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.
Yes We Can End the Epidemic: AVAC Fellows Orientation 2012
AVAC Partner Provides AIDS Briefing to Ohio State Representatives
Julie Patterson, director of capacity building for the AIDS Task Force of Greater Cleveland and an AVAC PxROAR member provided unprecedented HIV/AIDS testimony and education to the Ohio House of Representatives Committee on Health and Aging. She was invited by the Republican Caucus of the House of Representatives. The event, which took place the week after World AIDS Day, allowed Patterson to review HIV disease, prevention, treatment and testing and to provide information on recent breakthroughs in biomedical HIV prevention research, including the HPTN 052 trial which found a significant reduction in transmission within HIV-serodiscordant couples when treatment was initiated earlier (350-550 CD4 cells) versus in accordance to national guidelines. Although the vast majority of HPTN 052 participants came from outside of the US, the trial is of great relevance for the domestic US epidemic, where “treatment as prevention” could be a potent part of a combination prevention package, supported by additional US funds (see first item.) Patterson explained that earlier treatment for HIV positive people is cost-saving, and urged legislators to support expanded ART programs with the goal of optimizing the health and prevention benefits of ART—and saving costs over the long term. For more on HPTN 052, read Patterson’s piece in Ohio’s weekly Gay People’s Chronicle entitled “Treatment as prevention, turning the tide in the AIDS epidemic”.
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.
AVAC Playbook 2012
AVAC Playbook 2012 includes AVAC’s analysis of what the top strategic goals should be on a global level, and particularly in hard-hit countries, over the year 2012. It also includes AVAC’s organizational priorities for contributing to these goals.
Press Release
AVAC Report Defines Agenda for Ending the Global AIDS Epidemic
New York, NY — AVAC today issued a three-part, science-based agenda for ending the AIDS epidemic within our lifetimes. The new report, titled The End?, is a unique strategic vision encompassing key steps to accelerate impact with existing HIV prevention tools, emerging strategies and longer term research. It identifies critical priorities in each of these areas and advances specific recommendations for both 2012 and for the next decade.
“The past year has seen building excitement about the possibility of ending AIDS in our lifetime. It is an ambitious goal, but a realistic one, provided we have a clear path forward and the will to do what’s needed,” said Mitchell Warren, AVAC executive director. “The science-based agenda in this year’s AVAC Report fills a gap at a critical moment: it describes the full spectrum of actions needed to realize the potential of existing, emerging and long-term biomedical HIV prevention options and change the AIDS response forever.”
The report comes at a pivotal moment for the AIDS response. Just weeks ago, US Secretary of State Hillary Clinton committed the US government to realizing an “AIDS-free generation.” A recent report from UNAIDS mapped a new framework for AIDS investments which are focused on high-impact, evidence-based strategies. Yet at the same time, the Global Fund to Fight AIDS, Tuberculosis and Malaria announced that it has insufficient funds for its next round of grants, effectively delaying any new funding commitments until 2014. Ensuring that the Fund is replenished and continues to support countries worldwide is a top priority for ending AIDS.
“Secretary Clinton and other leaders have put a spotlight on what’s possible. Now, it’s time to agree on a coherent, long-term plan to make it happen,” said Warren. “While our success at ending AIDS is far from assured, the scientific data are speaking loud and clear and expectations are running high. It is essential that funding, implementation and research commitments align. The future of the epidemic hangs in the balance.”
Game-changing research advances fuel optimism
Recent studies have demonstrated that antiretroviral (ARV) medications and other tools can prevent HIV transmission, creating new opportunities to accelerate the global decline in new HIV infections:
- In 2006, trials showed that voluntary medical male circumcision can reduce a man’s risk of infection from a female partner by about 60 percent.
- In 2011, a large US-funded trial released data showing that starting effective HIV treatment earlier reduced individuals’ risk of transmitting HIV by 96 percent.
- In 2009 and 2010, trials of oral and topical pre-exposure prophylaxis (PrEP) using ARV medications in specific populations of HIV-negative people provided proof of concept that PrEP is an effective prevention tool.
- In 2011, scientists identified vaccine-induced immune correlates of risk that help explain the positive finding from the RV144 AIDS vaccine trial—the first to demonstrate that a vaccine can have an impact on HIV transmission—and point the way to discovery of an effective AIDS vaccine.
