Good morning, here’s what keeps me up at night…

The following piece is adapted from a presentation given at the AVAC Partners’ Forum by Mannasseh Phiri, a columnist for Zambia’s Sunday Post and long-time HIV prevention advocate.

Several things really! First, at least one night every week I’m awake thinking which 1,000 words to write in my HIV/AIDS weekly newspaper column—before my deadline.

Secondly, elephants! The elephant in the room (that has brought us all together here in this forum!) is HIV—still consuming huge amounts of resources: financial, human, time, etc. There is a proverb from the eastern part of Zambia that says, “When ants are organized, they can kill an elephant”. I lie awake wondering why we, the ants in this room, are not well organized to fight this elephant that is HIV. Why do we in our countries do things differently from (and often without knowledge of) each other’s actions? Why for example is it that MSM/HIV research is permitted in Uganda, Kenya and Malawi where there are similar “colonial” laws criminalizing homosexuality to Zambia’s—where such research is not permitted?

In the Democratic Republic of Congo they have a nice Lingala proverb that says, “A dog has four legs but it only walks in one direction”. How many different directions are we walking as Africans—in HIV/AIDS prevention, research regulation, gay rights, etc?

The good people of Ghana have another proverb I like: “Like a turtle, a man should stick his neck out if he wants to go forward”. As advocates and activists we often must stick our neck out particularly on “sticky” issues. I recently had to go into hiding because I spoke out about homosexuality, MSM and HIV—and sections of Zambian society called for my arrest!

As for Uganda, I am even more confused now after hearing my long-time friend and activist Ruhakana Rugunda say that people of different sexual orientations should feel free to access health services without fear of discrimination! I am still looking for an appropriate African proverb for him and Uganda!

Finally, my five-year-old grandson Nicholas keeps me awake. Nicholas asks a lot of searching questions of me all the time. All of us have a Nicholas in our lives—young, inquisitive, innocent and searching for answers. I look at Nicholas’ eyes and I see him asking me “Koko! What kind of Zambia, Africa and world are you preparing today for my future? What if I am gay?” Look at and listen to your own Nicholas asking you tough questions and you will stay up at night too!

New funding announcement: Advancing exceptional research on HIV/AIDS and substance abuse (RFA-DA-15-005)

Purpose: To support highly innovative research projects that address a biomedical or behavioral issue relevant to HIV and drug abuse and/or lead to new avenues of research or new interventions for prevention and treatment of HIV/AIDS among substance abusers.http://grants.nih.gov/grants/guide/rfa-files/RFA-DA-15-005.html

Fellows 2014 Workshop—Wrapping up and starting anew

It’s been five years since we announced the first class of talented advocates in the AVAC Advocacy Fellowship Program—and in February, AVAC was thrilled to welcome seven new Fellows. These individuals joined the outgoing 2013 Fellows in Harare, Zimbabwe, for a joint wrap-up and orientation Fellows Workshop.

This meeting, held in tandem with the annual AVAC Partners’ Forum, provided updates on issues across the field of HIV prevention and opportunities for capacity building.

The 2014 Fellows plan to tackle a range of issues, including male circumcision implementation in South Africa, women’s prevention research advocacy in Kenya and PrEP introduction in Uganda. For more detail and for the full list of planned Fellowship projects click here. At the Workshop, incoming Fellows heard feedback from peers, alumni Fellows and other colleagues—including advice such as the importance of coalition-building and collaborating, being persistent with government officials and developing talking points for conversations with journalists.

The Fellows Workshop was also a venue for 2013 Fellows to reflect on their accomplishments over the past 12 months, strategize to cement their gains individually and as a group and continue to impact the HIV/AIDS epidemics in their countries and regions. The 2013 Fellows were presented with awards at a reception to celebrate their accomplishments this past year. Videos of each Fellow summarizing his or her project are available on our YouTube page.

New funding announcement: Advancing exceptional research on HIV/AIDS and substance abuse (RFA-DA-15-005)

Purpose: To support highly innovative research projects that address a biomedical or behavioral issue relevant to HIV and drug abuse and/or lead to new avenues of research or new interventions for prevention and treatment of HIV/AIDS among substance abusers. Open to  individual researchers and research teams; not limited to any one area of research on HIV and substance use. http://grants.nih.gov/grants/guide/rfa-files/RFA-DA-15-005.html

Conference Announcement: Controlling the HIV Epidemic with Antiretrovirals–From Consensus to Implementation, 9/22-24/13

IAPAC, in partnership with the British HIV Association (BHIVA), will host a second evidence summit in London, UK, featuring the presentation of data related to and discussion about the implementation of treatment as prevention (TasP) and pre-exposure prophylaxis (PrEP) in various clinical settings.

