Restrategizing Civil Society Engagement for Pandemic and Global Governance 

Ministries of health, researchers, advocates, academics and civil society members came together on the sidelines of UNGA79 to discuss strategies for more meaningful and impactful engagement of civil society in global governance for health, climate, and other development sectors, particularly in the context of the Pandemic Accord negotiations at Center for Indonesia’s Strategic Development Initiatives’ (CISDI) event, Restrategizing Civil Society Engagement for Pandemic and Global Governance. 

After two years of negotiations, countries did not reach an agreement around the Pandemic Accord and therefore agreed to continue negotiations for up to one year. The Pandemic Accord is meant to represent a global agreement on coordination, equity principles, financing expectations, and a range of capacity areas, including disease surveillance, healthcare workforce, lab facilities, and resources for non-pandemic related healthcare.  

However, “there’s been no other process where they so systematically ignored civil society,” said Nina Schwalbe, CEO of Spark Street Advisors. AVAC’s Sam Rick who moderated the event reminded the audience that for pandemic prevention, preparedness and response (PPPR) to succeed, lessons from the HIV response must be integrated into the architecture being built for PPPR. Meaning, the principles of equity must be embedded into every level of these agreements, and governments and civil society must be empowered to hold them accountable.

Schwalbe and colleagues expressed their deep concern and dissatisfaction with the ongoing Pandemic Accord negotiations. See the recent statement from the Coalition of Advocates for Global Health and Pandemic Preparedness. “With decades of experience in the global HIV and NTD movements, we have demonstrated through our work the crucial role that civil society and communities play in advancing multilateral governance and their impact on health outcomes, as pandemics start and end with community and as such, communities and civil society must be at the center of, and included in all pandemic negotiations… We urge Member States to agree to a governance structure for the Accord moving forward that institutionalizes meaningful civil society and community engagement.” 

The panel highlighted the disparities in vaccine distribution and the necessity for self-reliance in health systems. They emphasized the need for a unified message and strategic coordination among civil society organizations to influence global health policies effectively. 

“You need global health, that is, you need the highest possible health outcomes for as many people around the world, and you need all of those benefits to be equitably distributed… And I think it’s up to us in civil society, pressing our governments, pressing the WHO, pressing the United Nations to actually make this happen.” – Lawrence Gostin, Faculty Director of the O’Neill Institute for National and Global Health Law 

The panel made clear calls to action:  

  • Read and provide comments on the draft pandemic agreement text to identify gaps and push for stronger civil society participation. 
  • Engage with national authorities responsible for pandemic preparedness and response to ensure meaningful civil society participation at the country level. 
  • Support a unified message that can be widely endorsed by civil society organizations. 
  • Advocate for the establishment of formal, funded, and representative civil society engagement mechanisms in the pandemic agreement negotiations and other global health governance processes. 
  • Explore opportunities to leverage upcoming events like the COP meetings to amplify civil society voices and push for greater inclusion. 

For More on Pandemic Accord Negotiations, Read:  

Anna Miti Joins The Choice Agenda (TCA) as Co-Moderator

AVAC and The Choice Agenda (TCA) are delighted to welcome Anna Miti as the TCA’s new co-moderator. Based in Harare, Zimbabwe, Anna is a seasoned journalist, advocate for gender equality, an AVAC Cure Fellow, former AVAC Advocacy Fellow and co-convener of the Zimbabwe Media Science Cafe, who brings her passion for amplifying community voices to this role. 

Launched by AVAC with Jim Pickett in April 2022, TCA is a global forum for advocacy on the latest in HIV prevention. With monthly webinars hosting informed discussions and a moderated listserv of nearly 3,000 subscribers from 40+ countries, TCA offers the HIV prevention community a platform to come together, learn from one another and chart the way forward.  Anna will work alongside Jim and the AVAC team to foster inclusive advocacy around efforts to expand equitable access to HIV prevention tools around the world. 

“As a long-time member of the TCA, I have valued it as a place for robust discussions and a vital platform to access new, timely and relevant information. I am excited to now contribute to this platform as co-moderator. Together with other advocates, I aim to strengthen the TCA’s impact and contribute even more to HIV and science advocacy.” – Anna Miti, TCA co-moderator

“On behalf of the TCA community, I am thrilled to welcome Anna into the brand-new role of co-moderator. Her dedication to HIV prevention research advocacy, her deep well of experience, and her exceptional communication skills will help us improve and expand our work to support HIV prevention research literacy and advocacy. The sun never sets on TCA, and I couldn’t be happier to have such a savvy, partner to help us take TCA to the next level.” – Jim Pickett, AVAC senior consultant and TCA moderator.