AVAC Report 2011 outlines priorities for success
The agenda for action in the AVAC Report covers three major priority areas. Each area demands action today, while the dividends in terms of impact on the epidemic will be seen in the short, medium and long term:
- Deliver today’s proven strategies at scale, for immediate impact on the epidemic.Scale up innovative HIV testing programs to identify people who can benefit from prevention and treatment; expand access to treatment to preserve health and prevent transmission; and realize the full potential of voluntary medical male circumcision, a so-far underutilized tool.
For 2012, specific global goals include achieving universal access to ARVs at CD4 counts of 350 or below; and ensuring that relevant countries have long-term plans in place to roll out voluntary medical male circumcision with the goal of achieving 80 percent voluntary circumcision rates.
- Demonstrate and roll out emerging tools, including PrEP and microbicides, for even greater impact in five to 10 years.Quickly establish clear plans to understand how and for whom these promising tools might work; launch pilot projects to determine their best uses in different populations; and then prioritize their use in the populations, and in combinations, where their potential impact is greatest.
For 2012, global goals include swift implementation of pilot projects, establishing a clear pathway for confirmatory research on the tenofovir-based microbicide gel, and building and maintaining a pipeline of longer-acting options.
- Develop long-term solutions, including an effective vaccine and a cure.Sustain funding to capitalize on recent scientific advances that have energized the research field.
A key 2012 goal is to close funding gaps for trials that are needed to pursue leads from the RV144 vaccine trial. Such trials are increasingly threatened by potential research budget cuts in the U.S. and other nations. In addition, it is increasingly important to define how a vaccine could impact combination prevention.
Success hinges on sustained financing, used wisely
The report urges that resources for HIV prevention be allocated for greatest possible impact. Where necessary, funding that supports low-impact activities should be reprogramed, based on evidence, to further reduce infections and save more lives. Moreover, AVAC argues that to end the AIDS epidemic, the field needs to define, evaluate and implement combination prevention in every community affected by HIV.
“If we’re serious about ending the epidemic, then we all need to make certain that precious resources are put where they’re needed most,” said Warren. “And we need to ensure that adequate resources are available. We cannot meet these ambitious goals if the Global Fund, PEPFAR and other essential programs are not adequately funded.”
In launching the report, AVAC called on the United States, global health donors and developing countries to increase funding for scale-up of interventions including HIV testing, treatment and voluntary medical male circumcision. At the same time, renewed promise in the vaccine research field can only be pursued through sustained support from the US and other research sponsors.
“Today’s exciting science comes at one of the most challenging and frustrating economic times,” said Warren. “But the case for investing in the AIDS fight is the strongest it has ever been. If we spend more today—and spend it more wisely—we can save money over the long term and rid the world of one of the most devastating and prolonged epidemics in history.”
The full AVAC Report 2011: The End?, along with AVAC’s Playbook 2012, podcasts, graphics and other materials about ending the epidemic, are available at www.avac.org/report2011.
A PDF version of this press release is available here.
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.
Press Release
AVAC Applauds Secretary of State Hillary Clinton for Ambitious, Science-Based Vision to End the AIDS Epidemic
New York, NY — AVAC welcomes today’s remarks by U.S. Secretary of State Hillary Rodham Clinton as the first step in an ambitious vision for ending the global AIDS epidemic.
“Secretary Clinton rightly recognized that this is an era of unprecedented opportunity for changing the course of the AIDS epidemic and making an AIDS-free generation a reality. The announcement of an additional US$ 60 million for combination prevention impact evaluation in four countries is a useful first step in terms of realizing the vision. In the coming months, it will be critical for the Obama Administration to build on the plan that she outlined with specific commitments and objectives for the near-, mid- and long-term,” said Mitchell Warren, AVAC executive director.
Secretary Clinton emphasized three core prevention strategies that, if fully implemented, would lead to an AIDS-free generation: prevention of mother-to-child transmission, voluntary medical male circumcision and effective antiretroviral treatment for people who are HIV positive.
