2013 AVAC Advocacy Fellows Orientation

Last month, the AVAC Advocacy Fellowship 2012 Wrap-up & 2013 Orientation Workshop took place in Cape Town, South Africa. The three-day gathering provided an opportunity for the 2012 Fellows to present their projects, reflect on the program and discuss their future work as advocates. The 2013 Fellows and their host organization supervisors were oriented to the specifics of the program and discussed their proposed projects for their Fellowship year.

Four years in, AVAC’s Fellowship program continues to expand. New Fellows have joined the program from China and Nigeria — the first Asian and West African countries to be represented. The program has also evolved into a network with strong alumni participation. The alumni network of Fellows—now 23 strong—continues to be engaged and supportive of new Fellows.

A number of 2013 Fellowships directly build on the work of their predecessors. For example, Maureen Milanga’s 2013 Fellowship is building on Jacque Wambui and Lucy Ghati’s 2012 work in Kenya to follow-up on HIV-related commitments by political candidates. And Mickey Meji’s work around civil society engagement on treatment as prevention in South Africa will use some of the networks created by Bukelwa Sontshatsha last year.

Bringing together these plugged-in advocates also provided a window into what might be most needed and useful in local prevention advocacy. Their work — both Fellowship projects and continued advocacy by alumni — is focused on the latest research and figuring out how to quickly translate recent findings into policy and to use proven technologies to help their communities.

Following the Workshop, the South African Fellows past and present were also able to work with the AVAC team in coordinating a series of local civil society roundtable meetings on AIDS vaccine research and on the evolving and expanding women’s HIV prevention agenda.

Watch this space to follow the work of the 2013 Fellows and to learn more about the continued advocacy by our alumni.

PrEP Trial Design and Ethical Considerations

In January AVAC collaborated with the French AIDS organization Sidaction to host a meeting, Challenges of clinical trial design, degree of evidence and recommendations in the era of PrEP. The meeting provided a forum for local French researchers and advocates to discuss IPERGAY, the intermittent PrEP study currently underway with men who have sex with men in France. A number of international researchers, advocates and normative agencies were also on hand to broaden the discussion. Advocates on both sides of the Atlantic have questioned the use of a placebo arm in IPERGAY since the US FDA approved daily TDF/FTC (Truvada) for prevention last July. French and other European regulators, however, have yet to approve the use of Truvada as PrEP, therefore it is not currently available for prevention, only treatment.

The daylong gathering brought key stakeholders together to discuss the difficult questions of trial design and ethics—issues relevant not only to IPERGAY but to other current and future biomedical prevention trials. Presentations from the meeting are available at www.prepwatch.com/#sidaction.

While participants in the meeting highlighted the various perspectives on the actual IPERGAY trial design, there was general agreement on the important role of the trial in answering questions around intermittent PrEP, whether TDF/FTC could be taken “on demand”, meaning at the time of sex, and still reduce the risk of HIV transmission.

At the meeting the French organization AIDES called on the French regulatory agency (the National Security Agency of Medicines and Health Products, or MSNA) to approve Truvada via a compassionate use authorization for HIV prevention among most at-risk groups. For a copy of the press release, click here.

Continue following developments at www.prepwatch.org/#sidaction.

Supporting Lubricant Access in Africa

IRMA, amfAR and AVAC are delighted to announce that IRMA Nigeria, in partnership with the International Center for Advocacy on the Right to Health, Stop AIDS in Liberia (SAIL), and an organization in Zambia (which requested to remain anonymous), have been awarded Global Lube Access Mobilisation (GLAM) funding to campaign for access to safe, condom-compatible lubricants in their communities.

Throughout the world, and especially in Africa, safe, condom-compatible lubricant (water- and silicone-based) is inaccessible for most people who engage in anal intercourse. It is also inaccessible for women who engage in vaginal intercourse. A number of analyses in various settings indicate that the use of oil-based products is the most common form of lubrication and is known to significantly reduce condom effectiveness. Faced with the lack of condom-compatible lubricants, people often resort to such products as body lotion, soap, cooking oil, spit, pre-cum, antibiotic creams and even motor oil to provide lubrication during anal intercourse. This lack of appropriate lubricant products for people who practice anal and vaginal intercourse is unacceptable when we know that they can keep condoms from breaking and slipping.

