Avac Event

DoxyPEP Implementation – All Systems Go?

October 5, 2023 at 9am ET

As we await official guidance from the Centers for Disease Control and Prevention, please join The Choice Agenda (TCA) and the National Coalition of STD Directors (NCSD) for a US—focused discussion on the roll out of Doxycycline as STI PEP for helping gay, bisexual, and other men who have sex with men and transgender women reduce bacterial STIs, including gonorrhea, chlamydia, and syphilis.

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Brought to you by The Choice Agenda  and the US National Coalition of STD Directors

PEPFAR at 20: Keeping the promise

Our latest episode of Px Pulse is out, PEPFAR: Keeping the promise.  

PEPFAR is one of the greatest US foreign policy and global development achievements of the century. The program has saved upwards of 25 million lives since it launched in 2003. But as PEPFAR marks its 20th anniversary, it’s also fighting for its future.  

The US Congress needs to reauthorize PEPFAR for another five years by September 30 and reaffirm its commitment to this lifesaving program. Until a couple of months ago, most in global health and development expected smooth sailing for a five-year reauthorization of the program, as has happened throughout the past 20 years. PEPFAR has enjoyed deep and broad bipartisan support since its founding. Evangelical Christians, staunch conservatives and progressive liberals, Democrats and Republicans, HIV activists, civil society advocates and public health leaders have all championed PEPFAR, year in and year out. But a handful of Republicans, including past PEPFAR allies, are pulling reauthorization into high-stakes partisan politics. 

In this episode, Px Pulse talks to some of the people who put PEPFAR dollars into action and to global health leaders who explain why PEPFAR’s approach has been so effective, and what’s at stake in this debate. 

Tune in to hear: 

    Ilda Kuleba from Mothers 2 Mothers talks about the impact of PEPFAR on their work across 10 countries, training and employing HIV positive mothers as peer healthcare workers. 

    Dr. James Mukabi of World Vision’s Kenya program talks about how this Christian relief organization has changed the lives of thousands of orphans and other populations who are vulnerable to HIV.  

    Tom Hart, President of the ONE Campaign, which was co-founded by the rock star Bono, to be an early champion of PEPFAR and other poverty fighting efforts talks about PEPFAR’s accomplishments at the global level and what’s next as Congress debates reauthorizing the program.

    PEPFAR’s supporters have a job to do, to make sure everyone understands that the world has a lot to lose if PEPFAR is weakened and so, so much to gain if US policymakers unite in their support. We hope you will listen and pass on the episode, download the resources and, most especially, add your voice in support of PEPFAR.

      Announcing the New AVAC.org and Digital Resources

      We are delighted to share the new and improved AVAC.org! On our new site, you can easily access all the great data, policy analysis, tools and resources that you’ve come to expect from AVAC, including our much-loved infographicspodcastsWeekly NewsDigest and Pandemic Watchwebinarsresearch literacy materials and so much more! 
      The updated AVAC.org also reflects the expanded vision and practice of our dynamic programs. AVAC will always work to accelerate ethical development and equitable delivery of effective HIV prevention options. But, we also know that responding to HIV and preparing for future pandemics requires a comprehensive, integrated, and sustained response that is rights-based, people-centered and evidence-informed.
      To AVAC, this means connecting the dots between HIV prevention, sexual and reproductive health and rights, pandemic preparedness, strengthened health systems, research engagement and community leadership. It means recognizing that resilience in global health requires us to confront the threats posed by disparities in access, entrenched stigma, discrimination, criminalizing key populations and inadequate responses to other sexually transmitted infections.

      Visit the new AVAC.org for resources, tools and analysis that make these connections as we continue to track and translate the field, including:

      • Information on the entire pipeline of biomedical prevention strategies being investigated today
      • Our projects, which showcase the incredible partnerships and collaboration that underpin everything we do
      • Our podcast, PxPulse, which will deepen your knowledge and help you “check the pulse” of this fast-paced field and the urgent challenges still ahead
      • PxWire our quarterly update on where we are in biomedical prevention research
      • Our HIV clinical trials database, where you can find details on all biomedical prevention trials and our broader resource database containing fact sheets, infographics, blog posts and more on HIV prevention and the broader issues surrounding global health equity
      • Links to our newsletters—Pandemic WatchWeekly NewsDigest, and our Advocates Network

      And be sure to check out three vital AVAC resources that give you all the information you need on PrEP accessSTI vaccine and diagnostics R&D and HIV prevention R&D funding.

