New Podcast Episode: Decolonizing Global Health

Dear Advocate,  

Investing in the long-term success of African leadership is essential to breaking cycles that perpetuate inequity and that stall progress in the HIV response. In our newest episode of PxPulse, we explore why and how the decisions that shape global health must be made by those facing the greatest risks. As the world evaluates the pandemic response and debates on decolonizing global health gain momentum, equity in global health has never been more urgent.   

For more than seven years, COMPASS Africa, a civil society coalition of 29 organizations working in three countries as well as regionally and globally, has used data-driven advocacy to improve the HIV response with high-impact campaigns. In January, the coalition underwent a major transition, with Pangaea Zimbabwe assuming the role of secretariat (previously held by AVAC), marking a historic milestone in the development of innovative models for power-sharing in coalition and an important step toward decolonizing global health. These changes in COMPASS come as other efforts, such as negotiations on the Pandemic Accord, are struggling to advance, uphold or safeguard equity. 

Now is the time to test new models. In Decolonizing Global Health: Dr. Madhukar Pai and COMPASS Africa Tell Us Why and How, we explore what it takes to invest in equity and power sharing.

New Episode of PxPulse!

This episode of PxPulse features global health leader, Dr. Madhukar Pai, along with two leaders of COMPASS Africa, Francis Luwole and Barbra Ncube, talking about new models of power-sharing.

Listen now!

Tune in to Hear

Join the Conversation

To continue the conversation, register for the March 26 Choice Agenda webinar, Decolonizing Global Public Health: Exploring the how, from now, til as long as it takes.  

Celebrating Rep. Barbara Lee and the Black Women Who Helped Shape the AIDS Movement

Following Black History Month and during Women’s History Month, it is important to honor Black women who have championed efforts in ending the epidemic and have led the ongoing fight in ensuring healthcare equity and justice for all. Someone who has worn multiple hats both as an advocate and as a US policymaker is no other than Representative Barbara Lee.  

Throughout Rep. Lee’s close to three decades-long tenure as a member of the US House of Representatives, She has single-handedly created material change for people living with HIV and those at risk of infection, marginalization and stigmatization, both in the US and around the world. As AVAC’s executive director Mitchell Warren says, “when the definitive history of this pandemic is finally written, there is no greater shero in our collective story than Barbara Lee. The AIDS response wouldn’t be where it is today without her.” 

From co-authoring the Global AIDS and Tuberculosis Relief Act of 2000 and establishing the framework for the Global Fund to Fight AIDS, Tuberculosis and Malaria, to her instrumental work in drafting and passage of the President’s Emergency Plan for AIDS Relief (PEPFAR), to introducing legislation that would eventually lift the decades-old discriminatory HIV travel ban to the US, to her relentless efforts advocating to reform HIV/AIDS criminalization laws in the US, most recently with the Repeal Existing Policies that Encourage and Allow Legal (REPEAL) HIV Discrimination Act, Rep. Lee has walked the walk. She put grassroots-led efforts at the center of US and global policy in relation to those directly impacted by the HIV/AIDS epidemic. 

Thank you, Rep. Barbara Lee, for the legacy you have built in forging an AIDS-free generation and for centering impacted communities throughout your work. We look forward to your efforts as co-chair and co-founder of the bipartisan and bicameral Congressional HIV/AIDS Caucus and a member of the full appropriations committee in continuing to support HIV/AIDS prevention, education, research and access to treatment while combatting stigma.   

In addition to celebrating the tireless advocacy of Rep. Barbara Lee during Women’s History Month, it’s important to name the Black women who have changed the course of the AIDS epidemic including, but of course not limited to Raniyah Copeland, Dázon Dixon Diallo, Leisha McKinley-Beach, Yvette Raphael, and those we honor in our everyday actions, Hydeia Broadbent, Katrina Haslip, Dawn Smith, and the recently passed, Joan Gibbs. 

HIV Cure Updates and Opportunities

Last week’s Conference on Retroviruses and Opportunistic Infections (CROI) in Denver, Colorado, was full of new research, provocative discussion and debate on a wide range of issues from longer-acting injectable PrEP; the dapvirine vaginal ring (DVR) in pregnancy; doxycycline as post-exposure prophylaxis (DoxyPEP) to prevent sexually transmitted infections (STIs); and so much more. Check out our daily summaries of highlights from CROI and recordings and resources from the daily Community Breakfast Club sessions. 

It was also the setting for important updates on the HIV reservoir lending to new insights into potential HIV cure strategies. Progress in HIV cure research, as part of a pipeline of biomedical tools to help end the epidemic, must be supported and guided by an advocacy agenda that puts communities first. Read on for cure highlights from CROI, new opportunities for cure advocates, and an upcoming webinar on pediatric cure research with Deborah Persaud and Gabriela Cromhout.