In December 2012, IRMA, amfAR, and AVAC launched The GLAM Toolkit – Advocacy to improve access to safe, condom-compatible lubricant in Africa, Version 1.0. The Toolkit offers tools and ideas for civil society and government partners to secure affordable and sustainable condom-compatible lubricant. Tools include a fact sheet, case studies, the results of a review of African National and Strategic Plans on HIV/AIDS and a list of proposed advocacy activities.

After the Toolkit launch, the group released a request for proposals targeted to community advocates and organizations in Africa interested in improving lube access. Eighteen proposals were submitted from 11 African countries. IRMA Nigeria, SAIL and a Zambian organization received the highest scores in a thorough evaluation process and began their lube access advocacy projects this month. These include speaking with sex workers about lube’s importance, working to increase public awareness and reduce stigma, disseminating the GLAM Toolkit and much more.

To learn more about GLAM, click here, and download The GLAM Toolkit here.

AVAC Partners’ Forum 2012

What happens when 71 advocates from 10 countries gather to survey the state of HIV prevention for the year to come? At the annual AVAC Partners’ Forum (December 4-6), the answer was: a high-energy conversation that just wouldn’t stop.

For three days of plenary sessions and small group work, participants debated, strategized and prioritized—and energy was as high at the end of the final day as it was when the meeting kicked off with an overview presentation on the science of AIDS in Africa, by South African researcher Helen Rees.

The annual Partners’ Forum is a chance for advocates to share experiences, consider upcoming plans, strengthen existing collaborations and forge new connections. This meeting’s highlights were many and varied—and included a review of advocacy victories in Kenya, Uganda, Zimbabwe and many other countries; review and debate of the different definitions of “combination prevention” packages proposed by PEPFAR, UNAIDS and other groups; serious consideration of what non-surgical voluntary medical male circumcision devices will mean in 2013; deep concern over the open question as to whether specific long-acting injectable hormonal contraceptives increase women’s risk of acquiring HIV; and comprehensive updates on each biomedical prevention option and related advocacy priorities in 2013.

The conversation covered a lot of ground—with breaks for song, dance and socializing—but resulted in a focused, ambitious set of goals for 2013. These will take flight through many collaborations and projects in the coming year. Look for upcoming webinars to help advocates get up to speed on key topics—and, as always, contact us if you’d like to be more involved.

Ants Can Kill the Elephant

The following is excerpted from a longer piece by Mannasseh Phiri originally appearing in Zambia’s Sunday Post. Phiri is a long-time HIV prevention practitioner and advocate.

If you have ever heard me make a presentation on HIV and AIDS in Zambia in the last 10 years, you will know that I always start with a picture of a magnificent specimen of a bull elephant standing in its majesty on the banks of the mighty Zambezi. As I show the picture I tell the story of how the African elephant in many ways behaves like HIV—quietly consuming a huge amount of resources.

I was thinking about how I seriously need to rehash, freshen or renew my own presentations’ opening story about the similarity the African elephant to the virus HIV [when I was reminded of] a piece of African wisdom that I hadn’t heard since I was child. “When ants are well organised, they can kill an elephant”. HIV/AIDS is a giant elephant and if we the people organise ourselves well, like ants, we can conquer HIV!

I was recently holed up in hotel in Johannesburg with other ‘ants’—feeding off each other’s energy, enthusiasm, sense of purpose, conviction and determination that the end for this elephant is possible and can be achieved. For this meeting [the AVAC Partners’ Forum] the ants came from Kenya, Rwanda, South Africa, Uganda, Zambia and Zimbabwe—all of them researchers, advocates and activists—with the combined power to make a whole herd of elephants scamper in fear.