Join our Q&A with Anna, September 24

As part our webinar, Do Vaginas Demand Perfection? Implications for Event-Driven PrEP, we’ll host a 30-minute Q&A with Anna. We hope you’ll join us!

For more information about The Choice Agenda, upcoming events, or to join the listserv, visit AVAC’s The Choice Agenda page. 

Brand-new PxPulse Podcast on LEN’s Impact on HIV Prevention

The promise of long-acting PrEP has been super-charged this year by studies showing the powerful efficacy of an injectable antiretroviral known as lenacapavir (LEN). 

PxPulse’s new episode, Lenacapavir: The case for investing in delivering HIV prevention, goes deep on LEN. Recorded just days before Gilead’s announcement that PURPOSE 2, its second major trial of LEN as injectable PrEP, also found very high efficacy, Dr. Flavia Kiweewa, a principal investigator of PURPOSE 1, the first trial to announce efficacy, lays out the research findings and what they mean. And Chilufya Kasanda Hampongo of Zambia’s Treatment Advocacy and Literacy Campaign and Mitchell Warren of AVAC talk about how to change a long history of squandered opportunities to get rollout right. 

The PURPOSE 1 trial announced findings in June that a twice-yearly injection of LEN was 100% effective among cisgender women, with zero new cases of HIV. And the PURPOSE 2 trial among cisgender men, and trans and non-binary people, was shown to reduce the risk of HIV by 96%.  

LEN now enters a select category, one of five ARV-based options for PrEP that all protect against HIV if you take them. But many of the people applauding the results from PURPOSE 1 and 2 will tell you that breakthrough science like this, as hard as it is, is still the easy part. Breaking the back of the HIV epidemic demands overcoming an altogether different challenge — coordinating and accelerating every step in rolling out new products so that everyone who needs HIV prevention can get it.   

Listen to this podcast to learn what must be done to finally deliver on the promise of highly effective HIV prevention, from pills to rings to injectable PrEP and beyond. 

Explore STIWatch.org and get the latest resources to navigate the IUSTI & STI Prevention meetings!

Dear Advocate, 

AVAC is delighted to share its all-new STIWatch.org website just as advocates, clinicians, researchers and partners convene in Atlanta, GA for the Centers for Disease Control and Prevention STI Prevention Conference, and in Sydney, Australia for the 25th International Union Against Sexually Transmitted Infections (IUSTI) World Congress.  

Rates of sexually transmitted infections (STIs) continue to rise globally with too little public health intervention and investment. While many STIs are curable, they often go undiagnosed and untreated because they tend to cause few or no initial symptoms. Available diagnostics are often too costly to use for routine screening and testing in many low to middle-income countries (LMICs), and few vaccines exist to address the most common STIs. 

Discover STIWatch.org!

STIWatch.org is an updated platform designed to enhance understanding and advocacy for STI vaccine and diagnostics research, development, and rollout. It offers comprehensive information on common STIs, a clinical trials dashboard, advocacy priorities, and a range of resources and tools to support STI prevention and treatment efforts. 

Scroll down for more STI prevention resources advocates need to navigate these two conferences.

Resources

Follow the STI Prevention Conference events in real time in Atlanta on Twitter at #STIConf24 and on AVAC’s feed at @HIVpxresearch

STI Clinical Trial Dashboard: shares the latest STI research on diagnostics and vaccines

STIs: A Review of the 2022 Vaccine and Diagnostic R&D Pipeline and Investments: provides an annual analysis of global funding trends for STI prevention research

Advocates’ Guide to Doxycycline to Prevent Bacterial STIs (DoxyPEP): explores and addresses the explore and address the critical questions around who will benefit most from DoxyPEP and how to implement this strategy broadly to ensure equitable access. 

STIWatch.org is an initiative of AVAC with funding and support from the World Health Organization, the Bill & Melinda Gates Foundation and the National Institutes of Allergy and Infectious Diseases.  

Contact [email protected] for more information. To receive email updates from AVAC, signup here. 

HIV self-testing and PrEP, fighting health misinformation, innovations in GPP, and more!

This week AVAC is hosting a webinar on Innovations in GPP, sharing two new briefs to support PrEP access, a new podcast on strategies to counter health misinformation, and much more! 

Inform your advocacy on HIV self-testing & PrEP, PrEP for girls and women, and health misinformation

Brief: HIV Self-Testing and PrEP: Opportunities for scale-up

Read more here.

Brief: PrEP and Adolescent Girls and Young Women in Eastern and Southern Africa: the latest insights

Scale-up of PrEP since 2021 has allowed implementers and researchers to generate significant new evidence on opportunities and challenges for reaching adolescent girls and young women (AGYW) in Eastern and Southern Africa with PrEP services. This brief summarizes these insights.