      We are immensely proud to share these resources with you. We hope these tools and analyses will help to power your advocacy, accelerate ethical development and equitable delivery of effective HIV prevention options, and advance global health equity.

      From Brisbane to Chicago: A look at STIs, HIV and global health

      Late July saw two nearly simultaneous conferences on the future of research and advocacy for HIV and sexually transmitted infections (STIs). IAS 2023 in Brisbane and the 2023 STI and HIV World Congress (also known as ISSTDR) in Chicago are landmark annual events. Both conferences bring together civil society, advocates, policy makers, donors and scientists to share the latest scientific findings and discuss where advocacy is needed to both advance research and ensure equity informs every aspect of the development process, from basic science to delivering new interventions. There may be two gatherings, but it’s one vital conversation. HIV and STIs are inextricably linked, affecting the same communities, who face the same barriers to care and prevention against these health threats. At AVAC, we see the links and we are making the connections. Below we offer highlights from these two all-important world gatherings, and check out our recent webinar linking these conversations, Tales from Two Cities: HIV and STI research highlights from Brisbane and Chicago.

      AVAC at IAS

      Taking prevention to the next level: Packaging PrEP with primary health care services as a pathway to achieving 2030 HIV prevention and universal health coverage goals

      This satellite, co-sponsored by PATH, IAS, WHO and AVAC, put a spotlight on integrated, person-centered care, a central theme of the 2023 UNAIDS report launched at IAS 2023, The Path That Ends AIDS. UNAIDS reports that investing in person-centered priorities such as community-led services, integrating primary health care with HIV services, and a strong health workforce brings down incidence. And the pressure to scale up these approaches remains essential. According to the latest statistics in the report, only 42% of districts in African countries with very high HIV incidence are covered by prevention programs. Even more chilling, 4,000 adolescent girls and young women acquire HIV every week.A presentation in this session by former AVAC Fellow and CASPR partner Chilufya Kasanda from Zambia’s TALC put a face and a voice to this story. In Zambia, youth friendly services are scarce or non-existent, high rates of mental health issues are utterly neglected, and donors “flock to a few locations and leave out those who are most in need.” She said community advocates are too often dismissed as “people just making noise.” But, said Chilufyia, it’s young people who must receive support, their leadership must be nurtured and funded, and messages should be tailored just for them. “Young people need to know that pleasure, not only risk, is attached to sex. To get to pleasure, you need to be safe, that is the message.” Another AVAC Fellow, Elizabeth Onyango from Kenya’s Coast Sex Workers Alliance, called for accelerating access to the dapivirine vaginal ring. “Why is the ring not in our vaginas? Male condoms even come in different flavors! This is a women-first product and it needs more investment.”    

      Regaining lost ground for HIV prevention: Acting on lessons learned from oral PrEP scale-up new PrEP method mix

      Prevention will fail if the HIV response remains narrowly focused on products. Oral PrEP has brought invaluable lessons we have yet to learn about how to get programming right so that effective products actually reach those who need them. As AVAC Executive Director Mitchell Warren said at the conference, reflecting on the status of PrEP uptake since FDA approval in 2012- “Only 4m global PrEP initiations in 12 years is an epic failure. Science has given us products that work, but our policies and programs have failed to meet the needs.”

      This session featured presentations from AVAC on a package of tools called, Getting Rollout Right and the work of the Coalition to Accelerate Access to Long-Acting PrEPDaniel Were of Jhpiego talked about lessons from the Jilinde project, Kenya’s ambitious program to deliver PrEP.  The project adapted in real time to reach more people by recognizing that peer networks are essential, that stopping and starting PrEP is common, and that provider attitudes can be difficult to change. Daniel stressed the importance of focusing deeply on the people who need to use these products. 

      HIV Cure & Immunotherapy Forum

      This preconference forum on HIV cure research featured innovative presentations tracking the progress toward an HIV cure. AVAC Senior Program Manager Jessica Salzwedel participated in a panel discussion on the importance of increasing diversity throughout HIV cure research from trial participants, to advocates, to researchers. The session also featured the release of a new resource on community preferred language for HIV cure.

      bnAbs: From prevention to cure

      This session covered the potential for research on broadly neutralizing antibodies (bNAbs) to inform strategies for both prevention and cure. AVAC partner Maureen Luba joined the panel discussion to applaud collaboration among the bNAb researchers working in prevention and cure, and she called for the same collaboration with communities. She said research budgets for community engagement should reflect the importance of community leadership right from the beginning, to ensure success in the future. Maureen added “thinking about cost and choice is the elephant in the room. The resource envelope for HIV prevention is not expanding enough. Countries will be asking ‘where will we get the money [for bNAbs].’ We have to think about cost effectiveness now.”