Cure Highlights from CROI – Q&A with AVAC’s Jessica Salzwedel

AVAC’s Jessica Salzwedel who leads our advocacy for HIV cure research and serves as the community engagement coordinator for Research Enterprise to Advance a Cure for HIV (REACH), Immunotherapy for Cure (I4C), and Pediatric Adolescent Virus Elimination (PAVE) shares her highlights from the research presented at CROI and insights into what it means for advocacy in this Q&A.

Read the Q&A

“Four preclinical and clinical results stood out because they advanced how researchers might tailor cure strategies to optimize the impact for people with HIV. We heard more about the potential role of sex hormones in directing the immune system in a study looking at fetus acquisition of HIV. Another study showed that women may be better candidates for the so-called “block and lock” strategy. We also heard results from the IMPAACT P1115 trial, which showed that early HIV treatment can lead to control of the virus in children. And a nonhuman primate study of adeno-associated virus (AAV), which delivered broadly neutralizing antibodies (bNAbs) may offer a pathway to a scalable, durable control option for pediatric cure. In basic science new data suggests that autologous neutralizing antibodies in some people delay rebound. And finally, we heard about rare T-cells that seem to resist killing, which could be important in developing strategies that could lead to durable control and eradication of HIV. ” Read the Q&A to see what it all means.  

Join Us for the 2024 Cure Academy

The Advocacy-for-Cure Academy, organized in partnership with the International AIDS Society, awards fellowships to advocates or peer educators to take part in workshops on HIV cure advocacy with international experts. The academy develops fellows’ cure research literacy and reinforces their advocacy and engagement skills in line with recommendations from Research priorities for an HIV cure: International AIDS Society Global Scientific Strategy 2021. Applications are now open. Deadline Monday, 25 March 2024. The next Cure Academy runs June 8 – 10, 2024 in eastern Africa. 

And check out what five alumni from the program are doing with their fellowships intended to create solutions that advance HIV cure research in their local context. 

Webinar

Updates on Pediatric HIV Cure Research From CROI

Thursday, March 2, 10:00-11:30 am EST

Researchers Deborah Persaud and Gabriele Cromhout join AVAC’s Jessica Salzwedel to discuss the latest from CROI on pediatric cure.

REGISTER NOW

Resources

Wednesday’s CROI Roundup

By Jeanne Baron, AVAC Senior Producer & Editor

The presentations on the last day of CROI 2024 highlighted yet again that research conducted in ethical partnership with communities is about developing products and delivering them with speed, scale, equity and impact. Advocacy to build better systems to support the health and wellbeing of people all over the globe is a form of optimism about the future. From cure research findings to racial disparities in health, to regional Mpox responses, to a hard look at rollout challenges with existing HIV prevention options, CROI ended on a provocative note—challenging researchers and advocates alike to leverage what we have while developing what we need.  

Please enjoy our roundup from the final day of CROI and check out our summaries from Monday and Tuesday. And stay tuned for a full update on all the cure research coming next week! 

Community Breakfast Club research roundup 

More than 100+ advocates joined the final Community Breakfast Club meeting. Advocates Natasha Mwila and Moses Supercharger and researchers Carlos del Rio and Christina Farr offered highlights from sessions on the links between HPV and HIV; the latest cure research showing the potential of early treatment in children to control HIV; the potential of injectables for both treatment and prevention; and the need to accelerate access, especially following Tuesday’s SEARCH results. As one advocate on the call said, “We need to demand that access provisions are spelled out by innovators, as early as possible in the product development. Yes, choice is about the options that best suit your needs at any given time. But we can’t have choices when the options are out of reach.” There was also a clarion call to ensure mentorship for the next generation of scientists and advocates. 

The promise and pitfalls of biomedical prevention 

CROI ended on a powerful call to action to better understand the options that exist today and solve the problems of access. At one of the final sessions, Promise and Pitfalls of Biomedical Prevention: Beyond Phase III, three presentations put a spotlight on the status of approved products and the need for choice.  

Rupa Patel from the CDC took attendees through a maze of access barriers facing injectable cabotegravir – from insurance to personnel issues – in the U.S.— the only country with a commercial market at this time. Rollout in other countries is just beginning with initial, limited supply (1.2 million doses for low- and middle-income countries through 2025). Still, it’s moving faster than oral PrEP, where it took more than three years after FDA approval before a single African country approval. In contrast, just two years post-FDA approval, seven African countries have approved injectable cabotegravir, with several others pending. (Check out AVAC’s PrEP tracker for details.) But these gains are still too slow. Patel concluded by offering future solutions, including accelerating the entry of generics in the market, pursuing scientific and regulatory efforts in parallel, and expanding models that build up community delivery of HIV services.  

