Press Release

AVAC report finds that world is already falling behind pace to end AIDS epidemic; five essential actions needed in 2013 to avoid historic missed opportunity

New York, NY – AVAC today issued a “top five” list of global actions needed in 2013 to accelerate HIV prevention efforts and preserve the opportunity to end the AIDS epidemic. The recommendations address urgent, unresolved challenges that threaten the delivery of powerful new HIV prevention methods that could help dramatically reduce the 2.5 million new HIV infections that occur worldwide every year. They include critical actions to speed access to HIV treatment, voluntary medical male circumcision (VMMC) and pre-exposure prophylaxis (PrEP), and to safeguard vital new research on vaccines, microbicides, other HIV prevention options and a cure.

“Recent scientific breakthroughs give us reason to be optimistic like never before, but our chances of success are already imperiled,” said Mitchell Warren, AVAC executive director. “Right now, the world isn’t moving as fast as it should be to begin ending the epidemic. There is still time to get back on a winning pace but only with focused, aggressive action now. This can be the year that HIV prevention begins to achieve its potential – in fact, it has to be.”

The priorities are featured in a new report, Achieving the End: One Year and Counting, which offers AVAC’s critical assessment of progress achieved since global leaders began to discuss the opportunity to “begin to end AIDS” in late 2011. The report reflects input from HIV prevention leaders across a broad spectrum.

“We have a narrow window to translate the past year’s excitement into life-saving changes on the ground,” said Dr. Helen Rees, Executive Director of the Wits Reproductive Health and HIV Institute (WRHI) in South Africa and a member of AVAC’s board of directors. “The possibility of ending AIDS is very much alive but depends on much bolder leadership, increased coordination and agreement on a clear set of short-term priorities.”

“The world needs immediate answers to the question, ‘What now?’, and then it needs to act on them,” said Warren. “We’ve identified what we believe are the five HIV prevention priorities that can make the greatest possible difference in the coming year. Whether we’re on pace to end AIDS in a year’s time will depend in large part on our success in these areas.”

AVAC’s priority recommendations for 2013 are as follows:

  1. End confusion about “combination prevention” – In 2012, there was long-overdue recognition that different countries will need to implement different combinations of HIV prevention interventions for different populations at risk. But the hard work of defining those combinations and establishing priorities has not been done. In 2013, donors, policy makers and civil society need to be held accountable for choosing, implementing and evaluating the right packages of interventions for specific circumstances.
  2. Close the gaps in the HIV “treatment cascade” – Antiretroviral treatment not only improves and prolongs the lives of those infected, it is among the most powerful HIV prevention strategies available, reducing the risk that an infected person will pass on HIV by up to 96 percent. But only a small proportion of people diagnosed with HIV are linked to antiretroviral treatment and an even smaller share stay on treatment and have their HIV infection suppressed to levels low enough to prevent transmission to others. A range of studies is looking at ways to narrow this gap, but these efforts are uncoordinated and incomplete. In 2013, researchers and funders need to convene and establish a clear research and implementation agenda to close the gaps in the treatment cascade.
  3. Prepare for new non-surgical male circumcision devices – In 2013, the World Health Organization (WHO) is expected to approve new male circumcision devices that could eliminate the need for surgery, speed recovery and lower costs in many of the 14 priority African countries where VMMC could reduce HIV infections by 20 percent. While the new devices may not be right for every country or setting, there could be months or years of lost opportunities unless national health leaders immediately take action to evaluate their benefits, costs and optimal uses.
  4. Define and roll out needed PrEP demonstration projects – Global health agencies including WHO and UNAIDS have said they are awaiting the results of real-world demonstration projects before they can provide guidance on the use of PrEP – yet there is no clarity on what range of studies is needed, and few are under way. By the end of 2013, a core set of studies must be defined and moving ahead.
  5. Safeguard HIV prevention research funding – New momentum on research into HIV vaccines, microbicides and other new tools is threatened due to the possibility of federal budget sequestration in the US and similar pressures in other countries. The potential cuts could slow or halt progress on some of the most promising HIV prevention research in many years. Policy makers must have the courage to preserve this vital research in 2013.

“The most urgent questions about new prevention tools have been clear for months or even years, and yet the work to answer them is barely under way,” said Warren. “That’s as unconscionable as it is unnecessary. Millions of lives depend on our ability to pick up the pace.”