      Next Gen HIV Prevention research: Clinical Trials in an era of highly effective standards of care

      Investigators and advocates discussed innovative methods to test how new interventions compare to oral PrEP, and how to also make comparisons to HIV incidence in a given community. Models of community engagement were just as important in the conversation. Ntando Yola of APHA described robust programs that brought community members along as these complex new trial designs were developed. Investing in Good Participatory Practicemeans investing “in the platforms that equip and empower communities and advocates,” said Ntando. And for more on how trial design is evolving, check out AVAC’s Evolving Designs for HIV Prevention Trials.

      AVAC at the STI & HIV World Congress

      The STI Prevention Pipeline: Where Are We, and What Will It Take to Move Forward Faster?

      This session on the state of the field offered updates on how STI prevalence and incidence rates are estimated, STI vaccine acceptance, STI test development, and information on the first US STI National Strategic Plan and Federal Implementation Plan. The session included discussions about advocacy priorities in each of these areas, with discussions continuing in the Advocacy Zone throughout the conference (see below). For more on the STI pipeline, check out the resource pages on STIwatch.org.

      Setting Up a Remote/Home Testing STI Programme: A Practical Toolkit

      This session explored the power of remote testing to curb STI acquisitions. Remote and home-testing brings many benefits. It’s convenient, overcomes barriers from stigma, offers privacy, reflects trauma-informed principles, and can overcome structural barriers. For the status of testing for several STIs go to the pathogen pages on STIwatch.org.

      Symposium: New Vaccine Approaches to STI Prevention, STI Vaccine Acceptance, and Equity

      This symposium shared progress on STI vaccine research and examined the question, “what factors could influence acceptance of STI vaccines and how do we ensure equitable access to these vaccines”. AVAC’s Dr. Alison Footman referenced the disparities in the COVID-19 vaccine and how vaccine access can differ due to income, health insurance, and region. Considerations around equity, access, vaccine hesitancy, vaccine confidence, and vaccine awareness must be confronted as an integrated part of the advocacy for STI vaccine development. This session provided a platform for framing these issues and developing an agenda for advocacy.

      ISSTDR Advocacy Zone

      AVAC hosted an Advocacy Zone at the conference, which bubbled with activity throughout the meeting. Advocates used this space to weigh in on questions and share perspectives on how the STI field can grow and how advocacy can equitably advance the field. Overall themes included the need to normalize sexual health, center pleasure in STI conversations and the urgency for increased funding to support STI prevention and research.

      Spotlight on WHO News at Both Conferences

      The WHO made headlines from Brisbane and Chicago, with major announcements and research findings that will be shaping global health for years to come.
       U=U and Zero Risk

      In a policy brief released at IAS 2023, the WHO directly affirmed zero risk of HIV transmission from people living with HIV who have an undetectable viral load using any WHO-approved test and who adhere to treatment. The brief, The role of HIV viral suppression in improving individual health and reducing transmissionalso emphasizes the importance of expanding viral load testing, particularly in low and middle-income countries (LMICs) where access to testing falls far short of the need. The Lancet also published the WHO’s systematic review of the data behind this finding, championed since 2016 by the U=U campaign (undetectable=untransmittable).

      A Call to Expand HIV Self-testing

      Also from Brisbane, the WHO announced new HIV testing guidelines, calling for countries to expand use of HIV self-testing (HIVST) and to promote testing through social networks. In a July 22 press release, the WHO said, “These recommendations are issued at a moment of unique opportunity, when self-care and self-testing are increasingly being recognized as ways to increase access, efficiency, effectiveness and acceptability of health care across many different disease areas, including HIV.”

      Surveillance of Mpox

      The WHO presented their mpox surveillance data in Brisbane, building on findings reported at the Conference of Retroviruses and Opportunistic Infections that showed mpox severely impacts people living with HIV (PLHIV) who have a very low CD4 T-cell count. The WHO analysis draws from a larger set of data than was presented at CROI, and it found PLHIV with advanced immunosuppression were twice as likely to be hospitalized than people who are HIV-negative. See the aidsmap article for details.