Leila Mansoor laid out the complex journey of the dapivirine vaginal ring (DVR). Initial efficacy trials reported approximately 30% efficacy, but Mansoor presented additional exploratory analyses that estimated risk-reduction could actually be 75-91% with high adherence. In addition, the REACH study showed that when young women are offered high-quality counseling and choice, it results in high adherence; the young women in REACH preferred DVR to oral PrEP by 2 to 1. Data presented earlier this week expanded the evidence of the DVR’s safety for people who are pregnant and lactating. And 11 countries have approved it. Mansoor’s call to action: women need and want DVR as an option, and it is now being added to the SEARCH study.  

Jenelle Stewart then faced down the doubters of event-driven PrEP by marshalling evidence that the intervention works in men and may work in women. Stewart referenced a JAMA article by Jeanne Marrazzo just last week that high-but-imperfect adherence (4-6 pills per week) was protective for women. She followed with a clear call for event-driven PrEP for women without needing to go through another large, randomized trial. Stewart made several other provocative points, concluding that event-driven PrEP is desired by some, effective, and should be incorporated in public health guidelines.

Latest in Treatment

Wednesday’s news also included exciting late-breaking data about HIV treatment. An interim analysis of the LATITUDE Phase III trial of monthly injectable cabotegravir and rilpivirine showed superior efficacy of viral load suppression compared to daily oral ART in participants with adherence challenges. The Data Safety and Monitoring Board for this study, based on review of various endpoints, recommended that all eligible participants be offered the combination injectable.  

In addition, results of a Phase II study of weekly oral islatravir and lenacapavir showed safety and non-inferiority of viral suppression to daily ART. Take home message: this product has the potential to become the first weekly oral regimen for treatment.  

Race and HIV, STIs and Mpox 

Pandemic racial disparities were on full display during the session, Using Data to Inform Interventions: Epidemiology of HIV, STIs, Mpox, and COVID-19. While much of the research showed the potential to use epidemiological data to better address public health problems, it was clear that health systems and infrastructure aren’t keeping pace.  

Andre Dailey, from the U.S. Centers for Disease Control & Prevention (CDC), presented a study that observed an overall decrease in Black/White racial disparities in U.S. HIV diagnoses between 2017 and 2021, but showed that for some key populations, including Black/White MSM, people who inject drugs, and others, disparities in diagnoses either did not change or increased. This is not good news for health equity. Sonia Singh also from the CDC, presented data on the lifetime risk of HIV diagnosis among MSM in the U.S., 2017-2021. She found that overall lifetime risk of HIV diagnosis improved among MSM (1 in 7), but there are great racial disparities. That number is 1 in 15 among White and Asian MSM, 1 in 11 among Native Americans and Alaskan Native MSM, 1 in 7 among Native Hawaiian/Pacific Islanders, 1 in 5 among Hispanic/Latino MSM (of any race) and 1 in 3 among Black MSM.  

Mayara Secco Torres da Silva of the Instituto Nacional de Infectologia Evandro Chagas presented data on the two Mpox outbreaks in Rio de Janeiro, Brazil, pointing to the need for enhanced community surveillance, integration of HIV and STI services and access to preventive vaccines. Brazil had the second worst Mpox outbreak in the Western Hemisphere, after the U.S. In studying the two outbreaks from 2022 and 2023, several patterns emerged demonstrating several disparities in Mpox diagnoses. Those who were disproportionately diagnosed with Mpox were Black Brazilians, people having a secondary school or less education, and MSM. The second outbreak in 2023 saw a higher proportion of PLWP and PrEP users diagnosed with Mpox than in the first outbreak. Da Silva called for better Mpox surveillance systems. She said ensuring more people with HIV are sustained in care is necessary to prevent worsening Mpox outcomes, and reminded the audience that Brazil, and other low- and middle-income countries (LMICs) still have not had access to the smallpox vaccine that was a primary tool in virtually ending these outbreaks in the U.S. and Western Europe.  

HIV cure and upcoming webinars 

There was a wealth of news and updates on cure research at CROI 2024. Keep watch for the latest research on the HIV reservoir and cure strategies from AVAC next week. 

And mark your calendars for a host of webinars that will follow up on many of the questions raised at CROI 2024, avac.org/events-and-webinars/.

Tuesday’s CROI Roundup

By Jeanne Baron, AVAC Senior Producer & Editor

Yesterday’s second full day at CROI 2024 in Denver included several studies presented on biomedical prevention, and the sum total of the message is clear: PrEP works, and choice works! Advocates have long called for choice—and now the science shows it works for individuals and supports declines in population-level incidence. Whether we’re talking about a daily pill of PrEP, injectable cabotegravir, or the dapivirine vaginal ring (DVR), from the US to Kenya, Australia to Uganda, people deserve choice! 

