece, originally appearing in PSI’s magazine Impact, Kevin Fisher and Catherine Connor—writing as co-chairs of the Global AIDS Policy Partnership—call for increased funding of PEPFAR and further investment in domestic HIV prevention and AIDS treatment programs globally.
  • Corporate Leaders Must Stand Up for LGBT Rights in Africa — AVAC and partners worked in coalition with 26 organizations to develop a sign-on statement urging US corporations to raise the importance of human rights, including rights for LGBT individuals, for the recent US-African Leaders Summit.
  • A Prevention Agenda for Women — There is extensive evidence that integrating family planning services and HIV prevention and treatment isn’t just a good idea, it is the only effective approach to women’s health. A report from a 2013 AVAC/CHANGE meeting on the topic includes recommendations on how to integrate HIV and family planning services along with ideas on how to best move forward in the context of uncertainty about whether some hormonal contraceptives (HC) increase HIV risk and how to advance “method mix”—a wider array of contraceptive choices for women everywhere.

Have a comment on one of our blogs? Want to write something yourself? Reach out to us at [email protected].

New report finds missing and incomplete data imperils the global HIV/AIDS response

amfAR and AVAC call for improved, transparent and timely data collection

A new report from amfAR, The Foundation for AIDS Research, and AVAC outlines the need for a new approach to tracking data to guide the key decisions that shape the response to the HIV/AIDS epidemic. Critical and expensive decisions made with incomplete data are undermining the response—even as the systems for collecting this data continue to improve, the report found. Data Watch: Closing a Persistent Gap in the AIDS Response outlines corrective steps to sustain and expand the progress made in the past few years in the AIDS response and lays out key areas where better, more complete data is needed, including:

  • What proportion of people with HIV globally who are taking antiretroviral drugs remain connected to a clinical provider and have their virus fully suppressed, enabling them to remain healthy and avoid transmitting HIV to others?
  • What proportions of those communities most impacted by HIV (e.g., young women in Africa, gay men and other men who have sex with men, transgender individuals, sex workers, people who inject drugs) do not have access to effective HIV prevention tools due to pervasive stigma or discrimination?
  • Is global AIDS funding focused on those programs that will have the greatest impact in reducing transmission and disease burden worldwide?

The report, supported in part by the M•A•C AIDS Fund, makes the case that if we are to achieve ambitious new targets aimed at ending the epidemic by 2030, we must improve our data systems for the HIV response now. Data Watch updates amfAR’s and AVAC’s 2012 Action Agenda to End AIDS, which made the case for a more businesslike approach to ending the epidemic and proposed a multi-year plan with concrete strategies, targets and timelines.

“There is no doubt that the data we have shows that we are making progress in the fight against HIV/AIDS. Importantly, we are moving toward a ‘tipping point,’ when for the first time the number of people with access to HIV treatment will exceed the number of people who become infected,” said Mitchell Warren, AVAC executive director. “But to keep up the momentum, we must improve data systems and identify specific milestones that we need to meet over the next one to three years to ensure we get on – and stay on – target to achieve these ambitious goals.”

The report documents many cases where data is incomplete or missing, finding that sometimes necessary data collection systems are not in place. For example, in most low- and middle- income countries there is very little tracking of viral load—a measure of the amount of HIV in a person’s bloodstream—among people being treated for HIV. In many cases, data exists but is incomplete or not being optimally analyzed. Poor or missing data limits our ability to drive strategic action and accelerate progress toward ending AIDS.

“Good information is critical for making good decisions, and when resources are limited, data matters even more,” said Greg Millett, amfAR’s vice president and director of public policy. “With global AIDS funding falling far short of what is needed, we must maximize the impact of every dollar. The bottom line is clear: more complete and timely data will help save more lives.”

The report calls on UNAIDS, the US-funded PEPFAR program, and the Global Fund to Fight AIDS, Tuberculosis and Malaria to dramatically improve their collection, analysis and reporting of HIV/AIDS information. It outlines which data matters the most, including:

  • Coverage of core interventions including HIV testing, antiretroviral therapy, voluntary medical male circumcision, prevention of vertical transmission, male and female condom availability, and harm reduction programs.
  • Disaggregated information by gender, age, key population status, and other key factors. Overall numbers are insufficient.
  • Indicators of service quality including percentage of people on ART with undetectable viral load tests, retention in care data and more.
  • Impact data on incidence, HIV prevalence and AIDS-related deaths are the ultimate indicators of success.
  • Results-linked expenditure data sheds light on where programs are achieving results and on how reallocation of resources could improve program impact.