      Guidance on STIs

      WHO called for better access to testing and diagnostic services at the STI & HIV World Congress. Its new guidance on testing and diagnostics includes: target product profiles (TPPs) for point-of-care tests for STIs, to diagnose syphilis, chlamydia trachomatis, neisseria gonorrhoeae and trichomonas vaginalis; and an updated edition of The diagnostic landscape for sexually transmitted infections featuring tools to scale up screening for syphilis, chlamydia, gonorrhoea, trichomoniasis, mycoplasma, herpes, and human papillomavirus (HPV) in LMICs. Earlier this year, the WHO approved its multi-year implementation strategy for HIV and STIs. For more information on the status of diagnostics and vaccines for STIs, go to STIwatch.org.

      HIV Research Highlights

      Women Want CAB for PrEP as a Choice in HIV Prevention

      Researchers presented findings from the open label extension study of HPTN 084 studying injectable cabotegravir (CAB) for PrEP, among individuals born female. Among 2500 participants in seven African countries, nearly 78% chose injectable CAB and 22% preferred oral PrEP. And a related study, HPTN 084-01, also found CAB for PrEP was generally acceptable to a small study of cisgender adolescent women in a study conducted in South Africa, Uganda and Zimbabwe. 92% opted to continue use of CAB for PrEP in the open label extension. The study also found that engagement of parents or guardians could be pivotal, providing young women with the support they need to make choices with confidence. The HPTN’s Erica Hamilton said the study reinforces how much choice matters. “The efficacy of CAB for PrEP was reassuring, but some participants still preferred the oral tablet [which also has very high efficacy] for various reasons.”

      New Data on VMMC Among Gay Men and Other Men Who Have Sex with Men (MSM)

      A small but noteworthy study from eight cities in China showed VMMC offered protection against HIV transmission among MSM. Researchers say this first randomly controlled trial demonstrating efficacy among MSM should be followed up by larger trials.

      Tracking the Inclusion of Transgender People in Research

      The launch of AVAC and the Office of HIV/AIDS Network Coordination’s (HANC) Clinical Trial Scoring Tool, provided an initial analysis of the inclusion of transgender people in HIV research and a tool for tracking inclusion in the future. This tool generated great excitement during the poster session. The score card evaluating HIV research since 1991 found less than 1% of participants in 41 key HIV studies included transgender populations. “Dozens of attendees from Harare to Montreal to Hyderabad had questions and expressed interest in using the scorecard and applying it to other populations, too.”

      Cure at IAS 2023

      The “Chicago Patient” was first presented at CROI 2023 and is the first known case of rebound from a bone marrow transplant where the donor did NOT have a critical and rare mutation to what is called the CCR5 receptor, which is found on certain human immune cells. The individual decided to go back on therapy after two consecutive detectable viral loads. This case is interesting because it suggests that reservoir cells may persist even after extreme clearance measures that are part of a stem cell transplant.
      The “Geneva Patient” is the potential sixth cure for HIV. This individual received a bone marrow transplant from a donor with wild type CCR5 — meaning they did not have natural immunity to HIV. The individual experienced severe graft vs. host disease, a complication where the new immune system attacks the host. No virus can be found 20 months off therapy using the most sensitive assays. The medication used to stop the effects of graft vs. host disease promotes latency, meaning the reservoir cells have a harder time reactivating. Researchers are excited about this case because it provides clues on the role of the immune system in clearance and potential pathways toward an HIV cure. 
      The 5 cases of pediatric control were presented by Gabriela Chaumet of University Kwa Zulu-Natal. This longitudinal study followed 281 mother-infant pairs with in utero transmission. The children were started on ART soon after birth and about 92% were exposed to ART in utero through the placenta. Five of the children, all male at birth, who were not adherent to ART were able to control the virus below detectable levels without therapy. However, Only 40% of the infant cohort was male. The study suggests the importance of the virus itself and indicates the need to further understand the impact sex & gender may have on future HIV cure strategies.

