Press Release

With future of HIV prevention “on the line,” AVAC calls for sharper, bolder strategy to end the epidemic

Contacts

Mitchell Warren, [email protected], +1-914-661-1536

Kay Marshall, [email protected], +1-347-249-6375

New York — In a report issued today, AVAC warned that global HIV prevention efforts are in jeopardy due to an absence of strategic targets, resources and specific implementation plans to translate science, slogans and goals into action. The report calls for a robust set of global HIV prevention targets tailored to specific interventions and demands action in several key areas of the global AIDS response, including expanded rollout of daily oral pre-exposure prophylaxis, or PrEP, and alignment of science and human rights-based agendas.

“We’re at a make-or-break moment and the future of HIV prevention is on the line,” said Mitchell Warren, AVAC’s executive director. “Advances in HIV treatment and prevention research have made it possible to contemplate ending the AIDS epidemic in our lifetimes, but that will only happen with smarter planning, increased resources and greater accountability.”

The report was released ahead of the Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle (Feb. 23-26), where researchers are expected to present data from several major HIV prevention trials, including studies that could help drive global implementation of PrEP, as well as a key study of a tenofovir-based vaginal gel for women.

Report calls for smart, realistic goals and targets for HIV prevention

Today’s report, entitled Prevention on the Line, takes a close look at global goals for HIV prevention and what it will take to make them a reality. UNAIDS recently adopted the broad goals of reducing new HIV infections worldwide from 2.1 million in 2013 to 500,000 and eliminating stigma and discrimination, both by the year 2020.

Drawing upon lessons from WHO’s “3 x 5” HIV treatment initiative and other case studies, the AVAC Report concludes that ambitious prevention goals are critical – but that they will only work if they’re feasible, well-defined, measurable and supported with adequate resources and political commitment. In the case of the new UNAIDS prevention goals, the report points to a critical need for more specific, interim targets that can be tracked between now and 2020; for better data and monitoring approaches; and for resource allocations that are directly tied to achieving those targets.

“The UNAIDS prevention goals for 2020 are ambitious and inspiring,” said Warren. “But something important is missing from this picture: how to get there. We need a clear path forward, including short-term targets, so we don’t wait five years to see if the world is on track. And new targets won’t be met – and may even be irrelevant – if we fail to close the growing global funding gap for HIV prevention.”

Bold action needed to advance AVAC’s agenda to end AIDS

The report also recommends key actions to advance AVAC’s three-part agenda to end AIDS. First issued in 2011, the agenda calls for sustained efforts to deliver proven prevention tools, demonstrate and roll out new options such as PrEP and develop long-term solutions such as long-acting ARV-based prevention, vaccines and cure strategies.

Key recommendations for 2015 include:

1. Align high-impact HIV prevention with human rights and realities. Research has demonstrated the potential of high-impact prevention strategies, including biomedical approaches like HIV treatment for people living with HIV and voluntary medical male circumcision (VMMC). But these strategies won’t succeed in the real world if we give short shrift to human rights concerns, or if we fail to involve affected communities in designing and implementing prevention programs. Recent experience with treatment and VMMC, in particular, has shown that community buy-in is an essential ingredient of successful rollout and scale-up.

2. Invest now to scale up access to PrEP. Landmark trials have shown that daily oral PrEP is a powerful HIV prevention tool, and studies at next week’s CROI meeting could provide additional support. But the pace of rollout remains far too slow. Demonstration projects are small and disconnected, funding is limited and policy makers are not yet heeding growing demands for access. Funders should invest now in large-scale targeted implementation of PrEP, linked to national programs. National regulatory authorities and health ministries should prioritize licensure and rollout.

3. Accelerate research into long-term solutions. We must sustain and accelerate research on solutions such as an effective AIDS vaccine, long-acting antiretroviral prevention and treatment and a cure. Just like the rest of the AIDS response, this research needs its own short-term targets, aligned to long-term goals.

The new report and related resources, including downloadable graphics, are available now at www.avac.org/report2014-15.

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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.

New Px Wire: Top Ten Things to Watch in 2015

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!

Download the latest issue of Px Wire here.

Undetectable: New resources from Doctors Without Borders on viral load testing

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.

People Must Take Their ARVs So They Never Get to ‘Bulawayo’

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 Report has Bold Vision, Key Messages—But Needs More Precision on HIV Prevention

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.

Click here to download the new UNAIDS report.

The Tipping Point: Moving From Rhetoric to Real Milestones for Ending AIDS

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.

New Px Wire: The state of the prevention union

The new issue of Px Wire, AVAC’s quarterly newsletter on HIV prevention research and implementation, is now available.

Click here to download.

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.

Post AIDS 2014 Webinars: Experts, issues, answers—and more!

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! 

A Chance to Shape the Global Review of HIV/AIDS Treatment Access for Women

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!

Data Watch: Closing a Persistent Gap in the AIDS Response

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.