As part of the Action Agenda to End AIDS, amfAR and AVAC launched Data Watch to help advocates track progress—and to hold the key sources of global HIV information accountable for timely, accurate reports. An Action Agenda to End AIDS, launched by amfAR and AVAC at the 2012 International AIDS Conference, outlined key actions that need to be taken in 2012–2016 to lay the foundation to end the AIDS pandemic. For more information, visit endingaids.org.

The Big Picture of Small Molecules for Curing HIV Infection

Welcome to the first installment of a periodic series of P-values posts by guest authors. We’ll be featuring scientists, advocates and implementers from around the world. If you’ve got a point of view you’d like to share or a topic you’re expert in and would like to explain, Let us know.

This post is the first of what will be a series of posts from scientists working on cure research. Dr. David Margolis and Karine Dubé of The Martin Delaney Collaboratory of AIDS Researchers for Eradication explain one strategy being pursued by scientists as a possible way to cure HIV. After reading this, if you want to learn more check out this video on related research.

Highly active antiretroviral therapy (HAART) is a true miracle of modern science and has contributed to saving millions of lives worldwide. HAART can successfully reduce plasma HIV-1 levels in adherent HIV-positive patients to below the detection limit of clinical assays. As wonderful as HAART is, it does not clear HIV from the human body, but can only suppress it. HIV remains dormant or latent in around 1 out of every million white blood cells in suppressed patients in the form of HIV provirus that becomes integrated within the human genome (also called the reservoir).

There are several approaches to eradicating latent HIV infection that have been proposed by the Martin Delaney Collaboratories, including, but not limited to: intensification of HIV treatment in the acute phase of infection, gene therapy and stem cell transplantation research as well as latency reserving agents. Latency reversing agents are small pharmacological molecules that would help uncover where HIV is hiding in the cells of HIV-infected patients whose viral load has been suppressed.

The Collaboratory of AIDS Researchers for Eradication – CARE – endorses the approach of small pharmacological molecules to finding a cure for HIV infection. We believe that this method represents the safest, most scalable, and accessible strategy to eradicating HIV in the future. By using established drug discovery tools, we hope to launch a pipeline of small pharmacological molecules to be used in human studies. These small molecules would induce the expression of the replication-competent latent HIV proviral genomes within resting CD4+ T cells and make them susceptible to the immune clearance and the effect of HAART. In the literature, this is also called the “shock and kill” strategy or “induction and clearance.” This method relies on reactivating the rare remaining reservoirs while patients take their HAART.

Our priority is to discover new molecules that are safe and can act alone or in synergy with other drugs to reactivate HIV virus transcription. We screened over 10,000 new pharmacological molecules and we are examining their mechanisms of action. As these new compounds have various levels of potency and toxicity, it is important to evaluate them carefully using cell models and animal models before advancing them into clinical testing. Experiments are being conducted in vitro (in artificial laboratory cell models), ex vivo (in patient’s cells studied in the laboratory) and in vivo (in animal models or real human patients) using various cell lines and animal models, included humanized mice and non-human primates.

The small pharmacological molecules being proposed would act as inducing agents to disrupt the state of proviral latency. Examples of small molecules that have been studied include inhibitors of histone deacetylase (HDAC) that play a role in maintaining HIV in a transcriptionally silent state. For example, Dr. Archin and colleagues demonstrated in a proof-of-concept study that a single dose of the drug vorinostat, an HDAC inhibitor, can disrupt HIV latency in HIV-positive patients on HAART. HDAC inhibitors have several advantages compared to other latency reversing agents. Because they have also been studied extensively as part of anticancer trials, we know more about their toxicological and pharmacological effects at this time.

Studying small pharmacological molecules also means that we need to carefully examine the regulatory pathways for these drugs. For example, the positive transcription elongation factor b (P-TEFb) plays an important role in regulating HIV transcription. When P-TEFb is active, this means that HIV viral transcription is stimulated. Another protein required for HIV expression is NF-κB, which is an activating regulatory protein needed for the transcription of many genes.

We are also studying molecules that induce signaling using the protein kinase C (PKC) pathway. Some of the PCK agonists under investigation include prostatin (which can induce transcription of latent HIV-1 in J-Lat cells and peripheral blood mononuclear cells (PBMCs) from HIV-positive patients on HAART). Two other PKC agonists under study include bryostatin and ingenol; however less is more about these compounds’ ability to safely induce HIV expression in vivo.

