Spreading Heat at R4P: AVAC’s daily round-up

Hello from Chicago! It’s unseasonably warm outside and predictably air-conditioned and chilly inside the conference center. As we don shawls and keep our jackets on, we’d be remiss if we didn’t note that this fair city is also home to one of the great PrEP marketing campaigns to date: the Chicago PrEP Working Group’s pro-PrEP, pro-sex PrEP4Love campaign has taglines like “contract heat,” “transmit love” and “spread tingle”.

It’s too chilly in the conference center for us to sport the sexy skin-to-skin styles of the PrEP, campaign, but we’ll try to use today’s update to transmit the heat of the conference—what got us thinking, talking and perhaps even tingling.

Let’s start with the warm fuzzies. There’s a lot of good feeling here. It’s as though the field of biomedical prevention has turned a corner and, recognizing there are more corners to go, is nevertheless enjoying a moment in the sun. Oral PrEP is rolling out—albeit slowly, the vaginal dapivirine ring continues to be explored, there’s that promising monkey study and then—to top it off—Tuesday brought the welcome news that the vaccine efficacy trial HVTN 702 has begun screening participants in South Africa.

This trial seeks to build on the positive result of the Thai trial known as RV144; it’s the first vaccine efficacy trial to launch in seven years. Kinda makes you tingle, right? If not, check out @vaccineadvocacy—the handle for the Vaccine Advocacy Resource Group. They’re at the conference, decoding science and setting advocacy goals in force. Follow along.

There was more heat—including the kind generated by friction—in sessions that tackled daily oral PrEP.

A small, prospective trial in Uganda looked at the amount of TDF/FTC in breastmilk among lactating women—and at the amount detectable in their breastfeeding infants. Even though TDF/FTC is widely used among women living with HIV throughout their pregnancy, there has been debate—often heated—about whether women who become pregnant while taking PrEP should discontinue it, or whether pregnant women should be allowed to initiate PrEP at all.

Excluding pregnant women could have a real impact on how programs are perceived—and how well they meet their goal of reaching people who need PrEP most. It’s already becoming an issue. Robyn Eakle (WRHI), presented initial data from a PrEP demonstration project in South Africa known as TAPS, noted that pregnancy was one of the main reason that HIV-negative women were excluded from joining the project. Women who became pregnant during the study could remain and choose whether to continue PrEP.

The Ugandan study shows very low to no drug in breastfeeding infants—which should provide additional reassurance to program implementers considering whether pregnant women should receive PrEP. There is a separate and equally urgent need to ensure that contraceptives are available to all women who want them, so that every pregnancy is wanted and planned. In other arenas, PEPFAR head Ambassador Debbi Birx has spoken about exploring co-packaging of PrEP and oral birth control pills as one way to get this “dual protection”—and a satellite session on Monday and Tuesday discussion in the Advocates’ Corner brought more on these multipurpose prevention technologies (MPTs).

Discussions got downright fiery on Tuesday when it came to the report, from Dr. Howard Grossman of the Cleveland Clinic that a man using oral PrEP had acquired HIV in spite of high adherence to his regimen. He acquired a multi-drug resistant strain of HIV that is resistant to TDF/FTC (and to other drugs)—and it may be that PrEP doesn’t protect against resistant strains. There’s a lot of research showing that drug resistant viruses are less likely to be transmitted than “wild-type” HIV—perhaps because the mutations that confer drug resistance also make it harder for the virus to establish new infections—but as these data show, it can still happen.

Do instances of people acquiring HIV mean PrEP is a no-go? Not at all. Anyone seeking eloquent expression of the complexities of communicating about, advocating for and using less-than-perfect prevention must read JD Davids’ piece, Two People Got HIV Despite PrEP—and Millions Get HIV Without It, at thebody.com.

Meanwhile, other PrEP data were a reminder that viruses aren’t the only ones that are resistant. Humans are too. Sarah Calabrese (George Washington University) presented on a significant barrier to PrEP uptake in some settings: providers.