“HIV testing and counseling programs are the foundation for each of the interventions Secretary Clinton described, and it will be critical for the Obama Administration to focus on massive scale-up of innovative, ethical testing programs as part of its articulated plan for an AIDS-free generation,” Warren said.
“It is also critical to sustain investments in research and development of additional powerful prevention tools, including pre-exposure prophylaxis (PrEP) using ARVs in HIV-negative people, microbicides, and an AIDS vaccine,” Warren added. “If voluntary medical male circumcision, treatment as prevention and prevention of mother to child transmission are taken to scale, the number of new infections will plummet. Deploying additional tools over the long term,could help realize the greatest achievement of ending the AIDS epidemic in our lifetime.”
“This is truly a new era in the AIDS response, with unprecedented opportunities. Research has brought us a host of new ways to prevent HIV, but we have a long way to go before realizing their full potential. Having identified these key areas, the United States needs to continue to show leadership by articulating a clear plan with milestones for progress. Other developed and developing country governments, communities and donors need to show leadership, ownership and initiative as no single nation can end the epidemic on its own.”
AVAC will release its annual report on the state of global HIV prevention at the end of November, laying out a science-based prescription for the coming decade to realize the end of the AIDS epidemic.
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.
Modeling the End of the Epidemic
“We need to use modeling to communicate what the possibilities are and what’s been gained from investments to date.” This was the consensus of a small group of advocates, activists, public health leaders and modelers gathered on September 9 by AVAC and amfAR to take a closer look at the state of epidemiological modeling as it relates to the goal of ending the AIDS epidemic. There is scientific evidence for a range of potent prevention strategies including treatment as prevention, male circumcision in the immediate term and, in the future, microbicides, PrEP and vaccines. But decision makers face real challenges about determining priorities and budgets. Models can’t provide the answers, but they can give a sense of the benefits and trade-offs for different scenarios. On October 3, Tim Hallett, a modeler and epidemiologist from Imperial College London, met in Nairobi with AVAC and a small group of East African advocates including several of our Fellows, to discuss how advocates can be what Hallett calls “informed consumers” of HIV models. In the coming weeks and months, AVAC and its allies will be working to help frame the questions and modeling the needs critical to ending AIDS. Watch this space.
Advocating for Increased HIV Prevention Funding in Uganda
AVAC Fellow, Sylvia Nakasi, recently published a letter, “Uganda must move fast on HIV”, in The New Vision, a leading newspaper in Uganda. Her letter reflected on the recent announcement that Rwanda would consider implementing immediate antiretroviral treatment for all serodiscordant couples on the basis of effective data on treatment as prevention from the HPTN 052 trial. Nakasi called on Uganda to take similar steps, citing modeling data that suggests putting more resources into prevention now decreases how much will be needed to spend for treatment in the future. “As a country we need to move faster and also learn from our neighbors next door and speed up the process from research results to policy.” Given that Uganda sees 350 new HIV infections every day, prevention is a clear priority.
Press Release
AVAC says results of new PrEP trials provide clear evidence that antiretroviral drugs for prevention can help end the AIDS epidemic; calls for quick action on results
New York, NY – Results from two African studies of pre-exposure prophylaxis, or PrEP, released today provide clear evidence that the antiretroviral drugs used to treat HIV can also be used to prevent HIV among heterosexual men and women at risk of HIV infection.
“These results are tremendously exciting and confirm that we are at pivotal period in the AIDS epidemic,” said Mitchell Warren, AVAC executive director. “Antiretroviral (ARV) drugs for HIV treatment began to turn the tide of the epidemic 15 years ago, and it is clear that also using ARVs for HIV prevention will strengthen our response to AIDS. PrEP, ARV-based microbicides and treatment as prevention are powerful tools to help end the cycle of new infections and end the epidemic.”
“We now have data that earlier treatment initiation in HIV-positive people can reduce risk of HIV transmission—and that use of ARVs in HIV-negative people can reduce risk of infection. There is a global imperative to act on these results without delay,” Warred added. “Now is the time to include ARV-based prevention in national plans, applications to the Global Fund to Fight AIDS, Tuberculosis and Malaria and donor priorities. We need ambitious pilot and demonstration projects to guide programmatic design, along with national and international guidance on how best to use ARVs as lifesaving prevention tools. The next steps will not be simple but they will be essential. Scientific data do not change the world—programs and policies backed by civil society, donors, implementers and governments do. The countries where PrEP trials took place should lead the way in these critical efforts.”
