Advocates’ Guide to DoxyPEP

Earlier this month, the US Centers for Disease Control and Prevention released much-needed clinical guidelines on how and when to prescribe an oral antibiotic, doxycycline, as post-exposure prophylaxis to prevent acquisition of some bacterial sexually transmitted infections (STIs) after sex, so called “DoxyPEP”. 

Doxycycline is relatively inexpensive, easily tolerated, and widely available. It’s a promising tool to prevent bacterial STIs, including chlamydia and syphilis. However, many questions remain, including how DoxyPEP should be implemented equitably, if it is effective among cisgender women, and how it might impact the STI rates in low- and middle-income countries.

Read AVAC’s New Advocates’ Guide to DoxyPEP

AVAC’s new Advocates’ Guide to Doxycycline to Prevent Bacterial STIs (DoxyPEP) highlights the many DoxyPEP advocacy needs and considerations and covers an update on what the data do and don’t say, what we all need to know about this promising strategy for STI prevention and what critical questions remain that require advocacy and action.

Download the Advocates’ Guide.

DoxyPEP alone is not a complete solution to the escalating epidemic of STIs. But in a field with few recent innovations and limited investments in new prevention, detection, and treatment tools, DoxyPEP holds important potential. Today’s research, implementation, and policy decisions about DoxyPEP can shape the path for much-needed STI research and development in the future.  

We hope this new guide is helpful in our collective advocacy to ensure promising science is translated into public health impact. 

The Pandemic Accord

A Critical Fight in 2024

As the World Health Assembly concluded the 2024 session in Geneva last week, member states failed to reach an agreement on the Pandemic Accord. Aimed at formalizing global agreements that would improve pandemic preparedness, prevention and response (PPPR), negotiations for the Pandemic Accord faltered around commitments to key equity measures. Member States agreed to extend the negotiations through 2024. 

These issues are explained in AVAC’s updated Advocates’ Guide for PPPR in 2024, which covers what you need to know about still unresolved, but critical questions, such as agreements on sharing data and vaccines, and offers timelines in 2024 for strategic advocacy.

Additional Resources

The Coalition of Advocates for Global Health and Pandemic Preparedness, of which AVAC is a partner, issued a statement on the vulnerability and potential of the Pandemic Accord. 

“Without these commitments, we will fail to gain the necessary lead time to get ahead of rapidly spreading health emergencies and will have no chance of eliminating new viral threats once they emerge.” 

Fighting the Same Fight Again (blog)

Advocates must also seize opportunities to demand transparency and the comprehensive inclusion of civil society in the ongoing negotiations, an alarming deficiency in the Pandemic Accord process up to now. Find additional context on the role of civil society in global health initiatives in this blog.

What’s Next for the Pandemic Accord (recording)

And check out the recorded side event from Geneva where civil society came together and offered perspective on community priorities. And mark your calendars for the Independent Panel for Pandemic Preparedness and Response’s webinar June 18. 

AVAC’s PPPR Work (webpage)

Follow the work of the Coalition of Advocates for Global Health and Pandemic Preparedness and AVAC’s PPPR Work by contacting PPPR specialist Samantha Rick at [email protected]. 

The Pandemic Accord is a once-in-a-generation opportunity to strategize in ‘peace time’ before the next pandemic hits. Civil Society priorities can and must lead this effort. 

Pride and a Transnational Anti-LGBTQ+ Reaction

For five decades LGBTQ+ communities and their allies have come together in June to celebrate Pride, to demand recognition of our human rights, and to honor Queer lives. It was movement that ignited out of a climate of fear and ignorance, one that de-humanized trans people and same-gender loving people and made possible their continual persecution.   

As we mark the 54th anniversary of the New York City Stonewall Uprising of 1969, we celebrate the diversity and resilience of LGBTQ+ communities around the world and we must call out the transnational anti-LGBTQ+ reaction that is propelling gay-hate legislation, systemic violations of human rights, and violence against Queer people in countries across Africa, Asia and the US.  