Calabrese surveyed medical students in an effort to understand how patient risk behavior and motives may affect clinical judgement, and the results were sobering—willingness to prescribe PrEP was directly at odds with actual risk levels. When hypothetical patients were characterized as regular condom users, 90 percent of providers were willing to prescribe PrEP, but if patients indicated that they planned to discontinue condom use, willingness to prescribe dropped to 25 percent. Furthermore, providers were more comfortable with condom discontinuation in the context of patients seeking to conceive. Only a quarter found it acceptable to discontinue condom use in the service of greater intimacy.

Perhaps the only good news from these findings is a reminder that engaging providers is important everywhere—in the US, sub-Saharan Africa, Europe—everywhere that PrEP is being proposed, providers need to be part of the conversations about what it really means to PrEP4Love.

Providers wanting a real-time experience of this conversation should run, not walk, over to the Advocates’ Corner where Tuesday afternoon’s discussion was a terrific example of how global health really does include us all. In a discussion on women’s prevention, advocates, providers and programmers talked about what PrEP and female condom access—and lack thereof—looks like in their settings.

One Kenyan participant noted that she was surprised to hear about PrEP access issues here in the US, saying, “You were supposed to be a demonstration to us about how to do this.” In response, an American participant noted how African advocates had led the way by talking about PrEP even before it became available—and even as it rolls out slowly today.

A new report, PrEP Access in Europe, from the PrEP in Europe Initiative (PIEI) is another great reminder of how PrEP issues are truly global. The report tells the stories of people taking prevention into their own hands as they begin to seek ways to secure PrEP even though access is highly limited in a region with the fastest-growing HIV epidemic. The report calls on key stakeholders to take specific action.

Did some of the discussions have a little friction? Of course. That’s what happens when people get close to issues (or each other) in ways that matter. Be sure to check out our blog or watch the AN for a deeper dive into some of the issues coming up around discussions of the vaginal microbiome (the environment of healthy and not-so-helpful bacteria that live in our genital tracts). It’s a conversation that started in Durban, continued today—and that will be expanded even more in an upcoming webinar—stay tuned for details!

And for those on-site, be sure to add some Advocates’ Corner sessions to your conference itinerary. The full schedule of Advocates’ Corner is available here, and Wednesday’s sessions include:

  • 10:00am – 10:30am: Stories that Matter: Storytelling and Advocacy
  • 12:00pm – 1:00pm: HIV prevention for women and the dapivirine ring: Next steps for access and advocacy
  • 2:30pm – 3:00pm: Digital Media Strategies and Partnerships to Furthering Prevention Knowledge and Policies
  • 3:00pm – 3:30pm: Say It: Undetectable = Untransmittable
  • 5:00pm – 6:00pm: Let’s Talk about Sex, Baby: Desire in the context of HIV prevention
  • 6:00pm – 7:00pm: Launch for the SHARE.LEARN.SHAPE Survey

For the latest from the conference follow in real-time on Twitter and check out meeting coverage on aidsmap. And don’t just take our word for it, the Global HIV Vaccine Enterprise daily rapporteur summaries provide report backs from multiple viewpoints including a report from Morenike Ukpong from NHVMAS and others on yesterday’s sessions and opening. The conference organizers are archiving recordings of all sessions. Visit here to see the webcasts as they become available.

Not To Be Missed: New report on funding for prevention research

The span of a decade—that interval that’s neither too long nor too short to bring innovation—is one that’s often used in the HIV prevention research space, usually to convey optimism. Back in 1997, then President Bill Clinton called for a national commitment to develop an AIDS vaccine within ten years. Just this week, Bill Gates said, “With the right leadership and investments over the next decade, we can discover and deliver a vaccine for HIV.”

The success of these forward-looking claims has always depended on sustained funding. Note, in both cases, the emphasis on commitment and leadership. No one is promising a vaccine with anything less. A look back at the last ten years provides a warning on this front. Released today, the Resource Tracking for HIV prevention R&D Working Group’s latest annual report on global investment into biomedical HIV prevention reports that overall funding for HIV prevention research and development (R&D) has remained essentially flat for over a decade.