At this time, we cannot predict which compounds or combination of compounds may be effective at inducing expression of proviral DNA. We hope to investigate synergy both mechanistically and mathematically. Ideally, the chosen pharmacological molecules will reactivate latent HIV provirus without inducing a global activation of T cells. We also hope to get around the problem of toxicity by using low concentrations of the most effective inducing agents.

Once the HIV provirus is being expressed, the immune system needs to kill the infected cells. It will thus be important to re-invigorate the immune system of HIV-infected patients to ensure an effective immune response, so latency reversing agents can be used with immune-based therapies. For example, some of the immune cells could be expanded ex vivo and then be re-infused into HIV-infected patients.

Scientists within the Collaboratory are also working on ways to improve measures of the HIV reservoir. As of now, the quantitative viral outgrowth assay is the gold standard in terms of measuring replication-competent proviruses from resting CD4+ T cells. We are also using digital droplet PCR testing to quantify HIV DNA.

We are excited about the prospect of studying new latency reversing agents – as well as combinations of agents – that would be capable of aborting the state of HIV proviral quiescence. This strategy offers a diversity of options for the advancement of new compounds into clinical trials. It is also the safest way forward. We believe that small molecules represent the big picture for curing HIV infection.

CARE Website:
www.delaneycare.org

If you have any questions, please send them to:

  • Dr. David Margolis ([email protected]), Principal Investigator, The Collaboratory of AIDS Researchers for Eradication (CARE)
  • Karine Dubé ([email protected]) Program Manager, The Collaboratory of AIDS Researchers for Eradication (CARE)

No Turning Back in Fighting AIDS

This first appeared on PSI’s blog, Impact. 

The 20th International AIDS Conference marks a pivotal moment in the fight to end the AIDS pandemic – one that captures both the promise and the challenge of the years to come.

The past decade of financial and political commitment has resulted in a major expansion of access to HIV prevention and treatment services around the world. The public health impact of this commitment is both significant and unprecedented. Nevertheless, the gains are fragile and more must be done to reach everyone in need.

Almost three years ago, the United States government revitalized its commitment to ending AIDS through the ambitious goal of reaching an AIDS-free generation. Bipartisan support for the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the U.S. contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria, continues to bring us closer to meeting this goal. Last year, President Obama announced that his target for supporting 6 million people on treatment by the end of 2013 was ahead of schedule. And Secretary of State John Kerry announced that 1 million babies globally have been born HIV-free thanks to PEPFAR support.

PEPFAR has been instrumental also in one of the most impressive turnarounds in the global response to AIDS, providing access to voluntary medical male circumcision (VMMC). VMMC has been shown to reduce a man’s chances of acquiring HIV from a female partner by nearly two thirds. PEPFAR had supported 4.7 million circumcisions by the end of 2013.

This support has been critical. Investments in the global AIDS response are working. In 2012, there were 2.3 million new HIV infections, the lowest number of annual new infections in almost a decade. Twenty-six countries have seen a 50 percent or greater drop in new HIV infections since 2001.

Globally, new partnerships are emerging – 53 percent of all HIV-related spending in 2012 came from the governments of countries tackling the epidemic domestically. Costs of treatment have also decreased dramatically. In the mid-1990s first-line antiretroviral therapy was $10,000 per person per year. In some low- and middle-income countries today it is $140. Through this efficient use of resources and an increased investment, we stand poised to reach an important ‘tipping point’ in the fight against HIV and AIDS, in which the number of individuals receiving HIV treatment exceeds the number of new HIV infections.

Sadly, the challenges ahead of us remain daunting.

To date, 16 million people in Africa who are eligible for antiretroviral therapy cannot access treatment. The treatment-eligible children living with HIV in sub-Saharan Africa are only about half as likely to receive antiretroviral therapy as HIV-positive adults. And though HIV rates are declining globally, rates for certain key populations appear to be rising in several regions.

Yet international support for HIV efforts has remained flat or – as in the case of PEPFAR – dropped in recent years. Without expanded and sustained investment in cost-effective treatment and evidence-based prevention, there is a very real danger that we will reverse the prevention gains of the last decade.

As Secretary Clinton said when she launched the US Blueprint for an AIDS Free Generation: “The goal of an AIDS-free generation may be ambitious, but it is possible with the knowledge and interventions we have right now.”