Read on for details on an important advocacy movement against the anti-LGBTQ+ legislation in Uganda, a new podcast capturing the highlights and personal story of one advocate’s work, and the work of a cross-country collaboration strengthening advocacy for key populations.  

New Report

UNWANTED, OUTLAWED AND ILLEGAL: THE CRY OF LGBTIQ+ UGANDANS

It’s been one year since the Ugandan legislature passed one of the most draconian gay-hate laws in the world, the Anti Homosexuality ACT (AHA), which has since been approved by a Ugandan court ruling, now on appeal. The AHA intensifies the criminalization of LGBTQ+ people, including up to life imprisonment for consensual same-sex conduct, and even the death penalty in certain circumstances. A new report by the Strategic Response Team (SRT), UNWANTED, OUTLAWED AND ILLEGAL: THE CRY OF LGBTIQ+ UGANDANS, documents evictions, arrests, imprisonment, forced anal exams, and community violence against LGBTQ+ people since the passage of AHA. 

New Podcast

PxPulse: The Advocacy Chronicles

In a new edition of PxPulse: The Advocacy Chronicles, Allan Mwasa of SMUG International in Uganda discusses the Anti-Homosexuality Act (AHA), rising violence against LGBTQ+ communities in Uganda, how advocates are organizing, and what allies can do now. A donation to SMUG supports the work of the Strategic Response Team documenting civil rights violations and intensifying persecution of LGBTQI+ Ugandans. Click here to donate to SMUG. 

On the Radar

The Key Population Trans National Collaboration (KP-TNC)

And follow the work of the Key Population Trans National Collaboration (KP-TNC), a cross country collaboration strengthening advocacy for key populations. Working in Ghana, Kenya, Malawi, Nigeria, South Sudan, Tanzania, Zambia and Zanzibar, the KP-TNC strengthens relationships between KP-led organizations and development partners, regional organizations, the African Union, PEPFAR, The Global Fund and country governments, and develops strategies to advance advocacy for global health equity at large, and for HIV prevention and treatment among key populations. 

This moment requires global solidarity to push back against the lies, prejudice and discrimination that imperil LGBTQ+ people everywhere. Here’s to a powerful Pride! 

Announcing the Next Class of Advocacy Navigators

We are thrilled to announce AVAC’s 3rd class of Advocacy Navigators! This group of 12 emerging advocates from nine countries was selected from 100s of interested applicants. They will be paired with six mentors, seasoned advocates who are alumni of AVAC’s Advocacy Fellows program. These mentors provide support and guidance as the Navigators strengthen and expand their skills in HIV prevention advocacy. 

Meet the 2024 Advocacy Navigators

Elizabeth Zahabu, Tanzania; Gcebile Yvette Dlamini, Eswatini; Jessica Booysen, South Africa; Joseph Robert Linda, Uganda; Nawanyaga Gloria, Uganda; Rita Nyaguthii Gatonye, Kenya; Renny Mulala, Zambia; Madalitso Juwayeyi, Malawi; Rumbidzai Munhanzi, Zimbabwe; Takunda Clement Chanetsa, Zimbabwe; Nicole Ondisa Oduya, Kenya; Sharon Ramantele, Botswana.

Following the model of the AVAC Advocacy Fellows program, Navigators tackle curated coursework, focused networking, and personalized mentorship over six months.

Meet the 2024 Mentors

Anna Miti, Zimbabwe; Chilufya Hampongo, Zambia; Cleopatra Makura, Zimbabwe; Eric Mcheka, Malawi; Dr. Lilian Benjamin Mwakyosi, Tanzania; Simon K’Ondiek, Kenya.