Close followers of the annual “RT” report take note—a preliminary version was released at AIDS 2016 in Durban in July. The final version contains slightly updated data and the same overall messages: with a slight fall from US$1.25 billion in 2014 to US$1.20 billion in 2015, overall funding for HIV prevention research and development (R&D) has been more or less level for the past ten years.

And what a decade it’s been! Consider the developments in PrEP, the pipeline of injectable ARVs for prevention and treatment, the continued advance of the ARV-containing vaginal dapivirine ring, and the insights and advances that have come from sustained scientific inquiry related to the search for an HIV vaccine. These are exciting times. And the fact that all of this happened in the context of flat funding for research doesn’t mean that flat funding will get us where we need to go next. As Tom Hope, PhD (Northwestern University) stressed at an opening plenary of the HIV R4P conference where the report was launched, the fact that funding is declining concurrent with new discoveries is a major challenge for the field.

The report notes that preventive vaccine research funding constituted the bulk of all investments, followed by investments in microbicides, TasP, PMTCT, PrEP, VMMC and female condoms. With the exception of vaccines and female condoms, every other HIV prevention option tracked by the working group experienced a decline. These trends are somewhat reflective of the cyclical nature of large-scale clinical trials—when trials end, funding drops off. Likewise, as some interventions enter full scale rollout, like VMMC and TasP, research in this arena can be expected to slow down. Nevertheless, the overall trends bear close watching and strong advocacy to ensure that research continues.

The right products need to be tested in the populations who need them most. The report is also a powerful reminder that this isn’t necessarily how research works. It provides information on the demographic breakdown of almost 900,000 participants in ongoing HIV prevention trials in 2015, with the majority of these volunteers residing in sub-Saharan Africa, most notably Uganda, Kenya, and South Africa. Only one in eight trial participants in 2015 belonged to a population most affected by HIV, including MSM and transgender women, injection drug users, and cisgender women.

These sobering facts come in the context of a vigorous period in research and development. It’s a time of growing recognition from the global community that research has to be part of the long-term fight to end the HIV epidemic. Taking stock of all that’s been accomplished with ten years of flat funding, now is the time to support continued progress with additional, well-targeted resources.

The Resource Tracking Working Group hopes that this tool provides strong facts for advocacy and supports efforts to assess public policy and its role in accelerating scientific progress. We thank all of the individuals who contributed data to the report and who gave time and effort as trial participants.

Check out the report, share it with your fellow advocates, and be sure to let us know if your organization is either a funder or recipient of HIV prevention grants or if you have further questions or information about resource tracking at all!

Desperate Times Call for Desperate Measures: DIY PrEP in Europe

Did you know there were more new diagnoses of HIV in Europe in 2014 than at any point since the 1980s? In fact, Europe is home to the fastest growing HIV epidemic on earth. Faced with this fact, many people are taking prevention into their own hands as they begin to seek ways to secure PrEP even though access is highly limited in the region. In a new report by the PrEP in Europe Initiative we tell these stories.

Oral PrEP using TDF/FTC, known to be almost 100 percent effective at preventing HIV infection when taken as prescribed, was recently approved by the European Commission. This allows for the ARV combination of tenofovir and emtricitibine to be marketed as HIV prevention across the European Union.

Yet outside of France, where PrEP is available through the national health system at no charge, it is not available to anyone in a European health system unless they pay full price for the medication and find a doctor willing to write a prescription for it. Costs can reach several hundred euros per month. It has been available in the US through public and private health insurance plans for over four years now.

Gay men and other MSM in Europe are aware of the unacceptably high numbers of new diagnoses in their communities. These rates tell us that condoms alone are simply insufficient to protect all those at risk all of the time. The analogy with birth control is worth considering: women do not solely rely on male condom use to prevent pregnancy. Gay men, and other people at high-risk are therefore desperate to get their hands on the new blue pill, trademarked by the company Gilead as Truvada.