      STI Research Highlights

      GPP on the STI Map

      From two different sessions in Chicago, a GPP champion and San Francisco’s Bridge HIV medical director Dr. Hyman Scott called out the power of Good Participatory Practice. In sessions on Biomedical Prevention for STIs and HIV and Addressing the HIV and STI Syndemic, Hyman’s presentations called for GPP to be implemented broadly. “I am really glad to see AVAC at this conference. We need GPP to hold us accountable,” said Hyman. CASPR partner Zinhle Sokhela of Wits RHI also gave background on GPP during the session Centering Equity, Inclusion and Diversity in STI/HIV Research and referenced a Cameroon and Cambodia PrEP trial that ended prematurely due to lack of effective community engagement. “The [GPP] guidelines help prevent misunderstanding and miscommunication among researchers and stakeholders.”

      Antimicrobial Resistance and New Drugs in the Pipeline

      Resistance to existing antibiotics for different STIs is spurring a hunt for alternative drugs. The conference presented encouraging early findings on new interventions for herpes simplex virus (HSV) and mycoplasma genitalium (M. genitalium), which cause urethritis and other diseases. A retrospective review of data from 165 patients found minocycline cured 2/3 of the resistant cases of M. genitalium. Phase II studies of pritelivir demonstrated superiority over the standard of care for resistant cases of HSV.

      Women and DoxyPEP

      Dr. Jenell Stewart presented additional data on the DoxyPEP study out of Kenya and found, from hair testing analyses, that 44% of women assigned to DoxyPEP may have not taken any of the medication. This could be one reason why DoxyPEP has not shown efficacy among women, from data that was previously presented at CROI 2023. Watch this space for more data coming out of the D-PEP Kenya study, including a look at the correlation between PrEP and DoxyPEP adherence, as well as conversations about future research of DoxyPEP in cisgender women.  

      The Promise of Self-Testing

      A presentation by Preventx, a UK-based supplier of self-testing kits, featured their analysis that remote/home-testing led to the diagnosis of a similar number of STIs as those diagnosed in the clinic. Preventx shared that out of 2.2 million kits ordered over a given period of time, they saw a high rate of return, with 1.8 million kits returned.

      This cross section of research, advocacy and innovation in STIs and HIV should be a call to action for all of us who see how equity and sexual health cannot be siloed.

      P.S. In case you missed it, AVAC recently launched the latest HIV Prevention and Cure Resource Tracking Reports. Find all the details here.

      Press Release

      AVAC Applauds the Selection of Dr. Jeanne Marrazzo as New Director of NIAID  

      Wednesday, August 2, 2023 

      AVAC enthusiastically applauds the selection of Jeanne Marrazzo, MD, to serve as the new director of the NIH’s National Institute of Allergy and infectious Disease (NIAID). Dr. Marrazzo brings unparalleled leadership and research expertise to this pivotal role at NIAID, which oversees some of the largest investments to advance research on HIV and sexually transmitted infections in the world, at such a critical moment in global health science and politics. 

      “Jeanne has been a pioneer in both HIV prevention and STI research and advocacy for many years. This news of her selection as NIAID Director just does not get any better,” said Mitchell Warren, AVAC’s Executive Director. “Given her distinguished career, NIAID’s selection signals a commitment to pursuing a research agenda that is aimed squarely at defeating HIV while safeguarding principles that advance global health equity. Moreover, her appointment reflects the important intersection of science, policy, communications and advocacy that has defined her career thus far.” 

      “Perhaps most importantly, her longtime championship of community engagement and person-centered research provides a fantastic foundation for this role,” said Manju Chatani-Gada, AVAC’s Director for Partnerships & Capacity Strengthening. “She has always been accessible and provided time, mentorship and support to civil society advocates in breaking down and interpreting science. Ultimately, it is not just what science gets supported at NIAID, but how the science happens and how it is communicated, and Jeanne is the right leader at the right time to build on Dr. Fauci’s legacy.” 

      Dr. Marrazzo’s research included landmark investigations of pre-exposure prophylaxis (PrEP) for cisgender women as well as discovery and implementation science research focused on complex issues including hormonal contraception and HIV, antimicrobial resistance in gonorrhea, and other efforts especially as they effect women’s health and livelihoods and exacerbate the impact of infectious diseases. She provided pioneering leadership of the Microbicide Trials Network’s groundbreaking Vaginal and Oral Interventions to Control the Epidemic (VOICE) study, one of the most complex HIV prevention studies ever designed and conducted. 