There was also more conversation about DoxyPEP, and how researchers and public health programs are balancing the public health benefits of reduced syphilis and chlamydia rates, with the threat of antimicrobial resistance, especially for gonorrhea.  

Here are highlights of the research!  

Tuesday’s Community Breakfast Club message, Living with HIV for a Lifetime—It’s Complicated, rang loud and clear.  

Allison Agwu from Johns Hopkins and Judith Currier from UCLA, talked about strategies presented on cross cutting health issues from cardiovascular disease to HPV that are affecting quality of life for PLHIV. And they talked about advances in treatment, such as the progress of long acting injectables, combination therapy with broadly neutralizing antibodies (bNAbs), and a long-acting pill—all of which are in the pipeline. 

But the advocacy around these field-changing issues echoes the very same priorities for HIV prevention, and the same priorities needed for global heath equity at large. Once new products are approved, they simply don’t reach the people who need them most, and offering choice is the key to reaching impact.  

“We are learning we have to figure out access in parallel with delivery. Clinics just can’t operationalize these innovations; we have to focus on this more and fund implementation science,” said Currier.    

“We need the a la carte of options. Something that fits in someone’s life now may not fit later,” said Agwu. 

The Breakfast session moderator, Annette Sohn from amfAR, talked about the advocacy still needed to ensure research is inclusive and data is gathered for all the populations that carry a disproportionate burden of HIV — another issue of great importance in HIV prevention.  “We still routinely have to tell researchers to stop combining data on men who have sex with men and transgender women.” For more on inclusive research for transgender people check out the The Transgender Manifesto.  

Evidence for making the most of prevention tools and the power of choice! 

Studies from three different continents delivered the message: enriched programs that support coverage and choice of prevention options will yield dramatic results.  

PEPFAR representatives pledged to take the findings of the SEARCH Dynamic Choice study into their programming decisions. Why? Just look at these results: Conducted in Kenya and Uganda, the study offered oral PrEP, PEP or injectable cabotegravir to both men and women, and an option to switch products. Prevention services were person-centered, including access to a clinician by phone at any time, clinic and community access to services, and counseling to develop personalized adherence plans. Coverage among study participants increased to 69.7% compared to 13% in the standard of care. Among people who self-reported HIV risk, coverage was 76%. Of the 56% who chose injectable CAB, 42% were not on any prevention product in the prior month. And perhaps most intriguing of all, 28% of participants used two different products during the study and the study arm ended with zero incidence of HIV compared to 1.8% in the control group—these numbers show why adding to the method mix expands the number of people who continue with prevention, even as their needs change. “CAB-LA is not simply replacing oral PrEP. It’s expanding the pie,” said Moses Kamya of Kampala’s Makerere University, who presented these data.  

Data from the INSIGHT cohort looked at PrEP uptake and continued use among more than 3,000 adolescent girls and young women in six African countries over six months. Participants who were shown test results measuring protective levels of PrEP in their bodies had higher adherence. The results: uptake was greater than 90%, at least 64% showed evidence of recent use. Investigators reported that “real time feedback” from these tests motivated adherence. 

In the US, a study conducted by Emory University suggests a direct link between population PrEP coverage and decreased HIV incidence. Between 2012-2021, PrEP coverage in the US ranged from 3.8% in West Virginia to 22% in New York, and rates of new diagnoses fell in association with increased coverage by state.  

Data from Australia analyzed HIV incidence among all people prescribed PrEP in Australia’s national PrEP program by tracking government subsidized PrEP prescriptions and antiretroviral therapy (ART) between 2018 and 2023. ART was used as a proxy for HIV acquisition, because both testing and treatment among PLHIV are high across the country. The data showed that low PrEP usage among gay men and other men who have sex with men, along with younger age and hepatitis C treatment was predictive of HIV incidence. Nicholas Medland who presented the data said “the overall incidence rate is low. As long as you can get PrEP out the door, it works at the population level.” 

The Deliver Study investigating efficacy of the dapivirine vaginal ring (DVR) among pregnant and lactating people (PLP) provided data from people in the second trimester of pregnancy. Building on earlier findings in later stages of pregnancy, investigators reported no increased rate of adverse outcomes compared to pregnancy outcomes in the community, and that “data support using DVR” as an HIV prevention option for PLP.  At this time, 11 countries have approved DVR, but this data is needed for regulators to approve its use for people who are pregnant. See our PrEP tracker for the latest on DVR initiations, regulatory approvals and more.  

DoxyPEP rollout: Ready? Or not? 

Yesterday we reported on DoxyPEP research, which showed reduced syphilis and chlamydia rates among MSM and TGW (though limited reductions in gonorrhea). There’s cautious optimism among researchers and public health programs about DoxyPEP, but questions remain about antimicrobial resistance (AMR) and whether expanding this intervention to cisgender women (where more research is urgently needed!) would further increase AMR globally. A round table discussion featured many angles.  