It would be a great tragedy to miss that opportunity. Rather than fall behind, we must step up the pace and end this once and for all.

We’ve come too far to turn back now.

What Does PrEP Mean for Condom Use?

PxROAR member Nicholas Feustel spoke about PrEP to the German magazine Männer. What follows is a translation into English Nicholas did for us. The original article, in German, is available here.

PrEP (pre-exposure prophylaxis) is all the rage in the HIV prevention field, especially since the WHO reviewed the strategy positively. It‘s a heated debate: Do we still need to wear condoms to prevent HIV infection? Are HIV-negative people going to ‘prep‘, i.e. taking the HIV drug Truvada, the only one of which we know for sure that it can prevent HIV transmission? To help answer some of these questions, we spoke with Hamburg resident Nicholas Feustel, who advocates for PrEP.

Nicholas, you work with “AVAC – Global Advocacy for HIV Prevention”. What do they do and why are you with them?

AVAC is an organization headquartered in the USA, which advocates for biomedical HIV prevention. Much of their work is introducing new prevention options in addition to condoms. I personally would like to advocate for the destigmatization of PrEP and people who would like to take PrEP here in Germany, even before PrEP becomes available here.

Is AVAC associated with the pharmaceutical industry?

No, not at all.

Who should be taking PrEP in your opinion? Many read the World Health Organization recommendations and thought, “just because I’m gay, it doesn‘t mean that I have to take medication”.

Yes, the WHO statement was misinterpreted by very many people. The WHO is not saying that all gay men are to take PrEP, but that all gays should consider it. The WHO recommendations act also as political statements rather than individual instructions. In this case, the WHO wants to push PrEP as an option, now that we know that it works.

However, who should be taking PrEP?

The main target group are people who do not or do not always use condoms during sex. It is for those who find that condoms are not an appropriate way to protect against HIV for them. With PrEP, they could still make the decision to protect themselves from HIV. There just are many who do not get along with condoms. Be it because they lose their erection when putting on the condom or they want to be close to their partner without a latex barrier. And we know that many of the new infections occur in supposedly monogamous relationships. Or, for example for women, if it is not possible for them to get their partners to use condoms, PrEP could provide suitable protective ability. Ultimately, I do not care why people don‘t use condoms, I do not want to judge their behaviour morally. Some just don‘t, period.

But haven‘t we got used to condoms more or less? Why change our strategy now?

No one is to change their strategy. If condoms work for you, absolutely continue to use them! But consider this: When HIV and AIDS emerged, condoms were the only way to have safer sex. As a result, we got drummed for 30 years that only gays who have sex with condoms are good gays. And sex without a condom is evil, evil, evil. Imagine we already had a PrEP drug when HIV and AIDS emerged. Would people have chosen to use condoms or take a pill once a day? I think people who do not or do not always use condoms are not “hedonistic bareback sluts”. Condoms are simply not the appropriate means to protect themselves from HIV. PrEP could be an alternative for them.

Condoms also protect against other sexually transmitted infections (STIs).

Yes, but not fully. Many STIs are transmitted during oral sex. If someone who doesn‘t use condoms, but takes PrEP to protect themselves from HIV, that‘s already quite something! And also, for a new PrEP prescription you have to go to see your doctor every three months, where they will test not just for HIV but other STIs as well. With PrEP, people engaging in high-risk behavior would go to see a doctor regularly and other STIs would be detected and treated early. This might even reduce the spread of other STIs.

The drug used for PrEP, Truvada, does have side effects, right?

Commonly seen side effects of Truvada are short term gastrointestinal problems which usually disappear after a few weeks, and not everyone will experience these. Long-term side effects may include impairment of renal function and bone density. Again, not everyone will experience these. The good thing is, if you take Truvada as PrEP you can stop taking it any time.If, however, someone has been infected with HIV, they will be on treatment for the rest of their lives. When arguing against PrEP because of side effects, one must always consider PrEP and HIV therapy are two different things. PrEP with Truvada consists of two active ingredients, normal antiretroviral therapies have three active ingredients, so there is the possibility of more side effects. And in HIV therapy there is also HIV in the body—this is also a health aspect.

But we still don’t know the long-term effects of PrEP and what risk there might be.