It was not just the energy and enthusiasm of the “ants” that floored me. Their technical knowledge and understanding of the detailed intricacies and nuances of the research work they are doing made me ashamed of coming from Zambia. While cutting edge research in HIV prevention with oral antiretrovirals, vaginal and rectal gels, and vaginal rings is going on and advancing HIV science in Kenya, Uganda, Rwanda, Malawi, Zimbabwe and South Africa, Zambia is dithering with approvals because of suspicion.

I feel like the day is not far when I shall no longer need to always wear the AIDS red ribbon and the Until There’s A Cure copper bangle on my left wrist. Thanks to the meeting of the ants, the elephant’s days are numbered.

The GLAM Toolkit: Advocacy to promote lube access in Africa

The GLAM Toolkit was launched at a side meeting of the AVAC Partners’ Forum. GLAM (Global Lube Access Mobilization) is project of IRMA’s Project ARM (Africa for Rectal Microbicides), and this new resource provides background on the status of lubricant access in Africa and strategies for civil society to secure sustainable supplies of safe, condom-compatible lube.

After introducing the Toolkit, advocates discussed needs, innovative strategies and next steps for the promotion of lubricant as an HIV prevention tool. One challenge faced by advocates for lubricant access is the lack of concrete answers about lube safety. The evidence shows that condom-compatible lube (water- and silicone-based as opposed to petroleum-based) keeps condoms from breaking and slipping, which is important for HIV prevention. It is still unclear, though, which lubes are safe in humans and which might cause inflammation, increased shedding of epithelial cells and rectal bleeding. Such effects could possibly make a person more vulnerable to HIV infection.

Laboratory tests show that particular kinds of lube (iso-osmolar: having the same concentration of dissolvable substances in its cells as normal human cells) have little effect on the structure of rectal cells and the integrity of the rectal membrane. Other lubricants with higher (hyperosmolar) or lower (hypo-osmolar) levels of dissolvable substances are shown to alter cell structure in test tubes. Scientists have found that some hyperosmolar lubricants disrupt rectal epithelial tissue in macaque monkeys. The US Centers for Disease Control and Prevention (CDC) is currently conducting a trial in non-human primates to determine whether an unnamed water-based hyperosmolar lubricant affects SHIV susceptibility and transmission. (SHIV is a non-human primate version of HIV.) The CDC has said that lubricants with different chemical properties will be evaluated at a later date using this model.

Advocates have put the need for more clarity around lube safety front and center. As a result, the PEPFAR Scientific Advisory Board recently formed a lubricant safety working group to produce PEPFAR programmatic recommendations on the use of lubricants.

At the advocates’ meeting, participants agreed that there is an urgent need to clearly articulate what is known and unknown about the science, while working to meet the demand for lube from many different constituencies: gay men, men who have sex with men, and others who have anal sex. Women who have vaginal and/or anal sex also need safe, condom-compatible lubricants as well.

Click here to download The GLAM Toolkit.

Planning for Expanded Microbicide Research and Implementation

At the annual African regional meeting of the Microbicide Trial Network (MTN) in Cape Town, South Africa this past October, AVAC and many of our coalition partners led and contributed to discussions about key emerging issues in microbicides research. 2011 AVAC Fellow Brian Kanyemba led a civil society consultation providing feedback for an upcoming rectal microbicide trial being planned for several countries, including South Africa. Several AVAC Fellows and partners also participated in a full-day joint civil society and MTN Community Working Group meeting, Next Steps for HIV Prevention in Women: Tenofovir Gel and Beyond. In addition AVAC Fellow Grace Kamau and partners Bright Phiri of SAT and Catherine Tomlinson of the Treatment Action Campaign (TAC) joined MTN Community Working Group members on a panel discussing community concerns and perceptions and how to continue to educate and involve communities and local media about the research process. MTN, AVAC Fellows and partners will continue to bring community voices to the table, both in understanding the implications of trial results and planning for new trials.

Click for more information.

Momentum for PrEP and Other News from USCA

In October, AVAC’s Kevin Fisher and Deirdre Grant and a number of PxROAR program members descended on Las Vegas for the United States Conference on AIDS (USCA). USCA is a US-focused conference that largely attracts front-line providers from AIDS service organizations.