And a big congratulations to the graduating cohort of Advocacy Navigators who recently completed the 2023 program. Nine Navigators implemented new advocacy projects in their communities on the rollout of CAB for PrEP and DVR, meaningful engagement of adolescent girls and young women (AGYW) in HIV prevention, changing the age of consent, and advocacy for accessible HIV prevention for people with disabilities, sex workers and other key populations.

About the Advocacy Navigators Program

Since 2009 with the establishment of the AVAC Advocacy Fellows program, AVAC has recognized the imperative to support HIV prevention advocates with the knowledge and skills they desire. The Fellows Network represents a global movement of seasoned veterans and passionate newcomers, who call out neglect, insist on equity, monitor commitments and identify solutions. Now the Advocacy Navigator program, which is part of the Coalition to Accelerate & Support Prevention Research (CASPR), is leveraging the strength of this extraordinary program and its alumni community to expand and strengthen the network and continue to support and engage advocates for the long-term. 

The Advocacy Navigator program combines training and mentorship to young and emerging advocates in the field of HIV prevention advocacy. The program mobilizes a cohort of ambitious individuals and provides them with resources to build their knowledge, skills and confidence to meaningfully advance HIV prevention advocacy in their communities and countries. The program includes online coursework, personalized mentorship, and opportunities to directly apply learning through a community advocacy project. The program begins with three months of coursework and project development, followed by three months when advocates implement their plans. 

Keep up to date with this year’s Navigators and stay tuned for updates on their upcoming advocacy projects!

Tracking PrEP Rollout & Learning Lessons

Accelerating the rollout of the full range of proven HIV prevention options depends on learning from what’s been done in the past and investing in coordination and innovation to put improved solutions in place. The Biomedical Prevention Implementation Collaborative (BioPIC) is doing just that. Over the last two years, BioPIC—a project led by AVAC with support from the Gates Foundation—has been gathering and sharing evidence on these critical lessons to ensure the next generation of HIV prevention products reaches everyone who needs and wants them with much greater speed and equity.  

What We’re Learning—Highlights from 2024 Convenings

An ongoing series of think tanks, convened by BioPIC and WHO since 2021, are generating key insights for people-centered product delivery. Below, read the latest reports from these think tanks that are informing decision-making on priorities for accelerating access to PrEP. Go to the BioPIC’s page on PrEPWatch to find reports on all think tanks since 2021.  

  • Early Insights from EBONI and PILLAR, February 2024: Early insights from ViiV Healthcare, the manufacturer of CAB for PrEP, from two CAB for PrEP implementation studies, EBONI and PILLAR. Conducted by ViiV in the US, these are among the first studies gathering data in real-world settings. Learn more
  • Taking Stock of PrEP Evidence, March 2024: An analysis of current data and priority evidence gaps. This inquiry was not focused on any one PrEP product, and its findings are informing the focus of future think tanks. Learn more
  • Linking Modellers with the Latest Implementation Science Evidence, March 2024: A consideration of the latest modelling data and insights on injectable cabotegravir (CAB) for PrEP. Read about the biggest takeaways from CAB for PrEP modelling here, and learn more about the big questions that require further inquiry here
  • Discussing Early Results from the SEARCH Dynamic Choice Study, April 2024: Professor Moses Kamya of Makerere University shares early insights from the SEARCH Dynamic Choice Study in Kenya and Uganda, which gave participants a choice between oral PrEP, PEP, and CAB for PrEP, and analyzes the role of choice in PrEP coverage. Watch here
  • PrEP and the Role of HIV Self-Testing, May 23: Highlights from the WHO guidance on use of self-testing (HIVST) as an innovative way to increase PrEP access and coverage and further simplify PrEP delivery. Panelists also share experiences with procurement, costing, rollout and scale-up. Watch Here

As other new biomedical HIV prevention products roll out, BioPIC will continue to hold strategic convenings, identify and address evidence gaps, and work to accelerate equitable product introduction. To learn more efforts to coordinate the introduction of CAB for PrEP, check out the JIAS article Shaping and coordinating the implementation science agenda for injectable cabotegravir for PrEP: the role of the Biomedical Prevention Implementation Collaborative (BioPIC). To learn what’s needed to better coordinate rollout for not-yet-approved products in Phase III clinical trials, check out BioPIC’s Adaptable Product Introduction Framework. 

