Welcome to the New Year! Wondering where to put your attention and advocacy energy for the next 12 months? We don’t presume to have all the answers, but our new issue of Px Wire includes a highly selective list of ten issues, events and developments to hold attention and spark actions in 2015 — and beyond.
Want to see the bigger picture? Check out our updated timeline of biomedical HIV prevention research in the centerspread!
Viral load testing is commonly used in high-income countries but remains a relative rarity in many low and middle income settings. This test, which measures the amount of HIV in the blood, has historically been viewed as too costly for widespread use and as unnecessary for good clinical care of HIV. The past few years have seen momentum building towards adding viral load to HIV care in all settings, including resource-poor environments.
Doctors Without Borders, usually known by its French name, Médecins Sans Frontières, continues to produce invaluable resources for advocates seeking to understand why viral load is useful, feasible and worth demanding as part of a comprehensive HIV response. Their new report, Achieving Undetectable: What questions remain in scaling up HIV virologic treatment monitoring?, includes additional evidence from a five-country study of viral load implementation and MSF’s own operational experience in viral load scale-up. And in our database you can also find other, related MSF documents released over the past year.
On December 3, women’s rights and HIV prevention advocate Yvette Raphael talked on South African radio about her experience as an HIV-positive woman and discussed how treatment can protect HIV-negative people in serodiscordant relationships. Raphael, who is also a 2014 AVAC Advocacy Fellow, used creative metaphors to help explain the difference between viral load and CD4 testing. Want to know what these diagnostic tests have to do with driving to Bulawayo? Have a listen!
UNAIDS recently released Fast Track: Ending the AIDS Epidemic by 2030, its report for World AIDS Day (December 1, 2014). Coming nearly two weeks early, the launch was, itself, fast-tracked—and there’s plenty of “we can’t wait” urgency within the pages of the report, starting with the first page (that does more, typographically, with red ribbons than you might believe is possible). It reads:
“We have bent the trajectory of the AIDS epidemic. Now we have five years to break the epidemic or we risk the epidemic springing back even stronger.”
This is on target and a message to convey urgently and with clarity. UNAIDS has its work cut out as an agency that can provide leadership, mobilize resources and push for the shift to community-based service delivery that emerges as one of the core recommendations in the report.
In broad strokes, it’s the right message, with the right vision, at the right time.
But an effective response depends on strategy, details, milestones, resources and specifics—and these are still lacking. This is to be expected, as the UNAIDS Prevention and Non-Discrimination Targets are still in draft form.
The Fast Track World AIDS Day report is clear on what needs to happen to achieve the “90-90-90” goal that calls for 90 percent of people living with HIV to know their status, 90 percent of those to be on antiretroviral therapy (ART) and 90 percent of those to be virologically suppressed by 2020.
It also suggests the components of prevention programming that should also come on line—listing, in various places, male and female condoms, voluntary medical male circumcision, oral pre-exposure prophylaxis (PrEP) for sex workers, men who have sex with men, serodiscordant couples and adolescents, as well as cash transfers for young girls, harm reduction, structural interventions, mass media and behavior change. These prevention elements appear in different subsets throughout the document, leaving some confusion about what, exactly, is essential.
Everything that the UNAIDS report lists is important. But the details of what goes where—which packages, in which places—and what specific terms mean are missing. Cash transfers, for example, can be delivered in a range of ways, with different objectives and different outcomes.
There are also some elements that receive considerably less emphasis. Research and development of more potent ARVs for treatment and prevention, new prevention options for women and other key populations, vaccine and cure strategies, are fundamental to long-term success in “breaking the epidemic”. Within the five-year timeframe set by UNAIDS, there are short-term milestones to set and achieve in each of these areas, even though the ultimate goals may not be reached for many years.
The good news is that this is a solvable problem. We as advocates and activists must use our impatience and collective wisdom to fast-track a process to ensure that clear targets, resources and messages are developed with the same strategy, rigor and urgency as 90-90-90.
AVAC is working with many of our partners to inform this process. This new report adds urgency to this task and clarity to the questions we need to address. As the report stresses, we must all “hold one another accountable for results and make sure no one is left behind.”
In the coming days, AVAC will release “Prevention on the Line”—a briefing paper with core recommendations for effective target-setting across the research-to-rollout continuum. This will summarize core messages and analysis that will be expanded in AVAC Report 2014/15. To receive the Report and other updates in your inbox, please join our Advocates’ Network. Stay tuned—and stay in touch.
One way to measure progress in fighting AIDS is to compare the number of new HIV infections with the increase in HIV positive people on antiretroviral therapy (ART) over a given time period. An AIDS epidemic reaches its “tipping point” when the number of annual new HIV infection falls below the annual increase in patients starting ART. This poster was presented at the 2014 HIV Research for Prevention Conference in South Africa.
The new issue of Px Wire, AVAC’s quarterly newsletter on HIV prevention research and implementation, is now available.
