PxROAR Europe in Action

HIV prevention research took the stage at the 110th “jubilee congress” of the German STI Society (DSTIG) in Berlin last week. At the invitation of the organisers, AVAC and HIV Europe co-hosted a symposium—Modern Prevention Strategies—where panelists and audience members discussed the state of the art in HIV prevention and what modern prevention strategies mean for different affected communities in the region.

Members of PxROAR Europe were among those leading the discussions. Harriet Langanke, of the German Sexuality and Health Foundation (GSSG), led a session focusing largely on some of the highly affected communities in the region—migrant women and gay men and men who have sex with men (MSM)—and the potential opportunities for members of these communities to access to new all HIV prevention options.

Wezi Thamm, Chair of the international network WECARe+ (Women in Europe and Central Asia Regions Living with HIV) and a migrant from Zambia herself, made clear that legal conditions, language barriers and lack of insurance too often hinder migrant women from accessing HIV prevention and care. She demanded not only the development of new prevention options but that the prevention field focus on and address issues that may limit access.

During a special “poster walk” exploring the featured poster area at the conference, Harriet presented an abstract (co-authored by other PxROAR Europe members): Modern HIV Prevention Strategies: What are the implications for German populations? Community perspectives (click to download).

Click here for more information.

HIV Prevention Research Advocacy Fellows

In April AVAC released Spotlight, a biannual bulletin chronicling AVAC’s HIV Prevention Research Advocacy Fellowship. Spotlight is an excellent way to learn more about what Fellows do during their fellowship year and beyond.

Highlights from this issue of Spotlight include:

  • Advocacy Fellows’ commitment to ending the AIDS epidemic

  • Profiles of the 2012 cadre of Advocacy Fellows

  • 2011 Advocacy Fellows’ milestones

  • Inaugural 2012 Advocacy Fellows and where they are

Download Spotlight here.

A number of Fellows and a broad array of coalition partners have been working to influence the Country Operation Plans (CoPs) that guide the President’s Emergency Plan for AIDS Relief (PEPFAR). The US government, including President Barack Obama, has made strong commitments to beginning to end the AIDS epidemic using core elements of combination prevention including ARV treatment, voluntary medical male circumcision, HIV testing and PMTCT. To meet these goals, the COPs need targets that are ambitious and strategic. For more on Country Operating Plans, read the current issue of PxWire. Since PxWire was published, Advocacy Fellows in Zambia, Zimbabwe and Kenya have led efforts to submit letters directly to the US Office of the Global AIDS Coordinator listing key concerns and demands. AVAC, amfAR and Health GAP submitted letters echoing these concerns.

More on the Fellows’ work can be found here.

Click here to download Spotlight on Advocacy Fellows.

AVAC Partner Provides AIDS Briefing to Ohio State Representatives

Julie Patterson, director of capacity building for the AIDS Task Force of Greater Cleveland and an AVAC PxROAR member provided unprecedented HIV/AIDS testimony and education to the Ohio House of Representatives Committee on Health and Aging. She was invited by the Republican Caucus of the House of Representatives. The event, which took place the week after World AIDS Day, allowed Patterson to review HIV disease, prevention, treatment and testing and to provide information on recent breakthroughs in biomedical HIV prevention research, including the HPTN 052 trial which found a significant reduction in transmission within HIV-serodiscordant couples when treatment was initiated earlier (350-550 CD4 cells) versus in accordance to national guidelines. Although the vast majority of HPTN 052 participants came from outside of the US, the trial is of great relevance for the domestic US epidemic, where “treatment as prevention” could be a potent part of a combination prevention package, supported by additional US funds (see first item.) Patterson explained that earlier treatment for HIV positive people is cost-saving, and urged legislators to support expanded ART programs with the goal of optimizing the health and prevention benefits of ART—and saving costs over the long term. For more on HPTN 052, read Patterson’s piece in Ohio’s weekly Gay People’s Chronicle entitled “Treatment as prevention, turning the tide in the AIDS epidemic”.

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Priority Tools and Actions

This graphic from AVAC Report 2011 outlines the need to define, evaluate and implement combination prevention in every community affected by HIV. The boxes identifies some of the key strategies and actions needed to make this a reality.

AVAC Playbook 2012

AVAC Playbook 2012 includes AVAC’s analysis of what the top strategic goals should be on a global level, and particularly in hard-hit countries, over the year 2012. It also includes AVAC’s organizational priorities for contributing to these goals.

Invest Now to Save Lives and Funds

Published in AVAC Report 2011, this graphic was adapted from the paper authored by UNAIDS and others that advocated for a new “investment framework” for the AIDS response. It models changes in incidence and mortality if the world increases its investment in evidence-based AIDS programs–and what will happen if it doesn’t.