      “Jeanne is a remarkable physician, researcher and advocate. We are so optimistic about her ability to connect the dots—between HIV prevention, sexual and reproductive health, and pandemic preparedness, and help solve for the threats of disparities in access, stigma, discrimination and criminalization of key populations,” Warren added.  

      Dr. Marrazzo will be the first new director of NIAID in nearly 40 years and the first woman in this position. She will also be the first openly gay director of any institute at the NIH. The position was held by Dr. Anthony Fauci, whose vision, passion and commitment to ending the AIDS epidemic and advancing global health research has been an inspiration to AVAC and to so many. Dr. Marrazzo is expected to assume the post as NIAID Director later this year. 


      About AVAC: AVAC is an international non-profit organization that leverages its independent voice and global partnerships to accelerate ethical development and equitable delivery of effective HIV prevention options, as part of a comprehensive and integrated pathway to global health equity. Follow AVAC on Twitter @HIVpxresearch; find more at www.avac.org and www.prepwatch.org.

      Investment Trends for HIV Prevention and Cure R&D: Resource tracking reports

      New Reports on HIV Prevention and Cure R&D Funding

      AVAC and partners are delighted to share two new reports showing investments for HIV prevention and cure research and development (R&D) that were launched this week at the IAS 2023 Conference on HIV Science. Both reports explore a variety of factors influencing investment and detail how investment trends are changing.   


      In its 17th annual report, the Resource Tracking for HIV Prevention R&D Working Group, a collaboration among AVAC, IAVI and UNAIDS, documents 22 years of investment in biomedical HIV prevention R&D, including HIV vaccines, PrEP, microbicides, voluntary medical male circumcision (VMMC), treatment as prevention (TasP) or undetectable equals untransmittable (U=U), female condoms and prevention of vertical transmission (PVT).   

      Key Findings and Analysis 

      • Overall, total 2021 investments (the latest data available) in HIV prevention R&D show an approximate 12% increase for HIV prevention R&D compared to 2020. Money for HIV prevention has not returned to the high-water mark seen in 2012, when total investment was US $1.31 billion, but the figures have inched back up, to $1.25 billion in 2023, from $1.09 billion in 2020.  
      • Investment in HIV vaccine research declined, but still represents a majority of all HIV prevention research. At approximately $794 million, it is 63.5% of total HIV prevention R&D.  
      • Funding for microbicides is down for the 7th year in a row, and by 20% from 2020. However, this is in part attributable to several funders shifting to consolidating the PrEP category to include all products using antiretrovirals, including topical microbicides.   
      • 2021 saw the launch of USAID’s MATRIX Consortium, supporting further research on microbicides and dual prevention options.   
      • Also launched in 2021, USAID’s MOSAIC program, focused on developing and accelerating women’s access to new HIV prevention products. MOSAIC investments, funded as part of USAID’s long-standing microbicide investments, will be recorded by the Working Group from 2022 onwards. 
      • PrEP investment saw a two-fold increase, the highest seen since the Working Group began tracking, hitting approximately $270 million in 2021.  
      • A 30% increase in VMMC in 2021 reversed a decline seen in 2020. 
      • Funding for PVT decreased from US$25 million in 2020 to US$14.3 million in 2021, the lowest level recorded by the Working Group. 
      • The ratio of public to philanthropic investment remained the same as 2020, at 81% and 12%, respectively.  
      • Global philanthropic funding levels increased 16% in 2021 to US$150 million.  
      • Though the US continues to shoulder the bulk of all funding at approximately $922 million, diversity by geography is on the up. European entities increased their investments by 40%, reaching $161 million. Diversifying the funding base is vital not only for the long-term sustainability of the field, but also to ensure that the research priorities are informed by a diversity of perspectives. 

      The 2021 report of the Cure Resource Tracking Group, a collaboration between AVAC and the International AIDS Society, showed an impressive 30% increase in funding for cure research.  The report also provides an analysis of the cure research agenda and the scientific questions shaping investment decisions.  