This issue goes to press as global stakeholders in the HIV prevention field are preparing for the HIV Research for Prevention (R4P) conference in Cape Town. HIV R4P is the first-ever meeting to bring together researchers, implementers, policy makers and advocates from across biomedical prevention, including vaccines, microbicides, PrEP, voluntary medical male circumcision, cure and ART in HIV-positive people.
In this issue of Px Wire, we offer a selective “state of the union” update on various areas of the prevention field—highlighting key developments, messages and areas of work that warrant particular joint attention in Cape Town and beyond.
Our centerspread looks at the targets UNAIDS announced at AIDS 2014 in Melbourne—“90- 90-90” targets calling for 90 percent of people with HIV to know their status, get initiated on ART and achieve virologic suppression. Goals such as 90-90-90 help focus the field, and treatment is crucial in ending the epidemic—but this view is incomplete. The field must have the same attention and clear objectives in preventing HIV.
The full issue of Px Wire, as well as our archive of old issues and information on ordering print copies, can be found at www.avac.org/pxwire.
The special set of post-AIDS 2014 webinars concluded on Wednesday, October 8. As part of the ongoing Research & Reality series, these webinars gave advocates a chance to talk to leaders from various fields about issues including cure and prevention research, new global targets and more—all of which were raised at the recent International AIDS Conference.
See below for information on and links to slides and recordings from each of the AIDS 2014 webinars. And stay tuned for updates on future installments in the Research & Reality series.
UNAIDS, Targets and Civil Society
In Melbourne, UNAIDS launched a new initiative known as “90-90-90”, which lays out new targets for testing, treatment and virologic suppression. Where did these targets come from, what do they mean—and where does prevention fit in? Chris Collins, Chief of the Community Mobilization Division at UNAIDS addressed these questions and more.
October 8 — Animation: Flash, Audio: MP3, Slides: PDF
Data and Uncertainty: Understanding updates on hormonal contraceptives and HIV
AIDS 2014 featured analyses of data on the potential relationship between hormonal contraceptives and risk of HIV infection. Researchers Charles Morrison (FHI 360) and Kristin Wall (Emory University), and Mary Lyn Gaffield from the WHO discussed the newest findings and guidance.
October 1 — Animation: Flash, Audio: MP3, Slides: PDF
Results of the iPrEx open-label extension (iPrEx OLE): PrEP uptake, sexual practices and HIV incidence
Get details on the iPrEx OLE study from principal investigator Robert Grant, who presented the data at AIDS 2014. The first open-label PrEP study to publish results, these data from iPrEx OLE begin to answer a number of questions on PrEP use in the “real world”.
September 24 — Animation: Flash, Audio: MP3, Slides: PDF
Latest developments in VMMC research and implementation
AIDS 2014 brought more updates on voluntary medical male circumcision (VMMC) including new data on risk behaviors in circumcised men, the impact of cash transfers as part of VMMC programming and more. Kenyan researcher and implementer Kawango Agot reviewed the latest findings.
September 17, 2014; — Slides: PDF
State of the Art HIV Cure: Where are we now and where are we going?
The field of cure research is evolving and expanding, with various proposed trials that require informed engagement from many stakeholders. Get an update, discuss research and hear questions answered by plenary speaker Jintanat Ananworanich.
September 3, 2014 — Animation: Flash, Audio: MP3, Slides: PDF
As always, questions or comments are most welcome!
Earlier this week, AVAC, ATHENA Network, Salamander Trust and UN Women announced their collaboration on a Global Review of HIV/AIDS Treatment Access for Women. This project has multiple elements—desk review of available information, discussions with groups of women living with HIV, in-depth “country case studies” in a few places. Our goal is to ensure that the realities, priorities and advocacy of women and girls around a truly effective AIDS response are amplified and, ultimately, incorporated into work towards the UNAIDS “90-90-90” goals, and other country-level campaigns.
This Review is a great opportunity to share work, ideas and information that you have collected; there are also opportunities to take on new work as we build out the country case studies (this is one of AVAC’s primary focus areas within the project.) We would love to have an informational call with interested partners sometime in the coming weeks. If you are interested in joining, please contact us.
Looking forward to further collaboration!
In this update to the 2012 Action Agenda to End AIDS, amfAR and AVAC argue that critical and expensive decisions made with incomplete data can undermine the response to the AIDS epidemic—even as the systems for collecting these data continue to improve. The report describes the issues and identifies critical areas where better, more complete data are needed to guide the key decisions for the response to the HIV/AIDS epidemic. It also provides an update on prevention and treatment targets set in the Action Agenda.
With new guidelines in place calling for earlier access to antiretrovirals for HIV treatment, many more Kenyans are eligible for the drugs. Activists, including AVAC Fellow Maureen Milanga argue that the current budget for treatment falls short.
“The Government must expand its domestic funding this financial year to close the treatment gap and begin to end Kenya’s AIDS epidemic,” said Maureen Milanga arguing for more than doubling the current domestic financing for treatment.