Read more here.

Podcast: Bridging the Trust Gap with Kenyon Farrow of AVAC

In a new podcast by Health Nonprofit Digital Marketing, AVAC’s Director of Communications, Kenyon Farrow discusses how nonprofits can combat medical mistrust and disinformation around infectious diseases in a time of increasing epidemics and pandemics.

Listen now.

Innovations in GPP

This webinar will feature site-level, national, and funders from across the globe who have non-traditional approaches to GPP. Examples multiple perspectives – sponsor to site-level, will illustrate the evolution of GPP from CABs and town hall meetings to more innovative and partnership-based approaches.

Register here.

A call for unity, solidarity and government protection in Nigeria

Statement: A Call for Unity, Solidarity and Government Protection. Statement of Solidarity with the Nigerian Key Population Community on the Murder of their Leader, Christopher Ikpu Terfa.

Read the statement here.

Join us at the UN General Assembly 79

UNGA Side Event: Save the Date! Restrategizing Civil Society Engagement for Pandemic and Global Governance

Join AVAC and the Center for Indonesia’s Strategic Development Initiatives (CISDI) for a side event during the 79th UNGA High-Level Meeting. This event will draw lessons from the successful experiences of CSOs in enhancing inclusivity in multilateral discussions and implementation of agreements/treaties on topics such as one health, climate, human rights, and more. AVAC’s Samantha Rick will moderate alongside Eloise Todd of Pandemic Action Network, Lawrence Gostin of the O’Neill Institute for National and Global Health Law, Neil Vora of Preventing Pandemics at the Source and Olivia Herlinda of CISDI.

Register here.

Innovations in GPP, wins for U=U, expanding PrEP access and more!

Innovations in GPP

Upcoming Webinar on September 11, 10:00 am EDT

Register here

August webinars – PrEP access in pharmacies, Len for African Americans and more

ICYMI Webinar: Opportunities to Expand Equitable Access to HIV Prevention Services through Community Pharmacies

Recording / Webinar Slides / Resources

ICYMI Webinar: PrEP Your Booty – The Launch of HPTN 106 “Rev Up”

Recording  / Webinar Slides / Resources

ICYMI Webinar: Let’s Talk LEN: What Global Advances in HIV Prevention Mean for Black Communities in the US

Recording / Resource 1 / Resource 2

A big win for U=U in South Africa, learn how it was done

Podcast: PxPulse: An Advocacy Chronicle on U=U in South Africa with Mandisa Dukashe

Tune into to this episode to learn why U=U represents a vital strategy in the HIV response and how Mandisa Dukashe’s advocacy influenced the South African government to launch a national U=U campaign.

Listen here

Insights and findings on PLP in research, putting Len access in context and more

“The Long Wait for Long-Acting HIV Prevention and Treatment Formulations,” The Lancet HIV

“Harnessing Private Sector Strategies for Family Planning to deliver the Dual Prevention Pill,” Journal of the International AIDS Society

“Meta-analysis of Pregnancy Events in Biomedical HIV Prevention Trials in Sub-Saharan Africa: Implications for Gender Transformative Trials,” AIDS and Behavior

This month, AVAC will be presenting at the UN General Assembly and the STI Prevention Conference, hosting a handful of webinars and sharing important resources, so be sure to look out for our weekly roundups.

HIV leaders say it’s time to end the long wait for long acting products

Dear Advocate, 

How do we translate recent scientific advances in long-acting HIV prevention and therapy into public health impact? Read answers in this new The Lancet HIV commentary from a distinguished group of authors including our Executive Director, Mitchell Warren, AVAC board members, Linda-Gail Bekker, Solange Baptiste Simon, with partners Francois Venter, Kenly Sikwese, and others: The long wait for long-acting HIV prevention and treatment formulations. 

Major advances in long-acting HIV treatment and prevention, including the latest PURPOSE 1 results of lenacapavir for PrEP, hold great promise for achieving global targets. However, planning to coordinate among stakeholders, including pharmaceutical companies, governments, and multilateral organizations to deploy and ensure equitable access to these products, particularly in low- and middle-income countries, requires immediate action.  

“Civil society organisations and HIV activists have been instrumental in holding pharmaceutical companies, financial donors, governments, and international organisations accountable for commitments to the international HIV treatment response for decades,” the authors write. “These organisations and activists are needed to promote transparency in pricing, challenge restrictive patent practices, advocate for affordable and widespread availability of drug innovations, prevent companies from restricting broad access to medications, and require funding to allow this work to be done independently.” 

