The Px Wire centerspread from April-June 2013 Volume 6, No. 2 showcases the ARV-based HIV prevention pipeline from pre-clinical research to implementation projects.
ARV-Based Prevention Research and Development Product Pipeline
The GLAM Toolkit: Advocacy to promote lube access in Africa
The GLAM Toolkit was launched at a side meeting of the AVAC Partners’ Forum. GLAM (Global Lube Access Mobilization) is project of IRMA’s Project ARM (Africa for Rectal Microbicides), and this new resource provides background on the status of lubricant access in Africa and strategies for civil society to secure sustainable supplies of safe, condom-compatible lube.
After introducing the Toolkit, advocates discussed needs, innovative strategies and next steps for the promotion of lubricant as an HIV prevention tool. One challenge faced by advocates for lubricant access is the lack of concrete answers about lube safety. The evidence shows that condom-compatible lube (water- and silicone-based as opposed to petroleum-based) keeps condoms from breaking and slipping, which is important for HIV prevention. It is still unclear, though, which lubes are safe in humans and which might cause inflammation, increased shedding of epithelial cells and rectal bleeding. Such effects could possibly make a person more vulnerable to HIV infection.
Laboratory tests show that particular kinds of lube (iso-osmolar: having the same concentration of dissolvable substances in its cells as normal human cells) have little effect on the structure of rectal cells and the integrity of the rectal membrane. Other lubricants with higher (hyperosmolar) or lower (hypo-osmolar) levels of dissolvable substances are shown to alter cell structure in test tubes. Scientists have found that some hyperosmolar lubricants disrupt rectal epithelial tissue in macaque monkeys. The US Centers for Disease Control and Prevention (CDC) is currently conducting a trial in non-human primates to determine whether an unnamed water-based hyperosmolar lubricant affects SHIV susceptibility and transmission. (SHIV is a non-human primate version of HIV.) The CDC has said that lubricants with different chemical properties will be evaluated at a later date using this model.
Advocates have put the need for more clarity around lube safety front and center. As a result, the PEPFAR Scientific Advisory Board recently formed a lubricant safety working group to produce PEPFAR programmatic recommendations on the use of lubricants.
At the advocates’ meeting, participants agreed that there is an urgent need to clearly articulate what is known and unknown about the science, while working to meet the demand for lube from many different constituencies: gay men, men who have sex with men, and others who have anal sex. Women who have vaginal and/or anal sex also need safe, condom-compatible lubricants as well.
Click here to download The GLAM Toolkit.
Microbicide Clinical Trial Participants by Region
This graphic from AVAC’s Microbicides by the Numbers one-pager shows the prominent role played by African trial participants in microbicide research.
Achieving the End
Recent breakthroughs in HIV prevention research have created unprecedented opportunities to curb new HIV infections, save lives and set the world on a path towards eliminating HIV transmission.
The Geography of Microbicide Research in sub-Saharan Africa
This map from AVAC Report 2012 spotlights the countries hosting ring and gel microbicide trials in sub-Saharan Africa.
Planning for Expanded Microbicide Research and Implementation
At the annual African regional meeting of the Microbicide Trial Network (MTN) in Cape Town, South Africa this past October, AVAC and many of our coalition partners led and contributed to discussions about key emerging issues in microbicides research. 2011 AVAC Fellow Brian Kanyemba led a civil society consultation providing feedback for an upcoming rectal microbicide trial being planned for several countries, including South Africa. Several AVAC Fellows and partners also participated in a full-day joint civil society and MTN Community Working Group meeting, Next Steps for HIV Prevention in Women: Tenofovir Gel and Beyond. In addition AVAC Fellow Grace Kamau and partners Bright Phiri of SAT and Catherine Tomlinson of the Treatment Action Campaign (TAC) joined MTN Community Working Group members on a panel discussing community concerns and perceptions and how to continue to educate and involve communities and local media about the research process. MTN, AVAC Fellows and partners will continue to bring community voices to the table, both in understanding the implications of trial results and planning for new trials.
Reaching the Tipping Point: The time to act is now
AVAC Playbook 2012-2013: Progress toward global goals
AVAC first published its Playbook of global goals for ending AIDS in late 2011. This infographic from the AVAC Report 2012 builds on the objectives from 2011 and identifies five priorities for action in 2013.
The Change We Need to End AIDS in Uganda
2012 AVAC Fellow Alice Kayongo played a leading role in developing a civil society report, “The Change We Need to End AIDS in Uganda”, which details concerns and recommendations for shaping the national AIDS response in Uganda. This report was presented at the Joint Annual Review (JAR) of the country’s five-year National Strategic Plan (NSP) for responding to HIV/AIDS, which was first launched about a year ago. The mid-October JAR meeting was an opportunity to review progress and gaps. In the weeks leading up to the JAR, civil society participated in reviews of draft assessments of progress on the various elements of the NSP, including prevention, treatment and care, and health systems strengthening.
Kayongo was joined in this coalition effort by Sylvia Nakasi and Bharam Namanya of UNASO (2011 Fellow and Host Supervisor, respectively), and Leonard Okello, Alice’s Fellowship supervisor and Lillian Mworeko of ICW-EA (2012 Host)—as well as a broad range of other advocates.
The report, presented at the JAR, included a 10-point plan to halt new infections, save lives and ensure leadership, and provided a detailed critique of the national AIDS response to date.
This advocacy comes on the heels of a dynamic and successful campaign to increase funding for and recruitment of more than 6,000 health care workers throughout Uganda.
For a copy of the report, reach out to fellows@avac.org.
Press Release
AVAC statement on PEPFAR Blueprint
New York, NY – PEPFAR’s blueprint has enormous potential to accelerate global HIV prevention efforts. It rightly emphasizes that we need to ‘follow the science’ if we intend to deliver life-saving HIV prevention and treatment breakthroughs to millions of people worldwide. The blueprint underscores that success depends on scaling up combinations of effective strategies. It also places much-needed emphasis on voluntary medical male circumcision, which could prevent millions of HIV infections and do so more affordably than almost any other method today.
It’s particularly encouraging that the blueprint focuses on translating scientific breakthroughs into lives saved. Powerful new HIV prevention options could together lead to dramatic reductions in HIV infections, but we don’t have all the information we need to scale them up in the right combinations for various communities. Urgent questions about the real-world use of new prevention tools in combination have been clear for months or even years, yet the work to answer them is barely under way. That’s as unconscionable as it is unnecessary.
The blueprint also recognizes that ending AIDS will not be easy or quick. While current options can have a tremendous impact, continued science and innovation are essential to ultimately halt new HIV infections and deaths from AIDS.
The US has shown great leadership, and now it’s time for the rest of the global community to step up. Frankly, we are not on pace to end AIDS – but we could be. Global agencies, governments, donors and advocates need to work with PEPFAR now to agree on the most urgent priorities, set specific goals and demonstrate real progress within the next year.
A PDF version of this is available for download.
Contact:
Mitchell Warren, mitchell@avac.org, +1-914-661-1536
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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.