Core Activities for an Effective AIDS Response

Press Release

AVAC Report Defines Agenda for Ending the Global AIDS Epidemic

New York, NY — AVAC today issued a three-part, science-based agenda for ending the AIDS epidemic within our lifetimes. The new report, titled The End?, is a unique strategic vision encompassing key steps to accelerate impact with existing HIV prevention tools, emerging strategies and longer term research. It identifies critical priorities in each of these areas and advances specific recommendations for both 2012 and for the next decade.

“The past year has seen building excitement about the possibility of ending AIDS in our lifetime. It is an ambitious goal, but a realistic one, provided we have a clear path forward and the will to do what’s needed,” said Mitchell Warren, AVAC executive director. “The science-based agenda in this year’s AVAC Report fills a gap at a critical moment: it describes the full spectrum of actions needed to realize the potential of existing, emerging and long-term biomedical HIV prevention options and change the AIDS response forever.”

The report comes at a pivotal moment for the AIDS response. Just weeks ago, US Secretary of State Hillary Clinton committed the US government to realizing an “AIDS-free generation.” A recent report from UNAIDS mapped a new framework for AIDS investments which are focused on high-impact, evidence-based strategies. Yet at the same time, the Global Fund to Fight AIDS, Tuberculosis and Malaria announced that it has insufficient funds for its next round of grants, effectively delaying any new funding commitments until 2014. Ensuring that the Fund is replenished and continues to support countries worldwide is a top priority for ending AIDS.

“Secretary Clinton and other leaders have put a spotlight on what’s possible. Now, it’s time to agree on a coherent, long-term plan to make it happen,” said Warren. “While our success at ending AIDS is far from assured, the scientific data are speaking loud and clear and expectations are running high. It is essential that funding, implementation and research commitments align. The future of the epidemic hangs in the balance.”

Game-changing research advances fuel optimism
Recent studies have demonstrated that antiretroviral (ARV) medications and other tools can prevent HIV transmission, creating new opportunities to accelerate the global decline in new HIV infections:

  • In 2006, trials showed that voluntary medical male circumcision can reduce a man’s risk of infection from a female partner by about 60 percent.
  • In 2011, a large US-funded trial released data showing that starting effective HIV treatment earlier reduced individuals’ risk of transmitting HIV by 96 percent.
  • In 2009 and 2010, trials of oral and topical pre-exposure prophylaxis (PrEP) using ARV medications in specific populations of HIV-negative people provided proof of concept that PrEP is an effective prevention tool.
  • In 2011, scientists identified vaccine-induced immune correlates of risk that help explain the positive finding from the RV144 AIDS vaccine trial—the first to demonstrate that a vaccine can have an impact on HIV transmission—and point the way to discovery of an effective AIDS vaccine.

AVAC Report 2011 outlines priorities for success
The agenda for action in the AVAC Report covers three major priority areas. Each area demands action today, while the dividends in terms of impact on the epidemic will be seen in the short, medium and long term:

  1. Deliver today’s proven strategies at scale, for immediate impact on the epidemic.Scale up innovative HIV testing programs to identify people who can benefit from prevention and treatment; expand access to treatment to preserve health and prevent transmission; and realize the full potential of voluntary medical male circumcision, a so-far underutilized tool.

    For 2012, specific global goals include achieving universal access to ARVs at CD4 counts of 350 or below; and ensuring that relevant countries have long-term plans in place to roll out voluntary medical male circumcision with the goal of achieving 80 percent voluntary circumcision rates.

  2. Demonstrate and roll out emerging tools, including PrEP and microbicides, for even greater impact in five to 10 years.Quickly establish clear plans to understand how and for whom these promising tools might work; launch pilot projects to determine their best uses in different populations; and then prioritize their use in the populations, and in combinations, where their potential impact is greatest.

    For 2012, global goals include swift implementation of pilot projects, establishing a clear pathway for confirmatory research on the tenofovir-based microbicide gel, and building and maintaining a pipeline of longer-acting options.

  3. Develop long-term solutions, including an effective vaccine and a cure.Sustain funding to capitalize on recent scientific advances that have energized the research field.

    A key 2012 goal is to close funding gaps for trials that are needed to pursue leads from the RV144 vaccine trial. Such trials are increasingly threatened by potential research budget cuts in the U.S. and other nations. In addition, it is increasingly important to define how a vaccine could impact combination prevention.

Success hinges on sustained financing, used wisely
The report urges that resources for HIV prevention be allocated for greatest possible impact. Where necessary, funding that supports low-impact activities should be reprogramed, based on evidence, to further reduce infections and save more lives. Moreover, AVAC argues that to end the AIDS epidemic, the field needs to define, evaluate and implement combination prevention in every community affected by HIV.

“If we’re serious about ending the epidemic, then we all need to make certain that precious resources are put where they’re needed most,” said Warren. “And we need to ensure that adequate resources are available. We cannot meet these ambitious goals if the Global Fund, PEPFAR and other essential programs are not adequately funded.”

