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.
AVAC Playbook 2012
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.
Ensuring Gender Sensitivity in the Rollout of Medical Male Circumcision in South Africa
Leader Kanyiki, an AVAC Fellow, has been working with allies in South Africa since the beginning of this year to ensure civil society input into the National Implementation Guidelines for Medical Male Circumcision. This document, to be released on December 1, will guide South African policy and strategy for this powerful prevention tool. Kanyiki held meetings with policy makers, the Department of Health (DOH), the South African National AIDS Council (SANAC) and civil society as part of contributing to the drafting process, with a particular focus on gender sensitivity. Through the work of Kanyiki and allies, the final document states, “The involvement of women, both as sexual partners and mothers, will be promoted to the greatest extent possible. Men who wish to be circumcised will be encouraged to discuss the decision with their sexual partner.” While the inclusion of gender sensitivity language in significant, monitoring its implementation as South Africa’s medical male circumcision rollout moves forward is critical.
WHiPT Report Contributes to Greater Civil Society Involvement in MMC Implementation
Carol Odada, coordinator of Kenya’s Women’s HIV Prevention Tracking Project (WHiPT) team, presented the WHiPT report, Making Medical Male Circumcision Work for Women, at the recent meeting of Kenya’s National Male Circumcision Task Force. As a result of her presentation, which highlighted a range of concerns including the fear that medical male circumcision (MMC) will be conflated with female genital mutilation, Carol was invited to join the committee coordinating MMC roll out in Kuria, a Kenyan district where female genital mutilation is still practiced. “We will be able to document practices both good and bad,” Odada says, noting that after the presentation other MMC implementers also asked for guidance from the WHiPT team on addressing women’s concerns during rollout.
WHiPT Report Contributes to Greater Civil Society Involvement in MMC Implementation
Carol Odada, coordinator of Kenya’s Women’s HIV Prevention Tracking Project (WHiPT) team, presented the WHiPT report, Making Medical Male Circumcision Work for Women, at the recent meeting of Kenya’s National Male Circumcision Task Force. As a result of her presentation, which highlighted a range of concerns including the fear that medical male circumcision (MMC) will be conflated with female genital mutilation, Carol was invited to join the committee coordinating MMC roll out in Kuria, a Kenyan district where female genital mutilation is still practiced. “We will be able to document practices both good and bad,” Odada says, noting that after the presentation other MMC implementers also asked for guidance from the WHiPT team on addressing women’s concerns during rollout.
Press Release
New report provides women’s perspectives on medical male circumcision for HIV prevention: Findings from community-led research in five African countries
New York, NY—A new report from the Women’s HIV Prevention Tracking Project (WHiPT), a collaborative initiative of AVAC and the ATHENA Network, features an unprecedented collection of voices from Kenya, Namibia, South Africa, Swaziland and Uganda reflecting on what male circumcision for HIV prevention means for women. It highlights women’s perspectives, advocacy priorities and recommendations on this new prevention strategy.
Making Medical Male Circumcision Work for Women is the first report from WHiPT, which was launched in 2009 to bring community perspectives, particularly women’s voices, to the forefront of biomedical prevention research and the broader response to HIV.
The report highlights community-level support as well as concerns and misperceptions that can hinder effective implementation.
“Women are excited for medical male circumcision because they’re desperate for new prevention options, but they lack detailed factual knowledge of its benefits and risks,” says Cebile Dlamini of Swaziland for Positive Living. “For example, the fact that it only provides partial protection can be overlooked and some women and men believe once a man is circumcised, he is by definition HIV-negative.”
In total, nearly 500 women in HIV-affected communities completed a questionnaire, developed and administered by the women-led WHiPT teams in five countries. Almost 40 focus groups provided additional information about women’s attitudes about medical male circumcision. In each country, research took place in different locales, selected to reflect a diversity of circumcision practices, including communities that practice traditional male circumcision and those that do not circumcise, as well as those practicing female genital mutilation.