Of course we do not know what long-term effects PrEP may have. But Truvada has been used for 10 years in HIV therapy and is considered one of the best tolerated HIV drugs. And as the activist Peter Wiesner once said: Do we know the side effect of long-term, 20 years condom use? What does it do to our psyche? Instead of being able to have truly uninhibited sex – and I think there is nothing wrong with this desire – there is this constant fear of HIV, always the bad conscience, if you didn’t use a condom.

I think these considerations are, however, irrelevant, because we do know not everyone uses condoms all the time. We have not reached these people despite 30 years of prevention messaging around “fucking with condoms”. We could tell them for another 30 years, they just won‘t. Wouldn’t it be better to offer an alternative?

Why do we only hear of Truvada? Are there no other drugs available as PrEP?

Truvada is the only one we know from studies that, when taken daily, has a really high level of protection against HIV, higher than condoms. Currently there are also so-called long-lasting injectables in development. Then PrEP could perhaps mean just a once per month injection, or every three months, and you would be protected against HIV. However, it will probably take another 10 years until that is available.

For Truvada manufacturer, Gilead, PrEP must be a gold mine.

-ish! The patent for Truvada expires in 2017, then there could be generics, that is, exactly the same active ingredients, but from another manufacturer and cheaper. This means the prices will go down then. The PrEP market is not really exciting for Gilead, because it‘s not like millions of people will take PrEP. It will be only a small group of people who find that PrEP is the better method of protection for them. Do you think PrEP will play a role in Europe? I hope so! We have to admit: we are moving towards a post-condom era.

For those who want to use them, that’s perfectly fine, but there are also many men who simply can not be bothered to continue to use them after more then 20 or 30 years of condom use. Or young people who just haven‘t experienced all the dying. They say: Sure, we know the films of yesteryear, but now those taking drugs do well. And that is also what we want to achieve with the whole anti-stigma work: Nowadays you can live a normal life with HIV. Nevertheless, I find it is worth still trying to protect yourself from HIV. Science has moved on, and we know that those drugs that let people with HIV live long and healthy lives, and under successful therapy renders them virtually uninfectious, can also protect HIV-negative people from acquiring HIV.

Corporate Leaders Must Stand up for LGBT Rights in Africa

AVAC and partners are putting public pressure on US corporations who will be meeting with African leaders during the week of August 4th in Washington DC. We are working in coalition to develop a sign-on statement that will be published in media outlets and complemented by country-based advocacy in Africa, asking US corporations that have made public commitments to human rights, including rights for LGBT individuals, ask African governments to provide the same protections for their citizens. It’s good for public health and good for business.

The text of the sign-on statement is below. An important background document, developed by the Population Council, summarizes the public health impact of these bills. PLoS Medicine has an article reinforcing these points. To sign on or get involved in ongoing work please contact us. Please note the deadline for signing on is August 1st, 2014.

Sign on statement:
Corporate Leaders Must Stand Up for LGBT rights in Africa

US companies committed to lesbian, gay, bisexual and transgender (LGBT) rights, including, Coca-Cola, Dow Chemical, General Electric, IBM, MasterCard and Walmart, must take a stand for human rights and against stigma and homophobia, including anti-homosexuality legislation, that compromise the safety, health and lives of LGBT people throughout Africa. Each of these companies have clear policies that protect LGBT people from discrimination in the work place, and each of these multinational corporations has supported actions across the US and globally that promote non-discrimination and affirm the human and legal rights of LGBT populations.

Same-sex relations are illegal in 37 African countries. Ugandan President Yoweri Museveni and Nigerian President Goodluck Jonathan are in Washington this week at the US-Africa Leaders Summit discussing US investment in Africa. Both of these African leaders signed laws this year that call for imprisonment of citizens who dare to be openly gay, lesbian, bisexual or transgender. Under the laws, individuals who work with associations of LGBT can be prosecuted as well. The Constitutional Court of Uganda recently ruled against that country’s new anti-homosexuality law. Now is the time to urge President Museveni and these other 36 African heads of state to protect the rights of all citizens.

The CEOs of the listed companies who have investments, corporate partnerships, and often direct business with African governments including those of Uganda and Nigeria will have the opportunity to address their leaders, including Museveni and Jonathan. These companies’ leaders must use this forum to affirm their commitment to the rights and safety of their employees, customers, and broader communities by speaking out against criminalization of LGBT people, and those organizations working with them. In addition to violating human rights, anti-gay laws, policies and practices undermine progress made in combating the AIDS epidemic by further marginalizing the very populations most in need of HIV services.