This was AVAC’s fourth year presenting on PrEP at USCA, but importantly the first time since the United States FDA approved an indication for daily oral TDF/FTC (Truvada) as PrEP in July. Kevin and Deirdre led a seminar session PrEP can protect women and men against HIV! What do we need to know and do so we can translate results into public health impact? Over 75 people engaged in discussions on the state of PrEP research/implementation—the largest audience AVAC has had for this type of session at USCA—highlighting the growing need for information about PrEP, especially in translating research to rollout.

The audience participated in an energetic debate about whether at next year’s USCA, they thought they would be talking about how their communities had integrated PrEP into local HIV prevention efforts. In a reversal from previous years, almost everyone in the room was supportive of the idea that PrEP would be a part of their local prevention efforts. Previous questions surrounding PrEP have begun to be answered and its potential as a new—and needed—HIV prevention option is seen.

PxROAR members were also busy at USCA. Nichole Little led a roundtable discussion on PrEP and women based largely on her ROAR work—Sex, Biomedical HIV Prevention & The New Millennium Woman: Is PrEP The Answer For Me? Kieta Mutepfa helped facilitate a session on Strategies for HIV Prevention Message Development in Specialized Populations: A Case Study of Empowering Young MSM of Color in Los Angeles as Advocates for PrEP. Ebony Johnson was a speaker at the Opening Plenary Breakfast addressing what can be done to turn the tide of the epidemic among women and ensure social and health equity for all women in the United States.

The Change We Need to End AIDS in Uganda

2012 AVAC Fellow Alice Kayongo played a leading role in developing a civil society report, “The Change We Need to End AIDS in Uganda”, which details concerns and recommendations for shaping the national AIDS response in Uganda. This report was presented at the Joint Annual Review (JAR) of the country’s five-year National Strategic Plan (NSP) for responding to HIV/AIDS, which was first launched about a year ago. The mid-October JAR meeting was an opportunity to review progress and gaps. In the weeks leading up to the JAR, civil society participated in reviews of draft assessments of progress on the various elements of the NSP, including prevention, treatment and care, and health systems strengthening.

Kayongo was joined in this coalition effort by Sylvia Nakasi and Bharam Namanya of UNASO (2011 Fellow and Host Supervisor, respectively), and Leonard Okello, Alice’s Fellowship supervisor and Lillian Mworeko of ICW-EA (2012 Host)—as well as a broad range of other advocates.

The report, presented at the JAR, included a 10-point plan to halt new infections, save lives and ensure leadership, and provided a detailed critique of the national AIDS response to date.

This advocacy comes on the heels of a dynamic and successful campaign to increase funding for and recruitment of more than 6,000 health care workers throughout Uganda.

For a copy of the report, reach out to [email protected].

Promoting Combination Prevention Through Song

Remember prevention is better than cure,
Combination prevention will see us through
To conquer this infection, it needs you;
An AIDS free generation begins with you.

Last month 2012 AVAC Fellow Chamu Mashoko and a number of Zimbabwean musicians released “For You, I Will”. The song, which uses the message of taking care of yourself as a commitment to those you love to promote combination prevention, is part of Mashoko’s AVAC Advocacy Fellowship project.

To Mashoko, a song was an obvious way to spread this message. “Music is a universal language and among most Africans, important information is disseminated through music.” The song incorporates different styles of music and is performed in the three main spoken languages of Zimbabwe with the hope of furthering its appeal. It is the latest entry into the Zimbabwean HIV prevention songbook. In July 2012 a trio of famous musicians from Africa, including Oliver Mtukudzi and Winky Dee of Zimbabwe and Vee from Botswana, released a song on voluntary medical male circumcision at the International AIDS Conference.

Since its release, Mashoko and his collaborators have been interviewed on radio and in print and people have expressed an interest in a music video.

Click to listen to “For You, I Will” and read the lyrics.

For you, I’m really going to get HIV tested!
Take all the measures that will prevent us from being infected.
And let’s encourage everybody who is affected,
They need to feel respected and not to be rejected.

Click here to listen.