      Key Findings and Analysis 

      • Total funding went from $337 million in 2020 to $439 million in 2021. This increase represents a five-fold increase since tracking began in 2012.  
      • Approximately $362 million comes from public funders, approximately $40 million comes from philanthropy. Approximately $36 million is invested by industry.  
      • Only 6% of research sponsors report participant data derived from trials conducted in African countries, even though Africa is home to 68 percent of people living with HIV. There is a growing recognition that research needs to be done among affected communities and conducted in African countries. The establishment of the HIV Cure African Acceleration Partnership (HCAAP) aims to enable stakeholder engagement.  
      • The US NIH-funded Martin Delaney Collaboratories for HIV Cure Research expanded in 2021 and now include ten collaboratories.  
      • 2021 data show sustained geographic diversity in cure R&D, with several countries joining the US to increase their funding, including Canada, Switzerland and the Netherlands. 

      We hope these reports will serve as tools for advocacy and inform public policy. Funding priorities are instrumental to the decisions and commitments that allow scientific progress. All stakeholders need opportunities to understand these trends and advocate where change is needed.  

      A special thank you to trial participants everywhere. Without their time and dedication, scientific advance would halt, full stop. Also thank you to the individuals who contributed data to the report.  

      If your organization is a funder or recipient of HIV prevention or cure grants and we don’t know you already, please contact us at avac@avac.org!  

      Our Take: Are the UN Declaration on PPPR and the Pandemic Accord going in the right direction?

      The last few weeks have been filled with high-level negotiations among UN Member States on the way forward for global pandemic prevention, preparedness, and response (PPPR) efforts. Below, please find an analysis of the negotiated language to date in the Pandemic Accord, and the UN Declaration on PPPR, and their implications for equity in PPPR. These analyses were conducted by AVAC and partners working in collaboration to track progress toward equity in these agreements and develop an advocacy agenda for provisions in both that ensure equity in global health advances. The Declaration is an agreement that involves heads of state and potentially a role for all ministries of government. The Pandemic Accord is being negotiated by members of the WHO to strengthen PPPR.

      The Pandemic Accord: A look at negotiations to date

      The first draft of the WHO-led Pandemic Accord was released in May, containing edits to the zero draft from the Member States. As expected, edits from high-income countries introduced challenges to equity provisions in the text— particularly provisions aimed at ensuring that agreements to share access to data on pathogens is paired with commitments to also share the benefits developed from research using those data (termed pathogen access and benefits sharing). Other equity provisions that were challenged include intellectual property, and language on how the world should allocate vaccines, therapeutics, and diagnostics in the event of a global pandemic threat. Throughout the document, certain high-income Member States inserted caveats or wording, such as “encourage” or “as appropriate”, which would make implementation voluntary or compliance more subjective. Other phrases to weaken the agreements, such as replacing “commit to” with “recognize the importance of”, were also inserted.

      Negotiations so far have resulted in weaker, alternative language to several key articles than in the so-called zero draft of the accord. These include articles on technology transfer, the Pathogen Access and Benefit Sharing (PABS) System, health workforce strengthening, and the proposed Supply Chain & Logistics Network. There are, however, some clauses that have been strengthened. Global R&D networks, laboratory networks for genomic surveillance, knowledge translation, and the harmonization of regulation to accelerate WHO pre-approval and authorization all have stronger commitments and more details than before. You can find the first draft here and a closer analysis of the changes made between the zero and first draft here.

      The UN Declaration on PPPR: What’s in the Zero Draft?

      The zero draft of the UN Declaration on PPPR, set to be adopted at the High-Level Meeting on September 20, was released in June.

      Many provisions in the draft Declaration are positive, recognizing and affirming key points related to human rights and inclusive provisions that prioritize vulnerable and marginalized populations. The draft recognizes vaccine inequity as a vital concern, affirms key principles of equity and non-discrimination and the need to ensure adequate support for both health workers and the WHO. However, there are very few, if any, concrete targets set, leaving little to hold countries accountable. Missing from the Declaration, in particular the section on Overarching Health Related Issues, is the need for countries to prioritize and commit to building on the global responses to ongoing epidemics, including HIV/AIDS, TB, malaria, polio, other neglected disease outbreaks such as Ebola, Marburg, and cholera, and antimicrobial resistance (AMR).

      This is a missed opportunity with enormous implications. It signals a troubling and serious global inability to build on existing health and community infrastructures, integrate responses, and avoid erecting isolated pillars in global health architecture. Many of the capacities needed for PPPR already exist in the response to these other health threats. They can and must be expanded and strengthened for broader pandemic preparedness. In addition, the history of the responses to HIV/AIDS, TB, and malaria have made clear that community leadership in the response and civil society engagement are essential to achieve success in PPPR. The current response to existing health threats, which through trial and error have built resilient and effective systems, should serve as the foundation for any future pandemic preparedness and response efforts. The Declaration’s silence on this issue is gravely concerning.