As public health, human rights and HIV/AIDS advocates, we call on these leading corporations to play their role as global champions for equality—make it clear that financial investments require an environment that promotes the rights of all members of society, including sexual minorities.

Equal treatment under the law is not just good for health; it’s good for business.

Organizational Signatories:

AIDS Foundation of Chicago
AIDS Project Los Angeles
amfAR
Anova Health Institute
ATHENA Network
Australian Federation of AIDS Organisations
AVAC
Centre for the Development of People
Center Stage Media Arts
Center for Health and Gender Equality
Coalition for the Defense of Sexual Rights Nigeria
David Kato Foundation
Futures Group
The Global Forum on MSM & HIV
HIV Justice Network
HIV Prevention Justice Alliance
House of Blahnik, Inc.
Housing Works
International AIDS Vaccine Initiative
International HIV/AIDS Alliance USA
International Rectal Microbicide Advocates
Society Against Sexual Orientation Discrimination — Guyana
Sonke Gender Justice
Tennessee Association of People with AIDS
Total Health Empowerment and Development Initiative
Uganda Harm Reduction Network
Youth and Children Rights Shield

Individual Signatories

Angel Luis Hernández, HIV prevention community educator
Brian Kanyemba, Human rights and HIV advocate
Jacqueline Wambui Mwangi, HIV activist
Mannaseh Phiri, HIV/AIDS and sexual health rights activist
Paul Semugoma, Anova Health Institute, Elizabeth Taylor Human Rights Award winner

Global collaboration supports lubricant advocacy projects in Africa

AVAC, amfar, COC Netherlands and International Rectal Microbicide Advocates (IRMA) are pleased to announce seven Global Lube Access Mobilisation (GLAM) awards to projects in Africa.

GLAM, an initiative of IRMA’s Project ARM (Africa for Rectal Microbicides) in collaboration with amfAR, AVAC, and COC Netherlands, promotes advocacy in support of increased access to safe, condom-compatible lubricants for all Africans who engage in anal and vaginal intercourse, including GMT (gay men and other men who have sex with men, and transgender individuals) and heterosexual men and women.

In response to a request for proposals widely disseminated in February 2014, GLAM partners received 36 proposals representing 17 African countries (Botswana, Cameroun, Côte d’Ivoire, Democratic Republic of Congo, Ghana, Kenya, Lesotho, Malawi, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Togo, Uganda, Zambia and Zimbabwe). A diverse team of 20 advocates and public health professionals with an interest in lubricant access in Africa (from Nigeria, Uganda, Kenya, Zambia, Liberia, South Africa, Rwanda, Benin, Canada, Netherlands and the United States) reviewed the proposals.

Seven projects were selected for funding. These projects began in early July 2014 and will complete their efforts in December 2014. Following is a list of these projects.

Alternatives Cameroun (Douala, Cameroun)
Working in collaboration with other organizations in Douala and Yaoundé, Alternatives Cameroun plans to organize meetings and workshops with health officials and other HIV stakeholders in the country. The meetings and workshops will underscore the importance of providing safe, condom-compatible lubricant as part of comprehensive HIV and STI prevention programming. These activities support the ultimate goal of developing and securing a channel for the distribution of safe, condom-compatible lubricant throughout Cameroun.

Centre for Popular Education and Human Rights (Accra, Ghana)
Centre for Popular Education and Human Rights (CEPEHRG) will campaign to increase access, availability, and use of safe, affordable, condom-compatible lubricant by all who engage in sexual intercourse in Ghana, with special attention given to the LGBT community. The group will call for the inclusion of condom-compatible lubricant in the national essential drug list. Educational and social marketing efforts will take place at the community outreach level and through CEPEHRG’s national advocacy work.

Centre Stage Media Arts Foundation (Bulawayo, Zimbabwe)
Centre Stage Media Arts Foundation (CSMA) will convene policy advisory seminars to engage stakeholders from the Ministry of Health, legislators and members of civil society in support of three goals. One, integrate access to safe, condom-compatible lubricant in the Zimbabwe National HIV/AIDS Strategic Plan. Two, advocate for inclusion of lube as a line item in the national HIV prevention budget. Three, campaign for policy and program changes to allow for the distribution of lube through the same public health distribution channels that condoms are distributed through. A policy brief on the integration of lube access into national HIV prevention policies and programs will be produced. Traditional and social media will be utilized.