20th International AIDS Conference (AIDS 2014) theme selected

Stepping up the Pace has been selected as the theme for AIDS 2014, the upcoming 20th International AIDS Conference, to be held in Melbourne, Australia, from 20-25 July 2014.

Evaluation methods for large-scale, complex, multi-national global health initiatives – a workshop

On January 7, 2014, the IOM will host a workshop to share insights gained from the conduct of recent evaluations of the US President’s Emergency Plan for AIDS Relief; the Global Fund to Fight AIDS, Tuberculosis, and Malaria; the US President’s Malaria Initiative; the Affordable Medicines Facility-Malaria; and other large-scale global initiatives.

Evaluation methods for large-scale, complex, multi-national global health initiatives – a workshop

On January 7, 2014, the IOM will host a workshop to share insights gained from the conduct of recent evaluations of the US President’s Emergency Plan for AIDS Relief; the Global Fund to Fight AIDS, Tuberculosis, and Malaria; the US President’s Malaria Initiative; the Affordable Medicines Facility-Malaria; and other large-scale global initiatives.

Advocacy Fellow Ntando Yola at AIDS Vaccine 2013

On October 7, at the AIDS Vaccine 2013 Conference in Barcelona, AVAC Advocacy Fellow Ntando Yola gave a powerful speech on the continued and urgent need for an HIV vaccine. We hope you’ll all view the webcast here—and read on for highlights. Stay tuned to the Advocates’ Network for a conference wrap-up and webinar announcement.

Ntando worked at the Desmond Tutu HIV Foundation as a Community Engagement Coordinator prior to starting his 2013 Advocacy Fellowship hosted by the Networking HIV/AIDS Community of South Africa (NACOSA). In both of these roles, he’s participated in extensive dialogues with communities engaged in HIV prevention research. In the speech, he told the story of Grace, a South African woman living with HIV. “Brother, in ten years we’ll have a vaccine for HIV, won’t we?” she asked him. “At least when the vaccine comes, my son will be 15 years old and he won’t have to worry about HIV the way I have.” Using Grace’s story, as well as his own experiences growing up with—and witnessing the end of—apartheid, Ntando made a strong case for research and stakeholder engagement that reflects the realities of volunteers’ lives. “Trial participants who face everyday living realities in my country like flooded homes in the winter, may face township fires in the summer, live in shared ablutions, have high rates of unemployment. Yet in all these circumstances, they volunteer.”

Science Café in Nairobi

In July, AVAC and Internews in Kenya organized a journalists briefing on PrePex, a non-surgical device for voluntary medical male circumcision (VMMC) pre-qualified by the World Health Organization (WHO). (Click here for more on this process.) This was the first in a planned series of journalist “cafés” designed to spark conversation about VMMC and the role of non-surgical devices.

“Prequalification” is the process by which the WHO determines that a product meets required standards of quality, safety and efficacy for international use. This step paves the way for purchasing by international programs, such as PEPFAR and the Global Fund for AIDS, Tuberculosis and Malaria. PrePex is the first circumcision device pre-qualified by the WHO, and there are currently a range of evaluation studies underway to find out more about its acceptability, safety and feasibility.

Twelve journalists attended the conversation in Kenya—and they had a number of questions. “How will PrePex complement conventional VMMC surgery?” asked Thomas Bwire, an editor with Pamoja FM, a community radio based in the Kibera section of Nairobi. This is an essential question—and one that the evaluation studies described above are designed to address. As countries look at the information from these studies and decide if and how to introduce non-surgical devices alongside surgery, we will get a better picture of how these two options are viewed and sought by men as well as women, who play a key role as parents, partners and allies of men seeking circumcision.

Journalists also asked about the price of PrePex. The currently quoted cost is approximately US$20. There are ongoing negotiations that could bring the price down through bulk-purchasing agreements, but so far no new price has been set.

The journalists also emphasized the need to better communicate the partial protection message to men and their communities. Circumcision does not afford complete protection against HIV transmission and that must be made absolutely clear. VMMC is just part of combination HIV prevention—behavioral interventions, HIV testing, STI treatment, immediate initiation of ART, couples counseling and testing and condoms among others, as the local context dictates.

AVAC is collaborating with partners in South Africa, Uganda and Zambia to organize similar cafés in the coming months. Please contact us if you would like to be involved.