In “PrEP Access in Europe” by the PrEP in Europe Initiative, we set out the ways in which people across the European region are securing PrEP outside of traditional health systems and often outside of medical supervision. These include sharing pills among friends, smuggling pills into Europe from abroad, ordering generic versions on-line, and buying them on the black market. Emergency HIV prevention regimens for the ‘morning after’, formally known as PEP, contain Truvada and are therefore also being mined for the blue pills, with the rest thrown in the bin.

These DIY (Do it Yourself) approaches are worrying to physicians and PrEP advocates alike. One concern is that some people may be taking PrEP without a confirmed HIV-negative test result. Being sure you are HIV-negative when starting PrEP, and going for regular HIV tests are key to safe, successful PrEP use. TDF/FTC can also have side effects, both minor and, in rare instances, severe that can only be dealt with in the context of a health setting—so home-based PrEP might be a risky manoeuvre. Lastly, inadequate dosing or irregular drug supplies are not suitable when it comes to PrEP, just as they aren’t suitable for ART. For example, popping only one pill at the weekend, or a few pills here and there, won’t provide protection.

The Report shows that, in the absence of government and health authority action, DIY PrEP is the outcome. The fault does not lie with people who are seeking to take control of their HIV prevention options but with the national authorities that have failed to act.

The report calls on European governments and health authorities to take immediate action to make PrEP available to populations at imminent risk of HIV as a matter of urgency. Read the full report here.

Rebekah Webb is an HIV advocate and policy analyst with over 20 years of experience. She is a founding member of the PrEP in Europe initiative, currently sits on the Prevention Portfolio Steering Committee of the European AIDS Treatment Group, and is a partner in the management of AVAC’s European ROAR advocacy program.

Baseball, Guts and Glory: R4P kicks off in Chicago

Happy Monday and welcome to the first of AVAC’s updates from and about HIVR4P, the biennial conference on all things biomedical prevention. As conference goers are already discovering, this gathering of advocates, researchers, clinicians, journalists and more is taking place in a city—Chicago—that’s gripped with baseball fever. The Chicago Cubs are in the midst of playoffs for the World Series. Looking for a conversation starter with a native Chicagoan? Try “How about them Cubs?” Looking for a guide to on what may spark conference fever—read on!

It takes guts! Unpacking the latest news in “cure” research
R4P features a plenary talk by Dr. Anthony Fauci, head of the US National Institutes of Allergy and Infectious Diseases, on a recently published paper that is the latest spark of hope in the field of cure research. This speech could trigger more US and European coverage of a story that has already gotten a fair amount of coverage in the past week. And it could help spread the buzz to sub-Saharan Africa and beyond, given the strong presence of international journalists at the conference. Here’s a quick walk through what people at R4P are likely to hear about these new data and what it might mean for advocates.

What’s the news?
The paper, published by a team out of Emory, reported on intriguing results from an experiment exploring HIV remission (also known as virologic suppression) in monkeys. The results have been explained fully and very clearly in this aidsmap article and by veteran science writer Jon Cohen. Very briefly, the study design involved infecting monkeys with the simian form of HIV (SIV). All of the monkeys were subsequently put on antiretroviral treatment (ART) which controlled their virus. Some monkeys were also dosed with a simian version of an antibody, known as vedolizumab. In human form, this antibody helps treat inflammatory conditions of the gut, such as Crohn’s disease and ulcerative colitis. Others monkeys received a placebo. All the monkeys stopped ART after 90 days. The antibody group stopped the additional treatment after 23 weeks.

Eight of the 11 monkeys in the antibody group sustained virologic control, showed evidence of immune system replenishment, and remained off treatment for almost two years. In other words, they were able to keep SIV replication below the limits of detection—and saw the recovery of immune cells in the gut tissue that had been attacked by HIV. ART alone can control the virus but does not lead to immune reconstitution in the gut—one of the regions of the body where HIV first establishes infection. This type of virologic control means that the virus is likely still present in the body but at levels under the limit of detection (50 copies/mL).