Community Health Education Services & Advocacy (Dar es Salaam, Tanzania)
Securing government leadership and commitment to amend the national condom policy and include the provision of safe, condom-compatible lubricant in public health facilities is the chief goal of Community Health Education Services & Advocacy (CHESA). The group will work to build multi-sectorial awareness of the importance of lubricant and will engage the Minister of Health and Social Welfare, health care practitioners, community based organizations, as well as members of the GMT community. The public health message will be “Condom Compatible Lubricant Reduces New HIV Infections.”

Men Against AIDS Youth Group (Kisumu, Kenya)
Men Against AIDS Youth Group (MAAYGO) seeks to increase access to safe, condom-compatible lubricants through several methods. The group will conduct a needs assessment and implement a targeted advocacy campaign in Kisumu County for the GMT community, health care workers, and policy makers. Educational workshops will be conducted with the goal of developing a cadre of lube access advocates who will work to improve government policies and programs. A print/social marketing campaign highlighting the importance of lubricant access in HIV/STI prevention programming will be launched.

New HIV Vaccine and Microbicide Advocacy Society (Lagos, Nigeria)
The strategy New HIV Vaccine and Microbicide Advocacy Society (NHVMAS) will take to improve lubricant access in Nigeria will be to create public demand for these important products for both men and women. Advocacy will be conducted at the state and national levels to promote government investment in lube access. NHVMAS will utilize its listserv, engage the media, and conduct trainings to enhance community awareness of the importance of safe, condom-compatible lubricant in HIV/STI prevention programming.

Partners in Health Research and Development (Thika, Kenya)
The work of Partners in Health Research and Development (PHRD) will seek to improve knowledge of and access to condoms and safe, condom-compatible lubricant among key populations in Kenya. In addition, the group will undertake actions in support of the establishment of a sustainable condom and lubricant delivery system. Sensitisation sessions will be conducted for stakeholders including HIV prevention advocates, civil society coalitions, policy makers, government officials, donors, condom distributors and the media. The inclusion of safe, condom-compatible lubricant in the National Strategic Plan is one of the project’s key projected milestones.

Related materials:

Click here for the GLAM Toolkit in English in French.

The GLAM initiative supported three African projects in 2013. Click here for a GLAM PowerPoint presentation that includes information on these projects.

Click here to access the Project ARM report, On the Map: Ensuring Africa’s Place in Rectal Microbicide Research and Advocacy, published in 2012.

2015 Fellowship Deadline and Spotlight Release

We’re proud to announce the new issue of Spotlight, an annual publication highlighting the accomplishments of the AVAC Advocacy Fellows program, has been released.

If you want to be a part of the Fellows program, the application deadline is Monday, August 4. Learn more and download application materials at www.avac.org/2015fellowsapps.

Download this year’s issue of Spotlight to see what role AVAC Fellows play in shaping the ever-evolving landscape of HIV prevention. Coverage includes:

  • A review of key activities at AVAC’s 2014 Annual Advocacy Partners Forum and Fellows Wrap-Up & Orientation Workshop
  • An introduction to 2014 Advocacy Fellows
  • A look at Fellows’ work on LGBT advocacy
  • An analysis of how Fellowship applicants’ areas of interest have changed over the past five years
  • Updates on what Alumni Fellows are doing today
  • Reflections on the best part of being an Advocacy Fellow
  • A Memorial tribute to 2013 Fellow Taiwo Oyelakin

Prospective applicants or host organizations who want to learn more about the Fellowship program or have questions about the 2015 application process are encouraged to:

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

Therapeutic HIV Vaccines: Prior setbacks, current advances and future prospects

Getting into a taxi in any country and ask the driver about the AIDS epidemic is a great way to learn about local views and priorities—and to gauge what news has grabbed the popular imagination. From a decidedly unscientific survey, we’ve found that the notion of a cure for AIDS has dominated taxi discourse—and conversations in many other places—for much of the past year. One of the stories that seized attention of drivers, advocates and scientists was that of the “Mississippi baby”—an infant who was treated after birth with highly active antiretroviral therapy and was then lost to follow up. When she returned to medical care, she had no detectable virus in her blood—and it was thought that she might be cured of HIV.

Recently, there’s been disappointing news of a reversal in this case. Doctors have now detected HIV in the child’s blood for the first time in the two years that she spent without taking antiretrovirals. The fact that the child spent that much time off treatment with no detectable virus is intriguing, since it suggests that she was effectively controlling the virus via immune responses. The fact that the virus returned underscores how far we may have to travel to get to a cure. Treatment Action Group’s Richard Jefferys has an excellent blog post summarizing knowns and unknowns around these developments.