The new recommendations build on AVAC’s long-term agenda for global HIV prevention efforts, issued in late 2011. That report, titled simply The End?, established near-, medium- and long-term goals for delivering available prevention interventions, demonstrating potential impact of emerging tools such as PrEP and microbicides, and developing essential new tools, including AIDS vaccines. In addition to the five key priorities for 2013, AVAC’s new report includes key updates to the long-term agenda for global HIV prevention.

A PDF version of this press release is available.

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.

Countries in sub-Saharan Africa Conducting Microbicide Gel and Ring Trials

Activists Strategize in Peru

In May, AVAC partner Epicentro led a civil society meeting, Activism, Access to Health Services for LGBT and Biomedical HIV Prevention, to develop a plan for engaging with biomedical HIV prevention research occurring in Peru. Local advocates, including MSM sex workers and people living with HIV, participated in the two-day conference. (Download the agenda: English and Spanish.) The objectives were to promote a common understanding of the PrEP and rectal microbicide research taking place in the country and to identify strategies for community mobilization on these issues, HIV treatment and prevention, and LGBT health in general. The resulting advocacy agenda articulated a demand for access to affordable TDF/FTC for treatment of HIV-positive people—an issue that must be addressed before oral PrEP using TDF/FTC in HIV-negative people can be fully explored. It also identified the need for journalist training, sensitization of health workers on LGBT health issues, and general awareness-raising on biomedical HIV prevention.

Communities of gay men, other men who have sex with men, and transgender women have some of the highest rates of HIV in Peru. Yet access to HIV testing, care and treatment is limited—due to many factors including stigma, lack of gay-friendly services, and lack of awareness of health care rights among affected communities. Advocacy also includes continued support for ARV-based prevention research— the iPrEx OLE open-label extension PrEP study; MTN 017, the first phase II rectal microbicide trial; and early phase vaccine studies. For example, in March, Epicentro, AVAC, IRMA, IMPACTA and MTN organized a community consultation for the pending MTN 017 trial. Most meeting attendees were Lima locals, but there was representation from elsewhere in Peru as well as Paraguay and Argentina.

The next steps are to prioritize and operationalize the objectives generated at the meeting. To join the burgeoning network of local and regional Latin American advocates spearheaded by Epicentro, contact Steve Miralles at stevemiralles@hotmail.com or join the group directly at irma-alc@epicentro.org.pe.

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AVAC Partners at M2012

AVAC partners were a dynamic presence at the Microbicides 2012 (M2012) Conference in Sydney, Australia (April 15-18, 2012). HIV prevention advocate Milly Katana—a frequent collaborator and advisor on our 2010 Advocacy Fellowship and WHiPT programs—gave a plenary address, “Making Access a Reality for All Those in Need”. Bonnie Saxon Medeossi of the Witwatersrand Reproductive Health Institute (WRHI) presented “Putting the GPP guidelines to work: Achievements and challenges for the FACTS Consortium.” Through a partnership with AVAC, Bonnie and colleagues at Wits Reproductive Health and HIV Institute (WRHI) have been implementing the Good Participatory Practice (GPP) guidelines as a core part of the FACTS 001 trial of 1% tenofovir gel. This presentation, along with her overview in a GPP symposium led by WRHI and AVAC, resulted in networking and sharing of GPP tools amongst conference attendees. Fellow Alliance Nikuze chaired a session, “Criminalization and its intersection with HIV risk behavior” which also included presentations from 2011 Fellows Brian Kanyemba and Simon K’Ondiek. These presentations just scratch the surface of a busy week which also included the launch of Project ARM report on the African Rectal Microbicides movement in Africa (a project led by IRMA, with AVAC collaboration), presentation of the Omololu Falobi Award to long-time advocate Anna Forbes, media skills-building sessions by the Microbicides Media and Communications Initiative (MMCI), and a vibrant Advocacy Corner in the exhibition all that was brought to life by partners—including past, current (and maybe even future) Fellows—from around the world.

Charting the Course of the First Phase II Rectal Microbicide Trial

Last month the Microbicide Trial Network (MTN), in partnership with AVAC and other groups (see below for full list), held community consultations in Chiang Mai and Bangkok on the planned MTN-017 trial of a rectal formulation of 1% tenofovir gel. These consultations were organized in partnership with advocates who have worked with AVAC on implementing Good Participatory Practice guidelines in Thailand. MTN-017 plans to enroll approximately 216 participants, men who have sex with men and transgender women, at trial sites in South Africa, Peru, Thailand and the United States. Results of the Phase II safety trial will be used to guide decisions on future efficacy trials of the gel as an HIV prevention tool for use during anal sex. At the meetings in Chiang Mai and Bangkok, community stakeholders emphasized the importance of gathering data on rectal use of 1% tenofovir gel among transgender women. As a result of this feedback, the trial team decided to amend the protocol to include transgender women as trial participants—an example of GPP in action!