What does it mean?
Monkeys aren’t humans and SIV isn’t HIV. This is a mantra of HIV research and it bears repeating in this case. What’s seen in non-human primates doesn’t necessarily predict what will happen in humans. However, this is the first time this kind of result has been seen in non-human primates—so that’s an exciting development. It is an animal model “proof-of-concept” that gives researchers something to build on. One area for exploration is understanding why the regimen had the beneficial effects that it did. This involves unpacking the immune responses observed in the animals.

One important finding: some of the monkeys had brief peaks of detectable virus before their immune systems were back up to speed, called a viral “blip”. This is a critical piece of information for clinical trial design. Protocols involving treatment interruption will have to determine how quickly to put a participant back on treatment if a rebound occurs. It is also unclear what, if any, role early treatment played in the eight monkeys’ remission. Early treatment has been shown to reduce the overall size of an HIV reservoir, the collection of non-replicating cells that harbor HIV in the body.

As noteworthy as the results might be, it’s important to remember that the Mississippi Child was in remission for 28 months before viral rebound occurred. The questions raised by these new findings have implications beyond cure as well. Understanding why these study results can also help in the search for an effective HIV vaccine. Since the drug involved in this experiment is already in use in humans for other conditions follow-up can happen fairly quickly. And it is: a small study is underway in people living with HIV.

Advocates should be cautiously optimistic about results and ready with the facts. Remission implies the virus and can return, and a public eager to see HIV solved need to understand there’s a long road ahead.

To learn more about HIV cure research visit CUREiculum, TAG media monitor and the research database.

Stay tuned for additional coverage of the latest from the conference and follow in real-time on Twitter. And each day we will preview the sessions planned for the Advocates’ Corner, a dynamic space to exchange ideas, build solidarity, network, relax and socialize. The full schedule is available here, and tomorrow’s sessions include:

  • 10:00 – 10:30: Innovative prevention for women’s health: The promise of MPTs
  • 12:00 – 1:00: HPTN 083: Long-Acting Injectable PrEP HIV Prevention Trial for Transgender Women and Cisgender MSM in 8 Countries
  • 2:30 – 3:30: Moving Women’s Prevention out of the Siloes: A Discussion of Advocacy for PrEP and Female Condoms
  • 5:00 – 6:00: Launch of the PrEP in Europe report

Stay tuned for more tomorrow!

Preparing for HIVR4P

This week marks the start of the HIV Research for Prevention Conference (HIVR4P), the biennial meeting focused on biomedical HIV prevention research, and AVAC.org/HIVR4P is your one-stop shop for the latest on the data presented, hallway chatter and more!

At the end of each day you can expect a daily round-up of what we’ve seen and heard at the conference—which we’ll blast out on the Advocates’ Network list. For more real-time coverage check out our Twitter feed, which will be active throughout the week.

For those of you traveling to Chicago, we hope you’ll join AVAC and partners at a range of sessions (more on these satellites below) as well as the Advocates’ Corner. The Advocates’ Corner (located on the lobby level of the Sheraton between ChiBar and The Fountainview) will be open throughout the conference. In addition to the materials displays and opportunities for informal networking, the Advocates’ Corner will play host to a program of activities scheduled during breaks in the conference program. Click here for the full schedule.

Check out the entire R4P program online here and for those of you tracking from home, webcasts of the conference sessions will be available on the conference site the following day.

Satellites of Interest

MONDAY

Advocates’ Pre-Conference: Strengthening Advocacy for Research to Rollout
This pre-conference workshop will feature seasoned advocates and researchers from the HIV prevention research field who will provide new and experienced advocates, community representatives and trial staff with latest updates and previews on topics to be presented at the conference. Click here to register.
Monday, October 17, 8:30-15:00
Location: Superior

Engagement from All Angles: Advocates, Sponsors and Implementers Discuss GPP in Action
This satellite session will provide an update on global GPP implementation and an interactive discussion around roles and responsibilities of various research entities and advocacy groups. Case studies will be presented and a sponsor perspective will explore the benefit of an institutional approach to GPP.
Monday, October 17, 9:00-11:00
Location: Sheraton Ballroom II