The majority of teams conducted their research in settings where male circumcision for HIV prevention had not yet been introduced as part of a national HIV strategy. Therefore many reported perceptions and concerns can be integrated into emerging programs—making this report both timely and urgent.
The Kenyan WHiPT team surveyed women in settings where male circumcision was evaluated in a clinical trial and subsequently introduced. Reports from women reached by the Kenyan WHiPT team underscore women’s fears that male circumcision may lead to changes in men’s behaviors and perception of risk.
“The women reported their partners either adapting or continuing risky behavior after ‘the cut’”, says Carol Odada, from Women Fighting AIDS in Kenya.
The report documents women’s concerns that medical male circumcision might lead to an increase in heightened stigma for women living with HIV. This would be a result of circumcised men’s misperceptions that they could not be HIV positive and/or could not transmit the virus. Thus sex and or safer sex would be less negotiable than before circumcision, putting women at greater risk for gender-based violence and HIV.
The report also highlights perceptions of male circumcision for HIV prevention in the context of traditional practices. Specifically, it underscores the need for communications campaigns that directly address the distinctions between medical male circumcision, traditional circumcision and female genital mutilation.
“Some women report the concern that the promotion of circumcision for men would increase the promotion of female genital mutilation,” says Allen Kuteesa from Health Rights Action Group in Uganda.
The myths and misunderstandings identified by WHiPT teams – such as the perception that medical male circumcision is directly protective for women – underscore the urgent need for adequate education campaigns directed at women. Further, for women to access and act on information related to medical male circumcision and HIV, the information needs to be specifically tailored to women, and the socio-cultural context and realities of women’s lived experience need to be taken into account.
The report summarizes advocacy activities that WHiPT teams will undertake over the coming year to ensure that male circumcision implementation addresses women’s concerns.
To download the report and/or a recording of the global report launch teleforum with the report authors, go to www.avac.org/WHiPT.
About WHiPT: The Women’s HIV Prevention Tracking Project (WHiPT) is a collaborative initiative of AVAC and the ATHENA Network launched in 2009 to bring community perspectives, particularly women’s voices, to the forefront of the HIV and AIDS response. The specific purpose of WHiPT is to advance and facilitate the monitoring of HIV prevention research, advocacy and implementation by women who are the most affected by the epidemic. The WHiPT Report was produced by teams led by the AIDS Legal Network, South Africa; the ATHENA Network; AVAC; Health Rights Action Group, Uganda; Mama’s Club, Uganda; Namibia Women’s Health Network, Namibia; Swaziland for Positive Living, Swaziland; and Women Fighting AIDS in Kenya, Kenya.
Contacts: Cindra Feuer, +1 917 685 4942, cindra@avac.org
Tyler Crone, +1 206 697 4789, tyler.crone@gmail.com
Allen Kateesa, + 256 772 429 820, allenkuteesa@yahoo.com
Press Release
Clearinghouse on Male Circumcision for HIV Prevention Web Site Launched
The Clearinghouse on Male Circumcision for HIV Prevention – http://malecircumcision.org/ was launched today. The Web site is designed to generate and share authoritative information about the role of male circumcision in HIV prevention.
The Clearinghouse was initiated by the World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the AIDS Vaccine Advocacy Coalition (AVAC), and Family Health International (FHI).
“The Clearinghouse will serve as a virtual resource that provides a ‘one-stop-shop’ for the most recent news, research, and resources on the use of male circumcision to prevent HIV,” says Dr. Kim Eva Dickson, Medical Officer, HIV Prevention in the Health Sector at WHO in Geneva. “This site will fulfill the needs of the international public health community involved in male circumcision for HIV prevention , including scientists, civil society groups, policy-makers, health providers, and program managers.”
The Clearinghouse will provide evidence-based guidance to support the delivery of safe male circumcision services as one component in a comprehensive approach to HIV-prevention services. “It will be continually updated with emerging information on country progress in expanding access to safe male circumcision services, including lessons learned in implementation,” says Dr. Catherine Hankins, Chief Scientific Adviser to UNAIDS. “Providing access to tools and guidance, the Clearinghouse is an essential Web site aid for all those working on male circumcision for HIV prevention.”