We hope you will book mark these resources, and stay up to date on findings from future think tanks and webinars in 2024 on the BioPIC page of PrEPWatch.

Join Us for Our GPP Webinar Series

Good Participatory Practice Guidelines have been shaping and improving clinical research since 2007. They provide a global reference guide for ethical and effective stakeholder engagement, helping ensure the priorities of trial participants and their communities are centered in clinical trials and broader research agendas.  

However, GPP implementation is far from easy—it looks different in every context, outcomes can be difficult to quantify, engagement work is often seen as secondary to clinical processes, and therefore, undervalued and under-resourced. 

To help solve for this, last year AVAC introduced the GPP Body of Evidence, a new resource that brings together a set of tools highlighting the value of GPP, as well as the nuts and bolts of how to get it done.  

Now join us for a series of webinars in collaboration with The Global Health Network, Wellcome Trust, and WHO, to analyze the current state of GPP and discuss areas of growth and further development as we chart the way forward.

Register for the GPP Body of Evidence Series

It’s Not Just About the Trial: GPP from discovery to delivery in TB research
June 12, 2024 at 10am ET

GPP enhances every stage of the research lifecycle. In this webinar, our partners at TB Alliance and SMART4TB will share their experience, lessons learned, and innovative approaches in integrating GPP at the organizational, network and site level, from drug development through delivery. 

Register.

The GPP Body of Evidence: GPP monitoring and evaluation frameworks, REAL and REAL2
June 27, 2024 at 10am ET

Full details coming soon. Register here!

More webinars coming soon, including Not Your Average GPP: Non-traditional approaches and A GPP Roadmap for the Future: Professionalizing, measuring and requiring!

Watch this space for more details.

It’s time for GPP to become an international standard for clinical research. Making that case and making it happen, using the GPP Body of Evidence, has never been easier.  

Civil Society Voices at World Health Assembly

The annual World Health Assembly (WHA) is convening the last week of May in Geneva, Switzerland. As the decision-making body of the World Health Organization (WHO), amongst many other issues, the WHA will be attempting to finalize the Pandemic Accord after two years of ongoing negotiations.  

The Pandemic Accord aims to strengthen pandemic prevention, preparedness and response (PPPR) by addressing coordination, equity principles, and financing expectations. The agreement will, hopefully, also take on a range of capacity issues, such as disease surveillance, support for healthcare workforces, lab facilities, and resources for non-pandemic related healthcare. 

Civil society, including the Coalition of Advocates for Global Health and Pandemic Preparedness of which AVAC is a part, have been tracking the negotiations, calling out priorities, and demanding inclusion. To get the latest update from the Coalition, read the Joint Statement on the April 18th revised Pandemic Accord Draft. And check out the demands for civil society inclusion in this blog, Fighting the Same Fight Again: Civil Society and Community Engagement in Global Health Initiatives, by Samantha Rick (AVAC), Quentin Batreau (GFAN), and Eolann MacFadden (Frontline AIDS). 

The Pandemic Accord is a once-in-a-generation opportunity to strategize in ‘peace time’ before the next pandemic hits. Civil Society priorities can and must lead this effort. Join us!

Upcoming Webinar

Join us on May 28 for a civil society and community perspective on the Pandemic Accord. Click below for more details and to register.

Fighting the Same Fight Again

Civil Society and Community Engagement in Global Health Initiatives
Authors: Samantha Rick (AVAC), Quentin Batreau (GFAN), Eolann MacFadden (Frontline AIDS)

Pandemic Accord negotiations have so far failed to effectively engage advocate and civil society voices. With key parts of the Pandemic Accord moving toward further negotiation over the next few years, the Coalition of Advocates for Global Health and Pandemic Preparedness calls on advocates in and around the World Health Assembly to continue to rally for meaningful engagement with civil society and community and leadership roles for both in the ongoing multilateral process for pandemic prevention, preparedness, and response (PPPR).