In launching the report, AVAC called on the United States, global health donors and developing countries to increase funding for scale-up of interventions including HIV testing, treatment and voluntary medical male circumcision. At the same time, renewed promise in the vaccine research field can only be pursued through sustained support from the US and other research sponsors.

“Today’s exciting science comes at one of the most challenging and frustrating economic times,” said Warren. “But the case for investing in the AIDS fight is the strongest it has ever been. If we spend more today—and spend it more wisely—we can save money over the long term and rid the world of one of the most devastating and prolonged epidemics in history.”

The full AVAC Report 2011: The End?, along with AVAC’s Playbook 2012, podcasts, graphics and other materials about ending the epidemic, are available at www.avac.org/report2011.

A PDF version of this press release is available here.

Contact:
Mitchell Warren, mitchell@avac.org, +1-914-661-1536
Kay Marshall, kay@avac.org, +1-347-249-6375

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About AVAC: Founded in 1995, AVAC is a non-profit organization that uses education, policy analysis, advocacy and a network of global collaborations to accelerate the ethical development and global delivery of AIDS vaccines, male circumcision, microbicides, PrEP and other emerging HIV prevention options as part of a comprehensive response to the pandemic.

Press Release

AVAC Applauds Secretary of State Hillary Clinton for Ambitious, Science-Based Vision to End the AIDS Epidemic

New York, NY — AVAC welcomes today’s remarks by U.S. Secretary of State Hillary Rodham Clinton as the first step in an ambitious vision for ending the global AIDS epidemic.

“Secretary Clinton rightly recognized that this is an era of unprecedented opportunity for changing the course of the AIDS epidemic and making an AIDS-free generation a reality. The announcement of an additional US$ 60 million for combination prevention impact evaluation in four countries is a useful first step in terms of realizing the vision. In the coming months, it will be critical for the Obama Administration to build on the plan that she outlined with specific commitments and objectives for the near-, mid- and long-term,” said Mitchell Warren, AVAC executive director.

Secretary Clinton emphasized three core prevention strategies that, if fully implemented, would lead to an AIDS-free generation: prevention of mother-to-child transmission, voluntary medical male circumcision and effective antiretroviral treatment for people who are HIV positive.

“HIV testing and counseling programs are the foundation for each of the interventions Secretary Clinton described, and it will be critical for the Obama Administration to focus on massive scale-up of innovative, ethical testing programs as part of its articulated plan for an AIDS-free generation,” Warren said.

“It is also critical to sustain investments in research and development of additional powerful prevention tools, including pre-exposure prophylaxis (PrEP) using ARVs in HIV-negative people, microbicides, and an AIDS vaccine,” Warren added. “If voluntary medical male circumcision, treatment as prevention and prevention of mother to child transmission are taken to scale, the number of new infections will plummet. Deploying additional tools over the long term,could help realize the greatest achievement of ending the AIDS epidemic in our lifetime.”

“This is truly a new era in the AIDS response, with unprecedented opportunities. Research has brought us a host of new ways to prevent HIV, but we have a long way to go before realizing their full potential. Having identified these key areas, the United States needs to continue to show leadership by articulating a clear plan with milestones for progress. Other developed and developing country governments, communities and donors need to show leadership, ownership and initiative as no single nation can end the epidemic on its own.”

AVAC will release its annual report on the state of global HIV prevention at the end of November, laying out a science-based prescription for the coming decade to realize the end of the AIDS epidemic.

Contact:
Mitchell Warren, mitchell@avac.org, +1-914-661-1536
Kay Marshall, kay@avac.org, +1-347-249-6375

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About AVAC: Founded in 1995, AVAC is a non-profit organization that uses education, policy analysis, advocacy and a network of global collaborations to accelerate the ethical development and global delivery of AIDS vaccines, male circumcision, microbicides, PrEP and other emerging HIV prevention options as part of a comprehensive response to the pandemic.

Modeling the End of the Epidemic

“We need to use modeling to communicate what the possibilities are and what’s been gained from investments to date.” This was the consensus of a small group of advocates, activists, public health leaders and modelers gathered on September 9 by AVAC and amfAR to take a closer look at the state of epidemiological modeling as it relates to the goal of ending the AIDS epidemic. There is scientific evidence for a range of potent prevention strategies including treatment as prevention, male circumcision in the immediate term and, in the future, microbicides, PrEP and vaccines. But decision makers face real challenges about determining priorities and budgets. Models can’t provide the answers, but they can give a sense of the benefits and trade-offs for different scenarios. On October 3, Tim Hallett, a modeler and epidemiologist from Imperial College London, met in Nairobi with AVAC and a small group of East African advocates including several of our Fellows, to discuss how advocates can be what Hallett calls “informed consumers” of HIV models. In the coming weeks and months, AVAC and its allies will be working to help frame the questions and modeling the needs critical to ending AIDS. Watch this space.