Chase Cannon from the University of Washington started with a history lesson—prophylaxis for STIs isn’t new. It was a program of the military in the mid-20th century for American soldiers but ultimately ended. Current data shows the clinical benefits of DoxyPEP. It reduces STI incidence significantly, it’s cost-effective and well-tolerated.  While concerns about AMR are real, taking DoxyPEP is less exposure to doxycycline than taking a full course to treat an STI. Alongside the clinical benefits, Cannon made the case that the community interest and uptake is hard to ignore. He pointed to qualitative research that DoxyPEP has played a transformative role in reducing stigma, sexual stress and anxiety in MSM.  

Beatrice B.S.L. Bercot countered with a more sober look, warning that AMR is already a problem in many European and African countries, and she’s cautious about wider global rollout. Her solution? “The damage is done” with gonorrhea drug resistance, the world has an urgent need for a gonorrhea vaccine. She also noted that while DoxyPEP is promising for syphilis and chlamydia, we need more surveillance and monitoring to better understand AMR spread. 

Stephanie E. Cohen from San Francisco’s Department of Public Health focused on implementation questions. She said DoxyPEP research and implementation is making the same mistakes made with PrEP—a lack of research for cisgender women and people assigned female at birth, and similar racial disparities in DoxyPEP use as seen with PrEP. Cohen cautioned that focusing on “risk categories” in marketing DoxyPEP may exacerbate disparities just as it did with PrEP.  

Cohen urged training for providers, marketing strategies that are non-stigmatizing, and new surveillance tools to monitor AMR. She called for better clinical guidance on STI screenings of people using doxy-PEP to identify other STIs. 

The rich data presented on Tuesday made clear the connection between science and the real-world. But Sunday’s opening session reminded advocates that many researchers who lead the science fail to understand that fundamental truth. During the Martin Delaney Lecture given by Frank Mugisha of Sexual Minorities Uganda, those who listened learned about the impact of draconian homophobic and transphobic legislation that is imperiling the lives LGBTQI+ communities in countries across Africa and in the US. To our dismay, many researchers attending the opening plenary chose not to listen. To learn more, please read this statement from the CROI Community Educator Scholars and Mentors, advocates and others who stand in solidarity.  

CROI Roundup – Highlights from Monday

The highs and lows of great science but profound inequities were front and center on the first official day of CROI 2024. From increasing data on demonstrating the efficacy of DoxyPEP (doxycycline as post-exposure prophylaxis) against some sexually transmitted infections (STIs); and advances in the promise of long-acting PrEP; to data that reinforces the reliability of affordable rapid testing to screen for HIV— Monday showcased vitally important scientific insights.  

Sessions throughout the day, as well as at Sunday’s opening session, reminded all participants that every one of the scientic advances presented at CROI will fail, unless the voices of people who need solutions are heard, amplified and elevated and allowed to lead the discussions.  

Social and behavioral researchers discuss equity with R&D during CROI Community Breakfast Talk   

Monday’s Community Breakfast Club focused on social and behavioral science at CROI – disciplines that have often been marginalized. Speakers pointed out the ongoing need for more of this essential research at CROI. “As much as we try to discover new devices, they need to reach people to have impact. For example, long acting injectables have not worked in real life because we’ve neglected the complexity of rolling [them] out,” said LaRon Nelson, of the Yale School of Nursing. And Sari Reisner, an epidemiologist at the University of Michigan underscored that the outcomes of research are directly tied to the level of involvement from communities whom research is ultimately meant to serve. Don’t miss two more days of programming, sign up here. 

The HIV vaccine search continues 

Barney Graham and Julie McElrath both provided overviews of three decades of HIV vaccine research, and its current status. Graham explained in his opening session Fields Lecture how insights on HIV structure paved the way for rapid understanding of the SARS-COV-2 and resulting vaccines.  

And in her Monday plenary, McElrath summarized the collective knowledge gained from the ten vaccine efficacy trials that have been conducted over the past 20 years. (And check out our new summary graphic of the efficacy trials to date.) She then outlined the key strategies now moving forward–inducing broadly neutralizing antibodies (bNAbs), inducing supplementary CD8+ T-cell responses, and delivering bNAbs as passive protection while learning about vaccine design. Further sessions dug into finer details of early-stage investigations—updates on germline-targeting trials, which use a series of vaccines to prompt the body to develop precursors that lead to bNAbs; and newer adjuvants that enhance the germline targeting strategy 

Even longer long-acting PrEP products? 

A longer-acting injectable cabotegravir for prevention (injectable CAB) has made it through a phase 1 safety and tolerability study. ViiV, the maker of the currently approved injectable cabotegravir, presented findings on a new formulation that could double the time between intramuscular jabs, from two to four months, potentially making it a three-dose annual intervention, instead of six doses.  