Designing Prevention Clinical Trials in the Era of Highly Effective Combination Prevention
This session aims to gather perspectives from clinical investigators, statisticians, ethicists and community stakeholders on designing efficient and ethical trials for the pipeline of prevention agents.
Monday, October 17 13:30-15:30
Location: Chicago Ballroom IX

FRIDAY

Strengthening Community Advocacy and Solidarity for HIV Vaccine Research
Since 2014, the Vaccine Advocacy Resource Group has convened virtually to receive research updates, discuss advocates’ perspectives and priorities, and to move forward key actions. This satellite session aims to build the capacity of community advocates at R4P around HIV Prevention Research Advocacy, particularly how it relates to vaccine research.
Friday, October 21 9:00-12:00
Location: Sheraton Ballroom II

Implementing HIV/AIDS Combination Interventions Tailored to Populations and Geographies at Scale

The Kenya HIV Prevention Revolution Roadmap provides a framework for the future orientation of the national HIV prevention response. This session will share data, experiences and lessons in implementing the framework.
Friday, October 21 9:00-11:00
Location: Chicago Ballroom IX

Sex, Intimacy and HIV Prevention: What do women and their partners really want? Incorporating end-user input and developing a market launch strategy for PrEP
What do women really desire from an HIV prevention product? How can the HIV prevention field provide the optimal environment for women to adopt and adhere to these technologies? Team members from MPii Projects EMOTION, OPTIONS and POWER will provide an overview of each project and discuss how research and stakeholder engagement will be woven into an integrated launch plan for optimal results in PrEP introduction.
Friday, October 21 9:00-12:00
Location: Chicago Ballroom VIII

Making Sense of Recent Cure Headlines—People Living with HIV and Advocates Speak Out

Recent headlines touting that “a cure for HIV is near” have popped up on media platforms across the globe this week. These came after a trial in the UK reported treatment of the study’s first patient with a new therapy. Like many headlines, they’re not the truth—not even close. The trial won’t have final results until 2018. It’s only then that researchers will know whether the intervention had an effect. But this didn’t stop the mainstream media from trumpeting an early victory against the virus.

Coverage originated in the UK, but the hyped media coverage continues to ripple through mainstream and social media. In response to this flurry of hype, long-time activist and TheBody.com editor JD Davids’ penned an excellent opinion piece, ‘Infuriating’: People With HIV, Doctors, Advocates Speak Out on Bad ‘HIV Cure’ Reporting.

In the piece, JD points out that, “these stories aren’t just inaccurate. They’re harmful. People feel hopeful, then their hope is dashed. They learn to ignore HIV research news, including that which is responsible and accurate. Providers and advocates have to spend time sensitively debunking the misinformation and supporting those who are disappointed. All this takes time and spirit and energy that then can’t go toward proactive efforts to, well, cure HIV for real, while doing the hard work to honor and improve and save our own and other people’s lives in the here and now.” Read the whole piece here.

For those in search of accurate information, TheBody has an explainer piece on the study making headlines. Check out the AVAC cure page for basic materials and resources. And our CUREiculum is a suite of tools that provide simple, accessible information on HIV cure research in a module-based format. Each module was developed by a community-scientific partnership to help ensure that materials covering quite complex basic science are both accurate and accessible. The CUREiculum grew out of a recognition for the need among members of the community to increase literacy around the growing HIV cure research field—a need for which was reiterated this week.

Woman-Centric Research and Why it’s Time to Listen to the Ladies

Earlier this month, AVAC hosted a webinar to explain and explore the complex issues of hormonal contraceptives and HIV risk in light of a new analysis that is generating plenty of debate. New findings raise increased concern that one type of hormonal contraceptive, known as Depo-Provera, may raise a woman’s risk of acquiring HIV. At the same time, Depo-Provera has been an effective way for a generation of African women to control their reproductive health. The debate surrounding Depo-Provera has been passionate and comes at a time when a number of influential voices are calling for a paradigm shift that would align scientific research with the health needs of women.

