Exploring Treatment as Prevention in South Africa

AVAC 2013 Advocacy Fellow, Mickey Meji, has been speaking with South African community members to better understand how treatment as prevention might work for key populations in the country.

The South African government is working to reduce the number of new HIV infections in the country, setting specific targets, but none of these discuss how treatment as prevention (TasP) approaches might impact key populations or address their needs. That is why I chose to gather information about these populations’ experiences and opinions with respect to treatment as prevention and educate individuals living with HIV about TasP so they are able to engage in discussions on the topic and its impact on their communities.

As part of my Fellows project, I spoke with men who have sex with men, sex workers and transgendered people in four provinces in South Africa. They were HIV-positive, negative or unaware of their status. I was nervous at first, not knowing what to expect, but I quickly got the hang of it. I got more comfortable and those speaking with me more readily shared their stories. I found that those taking treatment primarily took medicine for their own health but a few did to reduce transmission to others. Only one person in our consultations mentioned taking PrEP. Feelings were mixed among HIV-negative participants over whether they would use PrEP or not were it available to them.

Over the coming month, I will conclude my community consultations. Then I will work with other AVAC Fellows in South Africa to analyze the information. These findings will guide my future work advocating for the health and rights of these populations.

AVAC is please to announce the call for 2014 Advocacy Fellowship applications. Much more information on the program, including a three-minute informational video, and application details are available at www.avac.org/2014fellowsapps.

Press Release

New report on global HIV treatment research and development investments in 2010 and 2011

Public-sector funding streams are flatlining, jeopardizing scientific innovation

New York, NY – Today, Treatment Action Group (TAG) released its latest report, Funding Scientific Innovation: Global Investments in HIV Treatment Research and Development in 2010 and 2011. For this report, TAG submitted surveys to 171 public, private, and philanthropic funders from around the world; of these 41 responded to TAG, reporting investments of US$2.6 billion in HIV treatment research and development (R&D) in 2011. The TAG report documents an 11.8% increase in funding from the baseline year of 2009, when 46 global funders were surveyed, but only a 6.9% increase from 2010, when 34 funders reported investing US$2.5 billion.

While investments recorded between 2009 and 2011 demonstrate a steady—albeit low—increase in funding, inflation and flatlining of public-sector budgets could put HIV treatment discovery in jeopardy. Simpler, more effective ART formulations are in the pipeline and more effective diagnostic tools are moving towards the market, but to ensure that these lifesaving tools are widely accessible, further commitment to HIV treatment R&D is necessary.

Funders from 18 countries participated in the yearly resource-tracking exercise. The US National Institutes of Health (NIH) was responsible for 62% of the total reported amount in 2011. This level of investment will decline with the impact of sequestration, the automatic across-the-board cuts to U.S. government spending, created in the Budget Control Act of 2011, which began last week on March 1.

The largest share of HIV treatment R&D funding, 51.8% (or US$1.4 billion) was directed to the development of new medications. Though the private sector is the leading funder of HIV treatment R&D, its participation in this resource-tracking effort was paltry, with only 8 of 41 institutions providing their investment figures for 2010 and 2011. As a result, private-sector participation is underrepresented here, giving the lead to the public sector, with 69.2% of the recorded 2011 total originating from public and international development agencies.

“We are disappointed that industry continues to be reluctant to report their investments in HIV treatment R&D,” said TAG’s executive director, Mark Harrington, “when we believe that their contribution to the research effort is significant, yet badly underreported.”

“TAG is concerned that public-sector investment is flat when the world needs to reach 15 million HIV positive people with treatment by 2015,” said Harrington. “This is particularly troubling in the United States—since the government funds 63% or nearly two-thirds of the global reported total of HIV treatment research—where the current sequestration of federal funding will cost the NIH $1.5 billion (5%) of its current-year budget, directly threatening urgently needed progress in research to develop more effective treatments for HIV, a cure, and a vaccine to end the epidemic,” he added.

“For the first time, the end of the AIDS epidemic is within reach if we act,” said Mitchell Warren, executive director of AVAC. “Research into better treatment regimens and ways to narrow the gaps in the treatment cascade have the potential to expand treatment access to improve health outcomes for people living with HIV/AIDS and will play a critical role in reducing the cycle of new infections. The past three years have been a period of modest growth investment in HIV treatment R&D. With greater sustained and flexible funding, the future of HIV treatment research will be even more promising.”

Along with drug development, TAG records investments in basic science; applied/infrastructure/unspecified research; HIV diagnostics; therapeutic vaccines; treatment as prevention; and operational and implementation science. “The goal of this report is to provide evidence-based data on investments in HIV treatment research. We urge more HIV research funders to participate in this project and help us create an accurate account of the world’s response to curbing and ultimately ending the epidemic with innovative tools,” said Marina Smelyanskaya, the report author. “With better data, the report can serve as a roadmap for activists, policy makers, and funders to identify key resources and gaps in HIV treatment R&D funding,” she added.

The report called for greater transparency of pharmaceutical research investments, multisectorial collaboration, and support from global advocates in its resource-tracking efforts.

The HIV Treatment Research and Development Resource Tracking Project is a collaborative initiative of TAG and AVAC, directed and managed by TAG, with financial support from the Joint United Nations Programme on HIV/AIDS (UNAIDS).

Download report here.

Contact:

Marina Smelyanskaya, +1-347-301-4955

###

About TAG: Treatment Action Group is an independent AIDS research and policy think tank fighting for better treatment, a vaccine, and a cure for AIDS.

TAG works to ensure that all people with HIV receive lifesaving treatment, care, and information. We are science-based treatment activists working to expand and accelerate vital research and effective community engagement with research and policy institutions. TAG catalyzes open collective action by all affected communities, scientists, and policy makers to end AIDS.

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.

Achieving the End: One Year and Counting

In AVAC Report 2012, Achieving the End: One Year and Counting we’ve identified five priorities for action.

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.

Key Strategies for Closing Gaps in the HIV Treatment U=U Cascade

From the AVAC Report 2012, this infographic highlights an AVAC 2013 priority of articulating and funding a retention science agenda that narrows the gaps in the Treatment U=U cascade.

People Not Receiving Antiretroviral and Treatment U=U and Services in One Year through Bilateral FY 2013 Sequestration

This graphic from AVAC Report 2012 illustrates the potential effects of US federal budget sequestration on HIV prevention and Treatment U=U implementation in 2013.

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.

Estimated Engagement in HIV Care Cascade in the US

As this graphic from AVAC Report 2012 shows, it is estimated that only 19 percent of HIV-positive people in the the US have an undetectable viral load.

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 [email protected].