Merck also presented data on the safety and pharmacokinetic profile of MK-8527, a product that they are hoping to develop as a monthly pill to prevent HIV. They reported the dose was safe, well-tolerated and sufficient to show anti-viral activity against HIV. The product is currently in a phase 2 trial in several countries globally; and later phase studies would be needed to demonstrate efficacy. Check out our prevention product timeline here. 

DoxyPEP brings down incidence of some STIs. But what else do we need to know? 

Studies corroborated the promise of DoxyPEP to bring down STIs. The DoxyVAC study showed reduced incidence of chlamydia and syphilis and some reduction of gonorrhea. But a vaccine against meningococcal disease (the 4CMenB vaccine) did not show a reduction in gonorrhea incidence, which was seen in an earlier phase of the research. Studies out of San Francisco of men who have sex with men and trans women showed a high demand for DoxyPEP among PrEP users and STI incidence decline. But there remain many questions on DoxyPEP. More data is needed for use among cisgender women, as well as research among communities in low-income countries. Many researchers and advocates are calling for more data on DoxyPEP’s potential to increase antimicrobial resistance (AMR)—which needs more attention as guidelines accelerate DoxyPEP use. Join us in April for an STI Awareness week webinar series where Fabian Kong, Annie Luetkemeyer, and Connie Celum will lead a discussion on AMR, DoxyPEP and more. Sign up here to receive updates, www.avac.org/signup. 

Can we eliminate HPV? 

In what proved to be one of the most elegant plenaries ever delivered, Nelly Mugo from the Kenya Medical Research Institute (KEMRI) provided a remarkable presentation on Shall We Reach Human Papillomavirus Elimination in the Face of Inequity? Her presentation reinforced the essential need to link the best possible science with deep and durable community engagement. And it was quite fitting that she delivered her talk on HPV Awareness Day, when AVAC, TogetHER for Health and partners launched a call to action for global leadership to increase access to lifesaving HPV vaccines for people living with HIV. 

Stay tuned for more updates from AVAC as we track the research and discussion at #CROI2024, and don’t forget to join us Tuesday and Wednesday for the Community Breakfast Clubs. 

Join us for CROI 2024!

The 31st annual Conference on Retroviruses and Opportunistic Infections (CROI) kicks off this weekend, and runs from March 3-6 in Denver, Colorado. CROI is the go-to forum for groundbreaking science in the HIV field, and this years’ program is full of exciting new research.

At AVAC, we’re tracking data and discussion on long-acting, injectable PrEP; the dapvirine vaginal ring (DVR) in pregnancy; doxycycline as post-exposure prophylaxis (DoxyPEP) to prevent sexually transmitted infections (STIs); and the latest in HIV cure and control. We’re also very excited for this year’s Martin Delaney Presentation—Unveiling the Power of Uganda’s LGBTIQ Advocacy in Shaping HIV Response and Health Care Access—that will be delivered by Frank Mugisha of Sexual Minorities Uganda (SMUG) in Uganda and couldn’t be more timely. Be sure to check out the conference program.  

AVAC and partners have worked to follow and explain the research presented at CROI for many years, making the science more accessible, connecting the findings to community priorities, and ensuring civil society and affected communities are represented within the program, and ultimately the research. For those attending or not, this email shares ways to follow along and join in the discussion and debate. 

Follow Along

Be part of the conversation by following AVAC on X (Twitter) at @hivpxresearch for real-time updates using the conference hashtag #CROI2024, and be sure to sign up and follow our partner, Aidsmap, who will be reporting from the conference.

Community Breakfast Clubs

Join the CROI Community Liaisons, AVAC, the European AIDS Treatment Group, and partners for daily Community Breakfast Clubs. These virtual webinars feature researchers and advocates discussing some of the most consequential science being presented at CROI. They are open to all, CROI registrants and non-registrants alike. CROI registration not required.

Monday, 4 March, 7:00am – 8:00am MT (Click here to determine the time in your location.)
Spotlight on Social and Behavioural Science at CROI 2024
 
Tuesday, 5 March, 7:00am – 8:00am MT (Click here to determine the time in your location.)
Living with HIV for a Lifetime – It’s Complicated
 
Wednesday, 6 March, 7:00am – 8:00am MT (Click here to determine the time in your location.)
Research Roundup: Scientists and Advocates Offer Fresh Perspectives and Seasoned Analyses of CROI 2024 Research
 
Looking forward to seeing you at the daily Breakfast Club sessions and to working together to unpack the research and be sure it is applied! 

AVAC Condemns Ghana’s Actions to Further Criminalize LGBTQ+ People

AVAC joins allies around the world to condemn in the strongest possible terms this week’s actions by Ghana’s lawmakers, who have passed legislation to further criminalize LGBTQ+ people.  