In mid-September, Anthony Fauci, the director of the US National Institute of Allergy and Infectious Disease (NIAID), hitched onto the star power of Barbara Streisand to jointly pen a call to action for greater scientific attention on women’s health, particularly when it comes to research on HIV and heart disease. Just a few days before, Melinda Gates, who along with her husband Bill, helps to set the global health agenda through the philanthropy of the Bill and Melinda Gates Foundation, announced a new priority for the foundation—eliminating inequalities among the sexes.

While Gates put out a message to the scientific field that women and girls need to be at the center of research on malaria, tuberculosis and HIV, the Foundation is also pledging $80 million to collect quality data on the conditions faced by women and girls all over the world. In an interview published September 10th in Canada’s L’actualité magazine, Melinda Gates said women…

“…are the center of the family. It’s the woman who decides what’s eaten in the house, when to have the kids vaccinated; everything that has to do with the children’s health revolves around her. If you don’t invest in her, empower her, give her the things she needs to lift her family up, you’re just not going to make the progress that you want to make. But if you put her at the center, you can change a lot for that family, and it has ripple effects through the economy.”

And over at NIAID, Fauci and Streisand are trumpeting the work of the REPRIEVE Trial, which has gone the extra distance to give equal attention to both men and women as it looks at the impact of statins to control heart disease in people living with HIV.

It’s starting to sound like leaders in global health recognize a chronic challenge that is undermining their good work: great advances in research, comprehensive efforts to develop solutions, and a commitment to share resources and insights continue to leave far greater numbers of women than men outside the circle of prevention and recovery.

It’s undeniable that global health indicators have shown some remarkable achievements to date: as many as 14 million men have volunteered to be medically circumcised as a preventive measure, mother to child transmission is heading towards eradication, access to treatment for HIV has reached 17 million people, many of whom live in the hardest-hit regions of the world. Yet in sub-Saharan Africa, the region most affected by HIV, young women and adolescent girls acquire HIV five to seven years earlier than young men, and in some countries HIV prevalence among young women and adolescent girls is as much as seven times that of their male counterparts, according to UNAIDS 2015 report on the issue.

The debate around Depo-Provera spotlights these contradictions. In a statement released September 26, 2016, The International Community of Women Living with HIV & AIDS Eastern Africa (ICWEA) called on authorities to meet the challenges raised by the complex reality of women’s lives. ICWEA pointed out that maternal mortality continues to be high in sub-Saharan Africa, and that doubts persist about the link between HIV and the popular contraceptive. ICWEA urgently called for an expanded mix of contraceptive methods, and the information to go with it so that women are able to act on real choices.

The World Health Organization (WHO) must invite more than a few token sub-Saharan women advocates to the up-coming Expert Review Group, which is meeting to evaluate the current evidence of a link between hormonal contraceptives and HIV. Governments and policy makers must prioritize the empowerment of girls and women as a center piece in their response to these pressing public health concerns. Any response to HIV, heart disease, and maternal mortality will fail whenever we fail to confront the inequalities that govern the lives of so many women around the world.

For more on issues focused on women and research, stay tuned for AVAC and Athena’s webinar on the vaginal biome coming soon. For a little background on this check out AVAC’s recent Px Wire.

AIDS Research and Treatment Special Issue

This journal is accepting submissions for an upcoming Special Issue titled “New Approaches to HIV Prevention and Therapy,” to be published in June 2017, and is open to original research and review articles. Submission deadline February 3, 2017. Call for papers here.

Start Talking. Stop HIV.

Nicely Done. The US Centers for Disease Control (CDC) gets five stars for this music video showcasing a number of key strategies for preventing HIV. It’s sex-positive, it’s fun and it gets the word out: There are more tools than ever before to protect you from HIV—try them, you’ll like them.