      The Declaration’s clauses relating to agreements on pandemic-related tools and products are strong, and notably stronger than those in the first draft of the Pandemic Accord. But equity provisions, and access to those tools, could be strengthened further, by including compulsory licensing and transfer of know-how when necessary.

      It’s vital for advocates to engage with these processes, and leverage their power to influence the emerging architecture in global health. Decisions being made now will have implications for years to come. And the voices of advocates are having an influence. For example, the US government’s contribution to the current draft of the UN declaration recently added specific recommendations from AVAC and partners on the inclusion of Good Participatory Practice. It’s up to all of us to make sure GPP and other provisions that ensure equity in global health are in place when the drafts become final.

      You can find the Declaration zero draft here and see our analysis and the changes we call for here.

      What’s Next

      These negotiations are setting the direction for pandemic readiness for years to come. As discussions continue in the weeks and months ahead, it’s imperative for advocates and countries to be raising their voices and calling for language and commitments that will ensure equity in PPPR. Building on the lessons the world has learned from ongoing epidemics, and integrating the response must be a priority to ensure the tragic results of inequity in global health are not repeated, again and again.

      AVAC will be sharing these analyses with our partners and governments with whom we work with. For more background, read AVAC’s Advocates Guide for PPPR. And you can take action now by sending these resources to your country’s UN representatives and other influential voices in your networks!

      IAS Science 2023 Conference: What you need to know

      The 12th annual conference of the International AIDS Society (IAS) on HIV science takes place July 23–26 in Brisbane, Australia, and virtually. This year’s conference will offer the latest on vaccine and cure science, research updates on broadly neutralizing antibodies, important discussions on trial design in the era of PrEP, the potential of community-led models of care and the importance of integrating services for HIV and sexual and reproductive health (SRH). AVAC and partners will be there! Read on for an overview.

      Just ahead of the conference, UNAIDS released their annual state of the epidemic report, The Path that Ends AIDS. The report charts a path that can end AIDS, and documents important progress, but challenges remain. Among them, global resources for HIV are marking another year of decline. With anti-LGTBQIA+ legal actions increasing in the US and in several African countries and reduced resources, efforts to end the epidemic will fail. See AVAC’s new graphic on the issue.

      title card with presentation info

      IAS Resources

      • Use AVAC’s Roadmap to find sessions where prevention, pandemic preparedness and the larger issues of global health equity are in the spotlight. You can download it as a sortable spreadsheet or PDF.
      • Follow events in real time, AVAC will offer comments and updates on Twitter, and our friends at NAM/AIDSMAP will be reporting throughout the conference. Join the conversation using the conference hashtag #IAS2023.

      Satellites, Sessions and Panels Featuring AVAC and Partners

      All times listed are local in Brisbane, Australia. Click for a time zone converter.

      Sunday, July 23

      Tuesday, July 25

      Wednesday, July 26

      Poster Presentations

      • No Data No More: A tool to end the exclusion of trans and gender-diverse people in HIV research
      • Raising New Voices in HIV Cure Research: A review of an advocacy-for-cure academy and grant program
      • The Value of Measuring Outcomes of HIV Advocacy: Utilising a novel and participatory approach for advocacy evaluation
      • HIV Prevention Research & Development Investments 2001-2021: Shifting investment priorities fund innovation in a challenging global health landscape
      • Revolution of Transgender Health Programming: The role of transgender activists in Health programming for Malawi

      While many will be gathering in Australia for the IAS conference, the 27th International Society for Sexually Transmitted Diseases Research (ISSTDR) is happening in Chicago at the same time – and AVAC will be there, too. Stay tuned for an update later this week for AVAC’s STI Roadmap and dedicated STI conference page. Advocates, implementers and researchers in both fields have much work to do together.

      Avac Event

      ICASA 2023

      December 4, 2023 to December 9, 2023

      The biennial International Conference on AIDS and Sexually Transmitted Infections in Africa, ICASA, will take place this year December 4-9 in Zimbabwe.

      ICASA offers an African platform for leaders, scientists, activists and community to frame the challenges, track the science and push innovation in the HIV response.

      A Comprehensive Approach for Progress

      Ending the Epidemic