The full group of collaborators included the International Rectal Microbicide Advocates (IRMA), the Thai Ministry of Public Health – US Centers for Disease Control and Prevention Collaboration and the Thai Research Institute for Health Sciences (RIHES) along with MTN and AVAC. MTN-017 consultations were also held in South Africa in October 2011 and are planned for Peru in March 2012. Contact avac@avac.org to learn more.

Background facts: The rectal formulation of 1% tenofovir gel was developed to address results from an earlier study, RMP-02/MTN-006, which found that while the vaginal formulation of 1% tenofovir gel used in CAPRISA 004, VOICE and FACTS 001 was generally safe to use in the rectum, side effects were problematic to a few study participants. A rectal formulation of the gel was subsequently developed and tested in MTN-007, the results of which will be reported at CROI in March of this year.

Yes We Can End the Epidemic: AVAC Fellows Orientation 2012

AVAC’s HIV Prevention Research Advocacy Fellows gathered for an orientation and wrap-up session in Kampala at the end of January. Fellows from 2010, 2011 and eight new fellows from 2012 together with their host organization supervisors gathered in Kampala, Uganda, to take stock of recent accomplishments, plans for the future and take steps to forge an African movement to end the AIDS epidemic. The three-day meeting included debates and discussions about how to prioritize prevention strategies that are available today, such as treatment as prevention and voluntary medical male circumcision (VMMC), and explorations of the agenda for emerging strategies such as PrEP and microbicides and hoped-for interventions like an effective AIDS vaccine. One highlight was an intensive afternoon session on the potential for influencing the Country Operating Plans that guide the President’s Emergency Plan for AIDS Relief (PEPFAR). These “COPs” can be used to leverage additional resources for the pillars of combination prevention—ARV treatment, VMMC and prevention of pediatric infection. In the coming months, advocates will be participating in intensive country-level campaigns.

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Project ARM Charts a Course of Action for Rectal Microbicide Research and Anal Health in Africa

The first meeting of Project ARM (Africa for Rectal Microbicides) was held in Addis Ababa, Ethiopia, in December. The two-day ICASA satellite meeting was initiated by IRMA (International Rectal Microbicide Advocates) and organized in partnership with AVAC. Forty delegates, including gay advocates from throughout Africa, met to chart a rectal microbicide advocacy and research agenda for Africa. Participants agreed that expanded research on rectal microbicides, anal sex behaviors and health should be prioritized for transgender women, gay men and other men who have sex with men (MSM) and heterosexual populations in Africa. They also discussed the need for expanded communication and education efforts to raise awareness of issues and developments related to rectal microbicide research and anal health. Rectal microbicides could play a key role in HIV prevention for gay men, transgender women and other MSM. But these are still experimental products, and there are immediate sexual health needs that could be addressed through responsive rights-based programming. One basic need is lubricants, or “lube” that can be used with condoms as part of safer anal sex. The Project ARM participants decided to create the Global Lube Access Mobilization (GLAM) campaign to support increased access and availability of condom-compatible lubes throughout Africa, employing the tagline “And Lube!”. The meeting provided a safe space for gay and other men who have sex with men (MSM) to publically articulate their issues and concerns. It is critical that such spaces flourish throughout the world. Unfortunately, another pre-ICASA conference meeting, Claim, Scale-up and Sustain, organized by AMSHeR (African Men for Sexual Health and Rights) to draw attention to MSM/LGBT and HIV-related issues in Africa, was shut down by local religious leaders. IRMA will release the Project ARM strategy report at the 2012 International Microbicides Conference in April.

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HIV Prevention Research: Defining moments since 2010

Published in AVAC Report 2011, this timeline shows the HIV prevention scientific breakthroughs from July 2010 to Nov 2011, including the CAPRISA 004, iPrEx and Partners PrEP trials.

Many Opportunities for HIV Prevention

To end AIDS, we need HIV prevention options that are highly effective before, during and after exposure or infection. This graphic from AVAC Report 2011 lists some of these tools.

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.