Homosexuality was illegal in Ghana before the passage of the so-called “Human Sexual Rights and Family Values Act”, which now furthers the criminalization of this community, making it a crime to identify as LGBTQ+, to form or fund LGBTQ+ groups, to advocate for LGBTQ+ rights or distribute advocacy materials, with multi-year jail terms attached. The new law also encourages communities to report LGBTQ+ people to authorities. Find more background on Ghana’s legislation here. 

“With these actions, Ghana is joining a hyper-fundamentalist global movement that uses anti-queer propaganda to strip away fundamental rights of citizens in a free society,” said Richard Muko, AVAC’s Senior Program Manager of Policy Advocacy, and member of the Key Populations Transnational Collaboration (KP-TNC).  

It is with grave alarm that AVAC re-states our concerns and demands from May 31, 2023—when Uganda’s President Yoweri Museveni signed into law the Anti-Homosexuality Act, a similar assault on citizens’ rights. 

“This is a growing, global tsunami. As with Uganda’s hateful AHA law, these anti-gay laws threaten lives and livelihoods, and the ability to connect key populations with the resources they need and deserve to prevent and treat HIV and to live their fullest lives. But the danger runs deeper than any one health threat. These actions represent a profound attack on free societies. We must unite to oppose these laws.  LGBTQ+ communities and other minorities must enjoy the full rights of citizenship, or these protections, which include access to healthcare, may well be imperiled for everyone,” said Mitchell Warren, AVAC’s executive director.  

Amnesty International has tracked a surge of intensifying hostility and discriminatory bills across 12 African countries in the last year, and in the US, 25 states passed anti-trans bills in 2023. Political leaders in the US and in countries across Africa are openly calling for LGBTQ+ people to be driven from public life, while US-based hate groups are providing support to proponents of this anti-civil rights agenda on the continent.  

“Singling out vulnerable communities as scapegoats, exposing them to violence and incarceration, is integral to instilling a climate of terror that enables divisive forces to consolidate power. It is imperative to stop these laws,” said Manju Chatani-Gada, Director of Partnerships & Capacity Strengthening  

AVAC urgently calls on Ghanaian President Nana Akufo-Addo to reject this bill. We are not alone. Here are statements from UNAIDS and The US Department of State. To add your voice, see guidelines here, prepared by LGBTQ+ activists working in Ghana. 

Join us at CROI 2024!

Dear Advocate, 
 
The 31st annual Conference on Retroviruses and Opportunistic Infections (CROI) kicks off this weekend, and runs from March 3-6 in Denver, Colorado. CROI is the go-to forum for groundbreaking science in the HIV field, and this years’ program is full of exciting new research.  

At AVAC, we’re tracking data and discussion on long-acting, injectable PrEP; the dapvirine vaginal ring (DVR) in pregnancy; doxycycline as post-exposure prophylaxis (DoxyPEP) to prevent sexually transmitted infections (STIs); and the latest in HIV cure and control. We’re also very excited for this year’s Martin Delaney Presentation – Unveiling the Power of Uganda’s LGBTIQ Advocacy in Shaping HIV Response and Health Care Access – that will be delivered by Frank Mugisha of Sexual Minorities Uganda (SMUG) in Uganda and couldn’t be more timely. Be sure to check out the conference program.  

AVAC and partners have worked to follow and explain the research presented at CROI for many years, making the science more accessible, connecting the findings to community priorities, and ensuring civil society and affected communities are represented within the program, and ultimately the research. For those attending or not, this email shares ways to follow along and join in the discussion and debate. 

 Follow Along 
 Be part of the conversation by following AVAC on X (Twitter) at @hivpxresearch for real-time updates using the conference hashtag #CROI2024, and be sure to sign up and follow our partner, Aidsmap, who will be reporting from the conference. 
 
Community Breakfast Clubs (CROI registration not required 
 Join the CROI Community Liaisons, AVAC, the European AIDS Treatment Group, and partners for daily Community Breakfast Clubs. These virtual webinars feature researchers and advocates discussing some of the most consequential science being presented at CROI. They are open to all, CROI registrants and non-registrants alike.  
 

Monday, 4 March, 7:00am – 8:00am MT (Click here to determine the time in your location.) 

Spotlight on Social and Behavioural Science at CROI 2024 

Tuesday, 5 March, 7:00am – 8:00am MT (Click here to determine the time in your location.) 

Living with HIV for a Lifetime – It’s Complicated 

Wednesday, 6 March, 7:00am – 8:00am MT (Click here to determine the time in your location.) 

Research Roundup: Scientists and Advocates Offer Fresh Perspectives and Seasoned Analyses of CROI 2024 Research 

Looking forward to seeing you at the daily Breakfast Club sessions and to working together to unpack the research and be sure it is applied! 