For decades civil society and community organizations have been recognised and legitimately engaged as vital stakeholders and leaders in the HIV response. But this principle of inclusion has been inadequately upheld in other health areas, and vitally important initiatives, including the negotiations of the Pandemic Accord, have failed to build on the success of the HIV response and fully utilize existing models and mechanisms for engagement. Without them, these efforts exclude critical stakeholders when they should integrate civil society organizations (CSOs) as a crucial driver of policy and programming. Although certain initiatives have created some opportunities for CSO involvement, organized campaigns and public outcry have been necessary to garner a seat at the table. With every new program, fund, or secretariat, advocates are compelled to engage in the same repetitive battle to obtain a minimum of two voting seats and consultation prior to decision-making.

Civil society representation at the World Health Assembly has been reduced, a formal mechanism for engagement at UN High Level Meetings has been rejected, requests for even observer status during Pandemic Accord negotiations have also been rejected, and civil society and community advocates have experienced hostility at international convenings such as International Conference on AIDS and STIs in Africa (ICASA). Preventing, preparing, and responding to disease outbreaks requires public trust, understanding of regional or cultural ways of working, geographical limitations, and the true needs of communities. We cannot build effective health infrastructure by erecting barriers to civil society and community leadership. 

It is absolutely crucial that civil society and communities band together to demand meaningful engagement in the processes that follow and refuse to permit governments and institutions from rolling back CSO access and decision-making power even further. 

We have seen throughout the 40 years of the HIV/AIDS response that meaningful engagement  turns the tide when biomedical innovations fall short of their potential because of real-world challenges. Decision makers, government representatives, and multilateral institutional leaders must enshrine a baseline level of meaningful civil society engagement practices where and when international decisions are made. As lessons from the global HIV response show us, it is possible, if not probable, that many of the outstanding issues in the Pandemic Accord could have been solved with civil society input and influence, as knowledge-brokers who bring unique insights, find solution, and foster trust where it’s needed most.

The Coalition of Advocates for Global Health and Pandemic Preparedness is a group of organizations advocating for an integrated and holistic approach to preparedness that emphasizes equity, inclusion, and synergies of multiple global health programs in advancing preparedness. We believe that all global health initiatives should be centered on the key principles of community leadership, equity, access, and human rights and that efforts to fight current epidemics and strengthen health systems are central to equitable pandemic preparedness.

The biggest lesson from the fight against HIV, TB, and malaria is that if space is not reserved for civil society, we must take it – “Nothing For Us Without Us”. Join us at the World Health Assembly or watch the recording of our side event focused on civil society engagement if you can’t make it to Geneva, and keep demanding meaningful engagement in every global health initiative.

HVAD 2024

Keep an eye on avac.org/hvad for any updates!

As we prepare to commemorate HIV Vaccine Awareness Day (HVAD) on May 18, the field continues to see some modest scientific breakthroughs, while still facing extraordinary challenges. Despite having an evolving toolbox of highly effective prevention options including new long-acting PrEP, we continue to see high HIV incidence in hard-hit corners of the world. Many advocates and researchers agree that ending the HIV epidemic globally without a vaccine will be extremely difficult—even with long-acting PrEP products on the market and more on the way. 

“This toolbox of PrEP options will hopefully be transformative, but it is critically important that we still prioritize a vaccine.”

– Nina Russell, Director of TB and HIV R&D, the Bill & Melinda Gates Foundation on the new PxPulse podcast

Scroll through our list below for an exciting new podcast, HVAD webinars, and other key resources to mark HVAD 2024.

New PxPulse Podcast Episode!