For a look beyond the headlines at the agenda, funding needs and challenges related to cure and therapeutic vaccine research, check out a recent article by AVAC, the Treatment Action Group, and the Global HIV Vaccine Enterprise. This piece builds on the discussions at a workshop on therapeutic vaccines that the groups held together in September 2013 and which included over 100 researchers, funders and advocates to discuss current issues in therapeutic HIV vaccine research and development.

Therapeutic vaccines are tools that aim to help people with HIV control the virus through enhanced HIV-specific immune responses. No such vaccine exists but in theory it could improve treatment efficacy or perhaps, some day, eliminate the need for ART.

Therapeutic vaccines have become a hot topic in cure conversations, too. It’s clear that HIV lurks in dormant, non-replicating cells and that these reservoirs need to be eliminated for an effective cure. Cure research is exploring a variety of one-two punch combinations that would flush out these reservoirs and then neutralize the remaining virus. A therapeutic vaccine could be an ideal tool for the second step in this process.

As the recent paper describes, research and investment into therapeutic vaccines has languished in the past few years. The paper suggests that there is a way to revamp and refocus the current pipeline of candidates to target immune responses not found in natural infection or targeted in previous studies. The paper notes that strategies to enhance vaccine responses in the therapeutic context should develop separately from work on preventive vaccines—but that the two fields should be in close communication to maximize synergies.

Unfortunately, when there’s a setback like the viral rebound in the Mississippi baby case, this too makes headlines and can turn “taxi talk” to despairing statements about how we won’t ever vanquish the virus. The truth is that we don’t yet know whether therapeutic vaccines can be developed to effectively control ART—and we don’t know whether a cure will be possible. But it’s important to move forward with sustained and energized research. There are clues to follow and uncertainty is unavoidable. At a moment like this one, when the headlines are reporting disappointing news, it’s especially important for advocates to help convey the necessity of moving forward.

A Prevention Agenda for Women

Thirty-plus years into the epidemic, there is extensive evidence that integrating family planning services and HIV prevention and treatment isn’t just a good idea, it is the only effective approach to women’s health. The notion that a woman should choose a family planning method in one clinic, and then go someplace else for a conversation about her HIV risk or status and related needs is unsustainable. And yet, there’s extensive work to be done to create a world where the same clinic or conversation encompasses sexual health, pleasure, family planning decisions, HIV risk and/or treatment—as well as gender-based violence, which is rampant and left out of both family planning and HIV conversations.

This week, in Melbourne, women are continuing to carry forward this work—including raising many of the issues highlighted in this report. These conversations are infused with mourning and urgency after the loss of several champions of an effective response to the epidemic and to women’s needs on the Malaysia air flight that was shot down just before the conference began. You can read women’s voices—including AVAC program director Emily Bass and a call to action on microbicide research from Zena Stein and Ida Susser—in the first issue of Mujeres Adalantes, the newsletter of the Women’s Networking Zone at the conference. And you can hear long-time advocate Lydia Mungherera deliver her impassioned and eloquent plenary in the webcasts section of the IAC official website.

Shortly before the conference in Melbourne began, CHANGE released the report from a meeting, cosponsored with AVAC, on “coordinated global advocacy” on family planning and HIV. This report summarizes the key recommendations related to integration of HIV and family planning services, how to best move forward in the context of uncertainty about whether some hormonal contraceptives (HC) increase HIV risk, and how to advance “method mix”—a wider array of contraceptive choices for women everywhere.

In the year since the meeting, advocates have been working to put many of these recommendations into action. An ad-hoc group of HIV and sexual and reproductive health advocates, led by African women’s groups, continues to push for clarity from the family planning community, normative agencies and researchers on how questions about HC and HIV will be addressed. There’s been a lot of activity, if not a lot of clarity. The proposed ECHO trial which would evaluate the impact of several hormonal contraceptive options on HIV risk scaled back its design from four arms to three after failing to raise the funds for the original design. Coordinated outreach by several members of the ad-hoc coalition to members of the FP2020 Rights and Empowerment Working Group has opened up a channel for discussing these issues with an entity that has an international profile and convening power. We will be watching and waiting to see how these types of conversations unfolds in Melbourne and beyond.