 
Best, 
AVAC 

Sexually Transmitted Infections

A Review of the 2022 Vaccine and Diagnostic Research and Development Pipeline and Investments

As overall sexually transmitted infections (STI) rates continue to rise globally, STI diagnostic and vaccine research and development (R&D) investments remain underfunded and neglected compared to other infectious diseases, a new AVAC report finds.  

This report, Sexually Transmitted Infections: A Review of the 2022 Vaccine and Diagnostic Research and Development Pipeline and Investments, examines disbursements by the U.S. National Institutes of Health (NIH) and the Bill & Melinda Gates Foundation—the largest investors across a vast range of global health R&D areas—and is one of few reports to track funding trends in vaccine and diagnostics R&D, and pipeline investments for some of the most common STIs, including chlamydia, genital herpes, gonorrhea, hepatitis B, human papillomavirus (HPV), syphilis, and trichomoniasis.  

It found that leading philanthropic and public funding for STI vaccine and diagnostic R&D totaled just US $103 million in 2022 with most of the funding coming from the NIH, at US $78 million, approximately 76 percent of total reported funding disbursements. 

“We’re seeing the gap widen—as the global burden of STIs continues to increase, funding for R&D tools to reduce this burden lags behind,” said Alison Footman, PhD, senior program manager for STIs at AVAC and lead author of the report. “If we’ve learned anything from the HIV and COVID-19 epidemics, it’s that we need to get ahead of transmission by prioritizing the health of people and communities and committing the resources needed to develop user-centered diagnostics, treatments and prevention methods. Point-of-care tests that are effective, affordable, and user-friendly, and vaccines to prevent and treat STIs are on the horizon but will only be developed and delivered if money is made available with urgency and scale.” 

Of the total US $103 million in STI vaccine and diagnostic R&D funding reported, only seven percent (US $6.8M) was dedicated to diagnostic research—a much lower amount than vaccine research, which was funded at US $93 million or 90 percent of the total funding. The remaining 3 percent was directed towards projects that examined both vaccine and diagnostic R&D. As with vaccine R&D, the NIH accounted for most of the diagnostic R&D investments (73 percent). 

“Many STI testing programs rely on patients to present with symptoms. But considering that most STIs are asymptomatic, this approach is missing the mark,” Footman added. “We need to be investing in tests for STIs that will improve detection, and therefore limit the time between test and treatment, and hopefully prevent transmission. The overall STI R&D investments are already too little overall, and just seven percent of total funding dedicated to diagnostics is not commensurate with the public health need.”  

Other Key Findings

  • Six institutes and centers within the US NIH contributed the bulk of funding (US $78 million) toward STI diagnostic and vaccine R&D.
  • 59 organizations were funded worldwide to conduct STI R&D; of those, 78 percent (n=46) were located in the US.
  • Institutions in South Africa and Zambia were the only African countries where local organizations were funded to conduct STI vaccine and diagnostic research. In total, US $814,279 was provided directly to these two countries, representing less than 1 percent of total funding spent.
  • By pathogen, most funding (51 percent) was dedicated to HPV R&D, with gonorrhea and syphilis rounding out the top three pathogens funded.
  • US $50 million was spent on HPV vaccine R&D, $18 million on gonorrhea vaccine R&D, $9 million on syphilis vaccine R&D, $8 million on chlamydia vaccine R&D, $3.5 million on genital herpes vaccine R&D, and $2.8 million on Hepatitis B vaccine R&D.
  • NIH spending accounted for most STI diagnostic R&D investments (73 percent).
  • Of diagnostic funding available, 66 percent was dedicated to multi-pathogen research, 33 percent towards HPV, and 1 percent towards hepatitis B. (Multi-pathogen diagnostic projects included research on syphilis, gonorrhea, genital herpes, and chlamydia).

The report also includes spotlights on DoxyPEP; on WHO’s new reports and manuals that provide information on diagnostics currently available to guide development; and on seven AVAC partners in East and Southern Africa who received funding to conduct projects on community needs to prevent, detect, and treat STIs. These advocacy projects helped build a stronger advocacy movement to improve funding and commitments in and around STI vaccines and diagnostics.  

For years, AVAC has been tracking investments and funding trends in HIV prevention and cure R&D. 

HIV Prevention Research & Development Investments 2021: Shifting investment priorities fund innovation in a challenging global health landscape

Global Investment in HIV Cure Research & Development in 2021

This new report on STI vaccine and diagnostic R&D is intended to help decision-makers and advocates identify current funding investments, opportunities, and gaps. Tracking investments over time can also demonstrate the effects of public policies and guidelines, such as WHO’s STI Vaccine Roadmap, on funding decisions and inform research priorities. 

For more information on the state of STI vaccines and diagnostics R&D, visit STIWatch.org, or get in touch at [email protected].