Key Messages

  • Long-acting antiretrovirals are perhaps the greatest advance in HIV care in over a decade and provide great promise towards achieving global HIV prevention and control programme targets. 
  • Current long-acting agents are firmly under the control of originator pharmaceutical companies and remain unavailable or cost-prohibitive across much of the globe. 
  • If action from the broader HIV community is stagnant, the populations who are most in need of these long-acting agents are unlikely to receive any benefit until well into the 2030s, resulting in a large number of preventable HIV infections. 
  • Coordination by international agencies, with assistance from relevant financial donors and stakeholders, will be needed in the complex research and access programmes required to provide widescale use of these indispensable products to people living with HIV or affected by HIV. 

Resources on Long-Acting HIV Prevention

The Lens on LEN: this primer for advocates shares the basics on injectable lenacapavir as PrEP.

Long-Acting PrEP Status Update: this webpage shares graphics and information synthesizing the current status of long-acting PrEP products. It’s updated quarterly.

PrEP Products Overview: this page on PrEPWatch shares the status of PrEP products in development and approved.
Injectable Cabotegravir Evidence Gap Tracker: this webpage summarizes the latest insights from the Biomedical Prevention Implementation Collaborative (BioPIC) on injectable CAB for PrEP, links to learn more, and information on where evidence is still needed, mapped against priority evidence gaps.

Years Ahead in HIV Prevention Research: Time to Market: this downloadable graphic shows the potential time points when the next-generation of HIV prevention options might find their way into new programs.

New Peer-Reviewed Articles, Upcoming Webinars & More!

Dear Advocate,  

AVAC and partners authored three new peer-reviewed articles this month on a range of HIV prevention issues. From the potential and challenges of long-acting formulations in HIV care, to the benefits of delivering family planning AND PrEP using pharmacies, e-pharmacies and private sector clinics, to the necessity for gender-transformative approaches to ensure effective and equitable participation of women in biomedical prevention trials, these are must-read pieces. Scroll down for more and mark your calendars for four webinars coming up, including this week!

The Long Wait for Long-Acting HIV Prevention and Treatment Formulations

This commentary in The Lancet HIV calls on WHO, financial donors, manufacturers, and governments to take coordinated action to make long-acting HIV prevention and treatment available at scale in lower- and middle-income countries.

Harnessing Private Sector Strategies for Family Planning to deliver the Dual Prevention Pill

The latest edition of the Journal of the International AIDS Society features newly published research by AVAC and partners on the benefits of delivering family planning and PrEP using pharmacies, e-pharmacies and telemedicine, in addition to private sector clinics. The research demonstrates why these delivery methods should be prioritized for rolling out the Dual Prevention Pill (DPP), a daily pill that combines oral PrEP with an oral contraceptive to prevent both unintended pregnancy and HIV. 

Meta-analysis of Pregnancy Events in Biomedical HIV Prevention Trials in Sub-Saharan Africa: Implications for Gender Transformative Trials

CASPR partners authored new research published in AIDS and Behaviorhighlighting the need for clinical trial teams to balance the goals of generating scientific evidence with participants’ fertility choices. The authors argue that to better support participants, trials should adopt strategies that accommodate changing fertility preferences, plan for pregnancies, and consider the ethical implications of allowing pregnant participants to continue in studies. This approach would contribute to a more gender-transformative approach to pregnancy in HIV prevention trials.

Mark Your Calendars: Upcoming Webinar

TOMORROW, August 27: Opportunities to Expand Equitable Access to HIV Prevention Services through Community Pharmacies 
Join The Choice Agenda and RxEACH, a national coalition effort working to expand and sustain access to HIV prevention and linkage to care services in community pharmacies for a webinar discussing the opportunity to expand equitable access to HIV prevention services, including PrEP, and what is needed to grow and sustain community-based HIV prevention service programs in pharmacies. 

August 29: Let’s Talk LEN: What global advances in HIV prevention mean for Black communities in the US
Join PrEP in Black America, Black Public Health, Federal AIDS Policy Partnership (FAPP), AVAC, and APHA, this webinar will explore the implications of the groundbreaking results from the PURPOSE 1 trial of Lenacapavir for US Black populations.
 
August 29: PrEP Your Booty
Join The Choice Agenda and HPTN 106 (REV UP), an innovative clinical trial from the HIV Prevention Trials Network that will investigate the safety and acceptability of a tenofovir-based rectal douche for HIV prevention, for a discussion with researchers leading the study.
 
September 11: Innovations in GPP
Join AVAC and champions of Good Participatory Practices (GPP) as they illustrate the evolution of GPPS from CABs and town hall meetings to more innovative and partnership-based approaches.