Listen to the newest PxPulse podcast, “An HIV Vaccine: Looking into the future with Nina Russell with Nina Russell of the Bill & Melinda Gates Foundation who talks about where she sees promise in the science, the goals for an HIV vaccine, and why it has an essential role to play alongside the scale up of PrEP.


And to round out your vaccine knowledge, listen to these two archived PxPulse podcasts: Evolving Strategies for an HIV Vaccine: In conversation with Katy Stephenson, and Research Fundamentals: An HIV Vaccine — What’s the challenge and what’s the science?.

Two HVAD Webinars!

Just What is Discovery Medicine? And What Does it Mean for HIV Vaccine Research
May 16, 2024 @ 9am ET

Join the Choice Agenda to gain a broad understanding of the current landscape for HIV vaccines and what discovery medicine means for HIV vaccine research and development moving forward, with a focus on community and advocacy priorities.

From the Lab to the Jab: Lessons learned and what’s next in HIV vaccine research
June 3, 2024 @ 9am ET

AVAC’s issue briefs, From the Lab to the Jab, cover the barriers to, and solutions for equitable access to vaccines in low- and middle-income countries. During this webinar, an expert panel will discuss lessons learned, an international initiative for vaccine development, and how research and access can be improved.

Partner Events

Communities across the globe are engaging in a wide array of events focused on HIV vaccine awareness. Watc this space for upcoming details on local and regional activities the Coalition to Accelerate & Support Prevention Research (CASPR) partners are leading.

Infographic

20 years and 12 efficacy trials have delivered two positive signals for vaccines and bNAbs, but unfortunately many more flat results. This infographic provides this historical timeline and key information about each trial.

And, on the heels of last week’s HIV Vaccine Trials Network (HVTN) annual meeting, where much discussion surrounded the potential of role of bNAbs in prevention (see AVAC’s 2023 HVAD spotlight on bNABs) be sure to watch this space for more resources that unpack it all.  

Will the Pandemic Accord Fail to Learn the Lessons of the HIV Response?

STOPAIDS, GNP+, WACI Health, AVAC & GFAN

In their statement at the 8th Intergovernmental Negotiating Body (INB) meeting, the Office of the United Nations High Commissioner for Human Rights (OHCHR) highlighted that from the HIV experience we know that if public health measures do not take human rights into account, we will leave marginalised populations behind, fail to address structural barriers to access to quality healthcare, and miss essential interventions altogether.

At the final negotiation meeting of the Pandemic Accord, Member States risk failing to learn these key lessons from the HIV response. 

Over the last two years we’ve seen the limited references to human rights further reduced with each version of the proposed Pandemic Accord text. In the revised text published in April 2024, Member States propose the Agreement is guided by the principle of ‘full respect for the dignity, human rights, and fundamental freedoms of all persons, and the enjoyment of the highest attainable standard of health of every human being’. Beyond this, key provisions including the need to develop and implement policies to respect, protect and fulfil the human rights of all people has been removed and the text fails to recognise or support the critical role of communities. 

Local communities are pivotal in advancing the HIV response, leveraging local knowledge to enhance policy execution, and reaching groups left behind by government-led responses.This is true in the HIV response, and is true in public health programs more broadly: participation from communities and civil society is crucial to minimise the gaps of public programs, ensuring that they reach all vulnerable populations, including the most marginalised. Engagement at the community level also ensures that large-scale policies are effectively translated for local contexts, reducing barriers to access and strengthening impact. To not include organisations that already have a plethora of expertise in the areas the Accord aims to help with would be irresponsible, and would be ineffective on behalf of the communities they aim to serve. The HIV response is globally recognised for its inclusion of communities in governance and decision-making and it is critical the Pandemic Accord replicates this inclusion in the implementation and governance of this instrument. 

At the final negotiation meeting, we must see Member States agree a Pandemic Accord that is grounded in human rights and supports the critical role of communities. We urge Member States to:

Download the full statement here.