The glitzy two-and-a-half minute production is part of the CDC’s Start Talking. Stop HIV. campaign reaching out to men who have sex with men, particularly black and latino gay men. The music video was just released and we’re dancing along in full support of this well-crafted, entertaining piece of work.

Moving Forward with PrEP and MSM in Kenya and Uganda—And It’s Just the Beginning

It’s been five months since the first ever consultation about PrEP for gay African men was held in South Africa. (Yes, there was consensus at the meeting at the outset to use the term “gay men”, rather than MSM, and also to be clear that we were not addressing the specific needs of transwomen, an urgent and separate agenda.) It’s terrific to be able to share the meeting report from the April consultation, and to provide the first of a series of ongoing updates, in this case from Kenya and Uganda, about work to expand access to oral PrEP to all the Africans who need it!

Kenyan PrEP Ambassador accepts PrEP User of the Year Award

From Kenya, the key population focused organization HOYMAS held their HIV/AIDS Champions’ Day in Nairobi on Monday this week. This year HOYMAS focused their HIV/AIDS Champions’ Day on highlighting the advocacy needs for new prevention options including oral PrEP. The event provided a platform for participants to exchange best practices, strategies for advocacy and ideas that advance the overall goal of prevention of HIV. One highlight from the meeting was when Brandon, who was named Kenyan PrEP ambassador by a Kenyan health organization known as LVCT, won the PrEP User of the Year.

Earlier in September, the Uganda LGBTQ community, led by Sexual Minorities Uganda (SMUG), held a meeting to discuss expanding PrEP access that put gay men at the center.

I am personally intrigued by the resilience of SMUG and of the entire Uganda LGBTQ community, even in the midst of the unrest. In the past six weeks alone, they have endured terrible police brutality at a Pride-related event, cancellation of the main Pride parade and ongoing harassment and stigmatization. In the midst of these rights violations, and their crucial work as human rights’ defenders, SMUG is also helping to ensure that the right to health is upheld. I salute them.

The September 9 meeting, held at a secure location, brought together about 25 participants from civil society organizations, members of Uganda’s LGBTQ community and members of SMUG. Some of the participants were attending a PrEP advocacy strategy meeting for gay men for the first time.

Richard Lusimbo from SMUG, the lead organizer of the meeting, reports that there was a deep sense of urgency within the members of the community who were at the meeting and others who were following on social media. You can get a sense of the lively discussion by searching #PrEP4MSM on Twitter he questions debated by meeting participants included: “Where has PrEP been?”, “Why don’t we have it yet?”, “How do we make this important prevention method available for our community now!?” Lusimbo noted, “The key word is ‘NOW.’” They want it now and they deserve to have access to it now!

The meeting participants stressed that community members need to be empowered with more education and information about PrEP. Many people are still confused about the difference between PrEP and PEP. PrEP stands for pre-exposure prophylaxis. It is an HIV prevention strategy in which HIV-negative people take an oral pill once a day before coming into contact with HIV to reduce their risk of infection. PEP stands for post-exposure prophylaxis. PEP is an HIV prevention strategy in which HIV-negative people take a short course of ARVs after possible exposure to reduce their risk of HIV infection. Basic questions that members of the community might be having about PrEP need to be asked and answered.

Some of the participants expressed the fear of continued stigmatization and homophobia in the country that might be heightened if PrEP is considered only for MSM. They stressed the need for PrEP to be rolled out for all populations at risk, as WHO has recommended, so that the Uganda government can support it without singling out specific populations.

Participants also expressed the need to come up with a clear communications strategy to inform the community about PrEP and to address misconceptions.

Further allies in PrEP advocacy in Uganda such as Health GAP helped members challenge the myth that lack of government funding in the short term should hold back implementation advocacy.

We are very excited about the ongoing PrEP advocacy and the work to create demand for prevention options for all populations in Africa, especially those most at risk. Ongoing collaboration with our Africa partners supports a broad and crucial effort—engage with national governments and other stake holders, advocate for the development of national PrEP guidelines and make sure there is community awareness of PrEP.

Watch this space for how the group moves forward in the weeks to come.