What’s Next for the Dual Prevention Pill (DPP)

Dear Advocate,  

The latest edition of the Journal of the International AIDS Society features newly published research by AVAC and partners on the benefits of delivering family planning and PrEP using pharmacies, e-pharmacies and telemedicine, in addition to private sector clinics. The article, Harnessing private sector strategies for family planning to deliver the Dual Prevention Pill, the first multipurpose prevention technology with pre-exposure prophylaxis, in an expanding HIV prevention landscape, demonstrates why these delivery methods should be prioritized for rolling out the Dual Prevention Pill (DPP), a daily pill that combines oral PrEP with an oral contraceptive to prevent both unintended pregnancy and HIV. 

The DPP is the Multipurpose Prevention Technology (MPT) closest to market and the first-ever with PrEP. Following the recent successful conclusion of a bioequivalence study, where researchers demonstrated the active ingredients functioned in the body the same as when PrEP and oral contraception are taken separately, the DPP could be approved by regulators by late 2025. The DPP could be a desirable choice for women seeking an option that will meet multiple needs in their sexual and reproductive health (SRH). 

The research found that a significant proportion of family planning (FP) services in Kenya (22%), South Africa (11.4%) and Zimbabwe (17.3%) are delivered using the private sector (such as private provider networks, pharmacies, e-pharmacies and telemedicine). But these channels remain underutilized and represent a largely untapped — yet growing — delivery channel with great potential to expand access to PrEP.

“Addressing the underlying reasons why this is the case will be a prerequisite to DPP rollout, not just in these three countries, but in all countries with high HIV incidence where the private sector is a popular source for FP, such as Eswatini, Lesotho, Malawi, Namibia, Uganda and Zambia”. 

The authors write.

Based on these findings, regulators should update national guidelines to allow for more diverse PrEP delivery. Training on PrEP delivery could be expanded among nurses and other providers, as well as doctors. Clinics, pharmacies, telemedecine and e-pharmacies could offer PrEP.  Implementers and researchers should also undertake research to better understand willingness and ability to pay, how these factors align with the cost of DPP delivery, and what additional subsidy may be needed to ensure successful rollout of the DPP. 

This research supports a Market Preparation and Introduction Strategy that is guiding plans for how, where and to whom the DPP is introduced. Providing users a range of options to access the DPP in non-traditional channels will minimize stigma, improve convenience, and offer discretion — all of which are features that will increase overall uptake and continuation. See our resources on the DPP below. 

Navigating the PrEP Landscape

PrEPWatch is here to help!

With a growing number of PrEP products in development and approved for use in various countries, and an increase in PrEP initiations worldwide, the future of PrEP has never been more exciting. Check out our newly redesigned PrEPWatch website to help navigate the latest research, policy developments, implementation strategies, and advocacy efforts worldwide. The updated site features an array of expanded PrEP resources and improved navigation. We hope PrEPWatch and its resources will be helpful in your advocacy. 

Explore the Latest on PrEPWatch

  • Enhanced Resource Library: An extensive collection of updated tools, research, and guidelines, making it easier than ever for users to access the latest information on PrEP implementation and best practices. Check out some of the most used resources like the Integrated Study Dashboard.
  • Interactive Global PrEP Tracker: Provides up-to-date information on PrEP initiations by country and delivery model, offering insights into the progress and impact of PrEP programs around the world.
  • Country Planning Tracker: Navigable matrix showing where PrEP products are currently approved and where approval is pending. It also tracks key indicators for the introduction of new PrEP options by country, including late-stage clinical trials and implementation research, procurement plans, and more.
  • CAB for PrEP Evidence Tracker: Summarizes the latest insights from the Biomedical Prevention Implementation Collaborative (BioPIC) on injectable CAB for PrEP, links to learn more, and information on where evidence is still needed, mapped against priority evidence gaps.
  • Updated Product Pages: Updated product information addressing frequently asked questions about PrEP options that are currently available and those in late-stage clinical development – including updates on the latest news related to injectable lenacapavir.
  • Long-Acting PrEP Status Update: Quarterly dashboard produced on behalf of the Coalition to Accelerate Access to Long-Acting PrEP with graphics on regulatory approvals, volumes, ongoing and planned implementation science studies, and non-profit prices for currently available long-acting PrEP products.

The resources on PrEPWatch come from projects and partners from around the world; if you have information to share or resource needs, please email [email protected]. And we are grateful for support to AVAC from the Gates Foundation via BioPIC and from PEPFAR via USAID and the Maximizing Options to Advance Informed Choice for HIV Prevention (MOSAIC) project that makes PrEPWatch possible.