“We congratulate the trial sponsors, scientific collaborators and partners who conducted these trials. We especially want to thank the more than 10,000 men and women whose altruism and commitment as trial volunteers made this effort possible,” Warren said. “These volunteers and their communities have made an inestimable contribution to HIV prevention research and to the eventual development of new ways for men and women to protect themselves from HIV.”
The Partners PrEP study in Kenya and Uganda enrolled 4,758 heterosexual couples in which one partner was HIV-positive and the other HIV-negative. The trial showed that both tenofovir (TDF, marketed as Viread) and tenofovir plus emtricitabine (TDF/FTC, marketed as Truvada) taken daily can reduce the risk of HIV transmission among both men and women. In the trial, daily oral TDF reduced HIV risk by an estimated 62 percent infections (95% CI 34 to 78, p=0.0003) and daily oral TDF/FTC reduced HIV risk by an estimated 73 percent (95% CI 49 to 85, p<0.0001) when compared to a placebo. Both drugs were effective in both men and women, and there were no significant safety events in the trial.
Separately, the TDF2 study in Botswana enrolled just over 1,200 sexually active men and women. At the time of its completion, TDF2 was an expanded safety trial that was not designed to provide information on effectiveness. However, analysis of final data on numbers of infections in the active and placebo arms indicated that daily oral TDF/FTC reduced the risk of HIV infection in both men and women participants by an estimated 62.6 percent (95% CI 21.5 to 83.4, p=0.0133) compared to those who received the placebo.
AVAC looks forward to continued discussion of the meaning of these findings for men and women in different contexts. Additional data from these studies not released today, but expected over the coming months, will help guide these discussions. These include data on drug resistance from Partners PrEP, data on drug levels in blood plasma, cells and tissue samples, viral genotyping of infecting strains within Partners PrEP couples to identify linked and unlinked transmissions, and other information.
These results add to a growing body of evidence confirming the powerful potential of antiretroviral drugs for HIV prevention. This includes the positive results of the iPrEx trial, a study of daily oral TDF/FTC in gay men, other men who have sex with men, and transgender women, which showed a 44 percent reduction in HIV risk compared to placebo; CAPRISA 004, a trial of 1% tenofovir gel in heterosexual women, which showed that women who received the gel had an estimated 39 percent lower risk of infection compared to those who received an inactive placebo gel; and HPTN 052, which demonstrated a 96 percent reduction in HIV transmission among HIV serodiscordant couples when the HIV-positive partner received early antiretroviral treatment.
“At this critical juncture in biomedical prevention research, it is essential that governments, program implementers and donors move with speed to identify and enact the next steps suggested by the findings from these two trials of pre-exposure prophylaxis and from other recent successful trials,” Warren said.
Today’s findings make even more critical that stakeholders act on recommendations put forward in a statement, “We CAN End the AIDS Epidemic,” which has been endorsed by more than 30 organizations and close to 400 individuals around the world to date. Next steps should include:
- Trial teams and Gilead, which donated the study drug, should ensure continued access to study drug for all participants in the Partners and TDF2 studies, including those in the placebo arms.
- National governments should work with donors and program implementers to identify the implementation research needed to address unanswered questions and evaluate the potential impact of PrEP in key populations and contexts and to evaluate treatment as prevention, building on the result from HPTN 052.
- At national and international levels, new findings from Partners and TDF2 as well as data from iPrEx and HPTN 052, should be integrated into ongoing strategic planning, funding proposals for the Global Fund to fight AIDS, Tuberculosis and Malaria and other processes.
- National AIDS programs along with civil society and other key partners must swiftly develop clear messages for a range of audiences, including at-risk individuals and communities, program implementers, policy makers, regulators and others, about what these data mean—and what questions remain to be answered.
- Funders, trial sponsors and researchers should prioritize additional research for PrEP and microbicides using different agents and mechanisms of delivery.
“Because the drugs evaluated in the Partners and TDF2 PrEP trials are licensed and available as treatment for HIV-positive people, men and women at risk of HIV infection need immediate information about what these data tell us and what questions remain. The US Centers for Disease Control and Prevention (CDC) moved quickly to provide interim guidance for PrEP use among men who have sex with men in the United States following the data from the iPrEx trial. Now CDC should move quickly to issue updated guidance for all populations in which PrEP has been shown to be effective.
At the same time, the World Health Organization (WHO) must move quickly to develop guidance for all populations for whom PrEP has now been shown to be effective,” Warren said. “And African countries, especially those where these trials took place, must also move quickly to determine the place of both PrEP using TDF/FTC or TDF, as well as earlier initiation of ARVs, in national prevention programs.”
In addition, the VOICE trial, which is looking at the use of oral PrEP and vaginal microbicides among women in several African countries, is expected to provide additional data that may help guide both PrEP and microbicide programs. “We know that the VOICE team and its independent Data and Safety Monitoring Board will be carefully reviewing the data from both of these trials and evaluating the potential impact on VOICE, and that the trial will provide critical additional information about both PrEP and tenofovir gel microbicides.” Warren said. Results from the VOICE trial are expected in 2012. Forthcoming data from the FEM-PrEP trial, which was stopped earlier this year after it was determined that the trial would not be able to provide an efficacy result, will also provide additional information about PrEP use among women.
More information is needed about issues such as adherence and possible drug resistance as well as optimal program design, integration of PrEP and earlier ART initiation into comprehensive prevention programs, and cost. Gilead announced earlier this month that it would make both drugs studied in these trials available to the UNITAID patent pool, which seeks to make generic versions of ARVs more affordable in developing countries, and which may help make PrEP more affordable.
Adherence—the ability to take PrEP as prescribed by the trial protocol—is a critical component of efficacy. Initial findings from the Partners PrEP study showed high reported adherence for the once-daily regimen. It will be important to learn why and how adherence was high in this study and what lessons can be learned for eventual rollout of PrEP. At the same time, research into intermittent dosing (e.g., weekly, semi-weekly or around the time of sex), which may be easier from some people to adhere to, is needed. Moreover, additional research is still urgently needed for other methods where adherence is less important, such as vaginal rings with monthly release, periodic injectable forms of ARVs and vaccines.
As with other HIV prevention trials, Partners and TDF2 provided a comprehensive HIV prevention package. All trial participants received condoms, safer sex counseling and treatment of sexually transmitted infections. Female participants were also provided with effective contraception. Participants were frequently tested for HIV and were intensely counseled on the importance of adhering to the daily regimen and using condoms and other prevention options—a level of counseling and testing not easily achieved outside of a clinical trial.
Demonstration projects and additional research can provide important information about how PrEP programs should be structured to account for these “real world” issues. Such projects should be prioritized and fully funded to provide answers as quickly as possible.
“As we move towards PrEP implementation, it is critical to remember that millions of HIV-positive people around the world lack access to the HIV treatment they need, which is often the same drug used in these trials,” Warren said. “We can and must find a way to ensure that PrEP is a part of comprehensive, well-funded response to HIV. That means ensuring access for all who need it to existing HIV prevention and treatment options, including universal access to treatment and care, PrEP, treatment as prevention and medical male circumcision; ensuring continued research to find and refine effective new options, including microbicides, vaccines, new and improved treatment options and a cure; and planning for integrating these new interventions into fully funded combination programs.”
More information on these and other PrEP trials can be found online at www.avac.org/prep. The sign on statement is available at endtheepidemic.org.
A PDF version of this press release is available here.
Contact:
Mitchell Warren, Mitchell@avac.org, +1-914-661-1536
Kay Marshall, kay@avac.org, +1-347-249-6375
###
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.
Press Release
Activists and Researchers: Evidence Shows We Can End the AIDS Epidemic; International coalition calls for clear actions from world leaders
New York, NY – An international coalition of scientists and activists today launched a common platform for ending the AIDS epidemic. Thirty years into the epidemic, as world leaders come together at the United Nations to recommit to a global AIDS response, the broad-based international coalition issued a statement calling for world leaders to support a rational, evidence-based approach to responding to AIDS. The group also calls for additional signatories to the declaration.
“As at so many other critical points in the epidemic, we have the opportunity now to use the fruits of science and research to show the way forward. Putting more people on AIDS treatment will save lives and prevent new infections, and will also help build and strengthen platforms for delivering comprehensive health services in resource-poor settings,” said Paul Farmer, Harvard University Professor and co-founder of Partners In Health. “We have the knowledge and the tools to reverse the epidemic—and we must not fail to use them.”
The declaration, “We Can End the AIDS Epidemic,” argues that highly-active antiretroviral treatment (ART) for HIV positive people is a preventive strategy that is a cornerstone to ending the epidemic.
The founding group of signatories includes African Services Committee, AIDS Foundation of Chicago, AIDS United, amfAR, AVAC, ATHENA Network, Black AIDS Institute, Canadian HIV/AIDS Legal Network, Fenway Health/The Fenway Institute, GIV, Health GAP, HIV Prevention Justice Alliance, International Community of Women Living with HIV, International Rectal Microbicide Advocates, International Treatment Preparedness Coalition, New HIV Vaccine and Microbicide Advocacy Society, Open Society Public Health Program, Partners In Health, Project Inform, Treatment Action Campaign, Treatment Action Group, and the Wits Institute for Reproductive Health and HIV, and more than two dozen leading the global AIDS researchers and advocates.
“This statement represents the common vision of scientists and activists to halt the epidemic. For the first time in three decades, we now have the real potential to end the AIDS epidemic. The question now is will we?” said Mitchell Warren, AVAC executive director. “Recent breakthroughs in AIDS vaccine, PrEP and microbicide research suggest powerful, additional tools for the future. Right now, the scientific evidence that treatment is prevention must serve as a clarion call to funders, policy makers and program implementers to move forward boldly and quickly to capitalize on the conclusive evidence provided by the clinical trial HPTN 052.”
HPTN 052 found that earlier initiation of antiretroviral treatment provides a health benefit to HIV-positive people, and is a highly powerful tool for preventing transmission to sexual partners.
The statement calls for:
- World leaders to adopt ambitious treatment and prevention targets.
- Donors, including PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria, to evaluate existing and new funds with core activities including antiretroviral treatment for individuals with CD4 cell counts at 350 or above
- All working on the AIDS response to end non-integrated, artificially-separated approaches to funding and delivering treatment and prevention services.
- Donors, communities, implementers, industry and researchers to map and execute an implementation research agenda for ART as part of combination prevention strategies.
“The most expensive, least effective strategy is to continue spending on AIDS the way that we are today,” said Nono Eland of South Africa’s Treatment Action Campaign. “We need more resources and better strategy. Funds need to be aligned with what is known to work—and reprogrammed where needed. We have no time to waste. World leaders at the UN this week should make clear commitments to the platform outlined in this statement.”
According to the declaration, and consistent with a new investment framework from UNAIDS published last week in the Lancet, funding needs to be directed to evidence-based strategies with combination ART as a cornerstone of a set of proven strategies to prevent and treat HIV, including male and female condoms, male circumcision, prevention of vertical transmission, behavior change programs that target social norms as well as individual risk, and activities addressing key populations including sex workers, men who have sex with men and harm reduction programs for injecting drug users. Funds that are not aligned with these core activities need to be justified and, where applicable, reprogrammed.
“The scientific evidence is clear. We know that early treatment has health benefits for HIV-positive people, and we now know that treatment also provides clear benefit for prevention,” said Kenneth H. Mayer, M.D. of Fenway Health. “As we work to scale up HIV treatment programs, we must also scale up and sustain research that builds on important proof of concept for biomedical prevention options, including pre-exposure prophylaxis, or PrEP, microbicides and vaccines to prevent HIV. Widespread treatment access coupled with new prevention options will be essential as we move to end this epidemic.”
The declaration grew out of a think tank on optimizing the potential of ARV-based prevention convened by AVAC with support from the John M. Lloyd Foundation. The meeting brought together 25 HIV experts to discuss the way forward capitalizing on mounting evidence of the broad benefit of widespread access to antiretroviral treatment.
The full text of the declaration, along with a list of signers, is available at www.avac.org/endtheepidemic, where additional individuals and organizations can also sign on.
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.