Visitors to the Clearinghouse will find:
- A browsable database of hundreds of scientific abstracts and full-text articles
- An inventory of research activities on male circumcision
- Tools and guidelines for provider training and program scale-up
- Evidence-based protocols and guidelines
- A compendium of better and best practices
- User-friendly summaries of advocacy issues and civil society engagement
- An opportunity to sign up for an RSS feed on news related to male circumcision
- A global mechanism for exchanging and integrating information on male circumcision programs and associated services
Experts from leading institutions around the world have reviewed information on the Clearinghouse including:
AIDS Vaccine Advocacy Coalition
Family Health International
Harvard University School of Public Health
JHPIEGO (Johns Hopkins Program for International Education in Gynecology and Obstetrics)
London School of Hygiene and Tropical Medicine
UNAIDS
University of Illinois at Chicago School of Public Health
World Health Organization
“Circumcising men is among the most promising public health tools to reduce new HIV infections in areas most affected by the epidemic,” says Al Siemens, PhD, CEO of FHI. “We are proud to have helped produce such a practical and evidence-based resource for health professionals interested in improving men’s access to high-quality male circumcision services as a component of comprehensive HIV-prevention efforts.”
The Clearinghouse also features user-friendly, regularly updated pages on advocacy issues that are tools for community stakeholders. “To optimize the benefits of male circumcision for HIV prevention, advocates, activists, community, and grassroots organizations need to be involved every step of the way,” says Mitchell Warren, Executive Director of AVAC. “This is an exciting and much-needed resource for sharing information, ideas and approaches to an emerging strategy.”
For more information
News media with questions are welcome to contact the Clearinghouse or call Beth Robinson, Deputy Director for Research Dissemination, Family Health International at +1 (919) 405-1461, or Emily Bass, Program Director, AIDS Vaccine Advocacy Coalition, at +1 (212) 367-1279.
World Health Organization (WHO)
WHO is the coordinating authority for health within the United Nations (UN) system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries, and monitoring and assessing health trends. WHO is the lead organization within the UN system for supporting the scaling up of male circumcision service provision. WHO is working with UNAIDS, UNFPA and UNICEF to assist countries to make evidence-based policy and program decisions to improve the availability, accessibility and safety of male circumcision and reproductive health services as an integral component of comprehensive HIV prevention strategies. WHO and UN partners use their globally accepted, complementary, normative and convening roles to lead policy setting, develop program guidance and coordinate research to guide countries in making decisions on implementing and scaling up safe male circumcision services for HIV prevention based on available and emerging evidence. Key WHO materials on male circumcision are available on the Clearinghouse on Male Circumcision for HIV Prevention site.
Joint United Nations Programme on HIV/AIDS (UNAIDS)
UNAIDS is an innovative joint venture of the United Nations, bringing together the efforts and resources of the UNAIDS Secretariat and ten UN system organizations in the AIDS response. The Secretariat headquarters is in Geneva, Switzerland , with staff on the ground in more than 80 countries. Coherent action on AIDS by the UN system is coordinated in countries through UN theme groups, and joint programmes on AIDS. UNAIDS’ co-sponsors include UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, ILO, UNESCO, WHO and the World Bank. UNAIDS led the preparatory UN work plan on male circumcision and supports WHO as the lead for UN implementation support for the introduction or expansion of safe, voluntary male circumcision services. UNAIDS recommends that male circumcision always be considered as part of a comprehensive HIV prevention package. Key UNAIDS materials on male circumcision are available on the Clearinghouse on Male Circumcision for HIV Prevention site.
AIDS Vaccine Advocacy Coalition (AVAC)
AVAC is a non-profit, community- and consumer-based organization that uses public education, policy analysis, advocacy and community mobilization to accelerate the ethical development and global delivery of AIDS vaccines and other HIV prevention options. AVAC’s participation in the Clearinghouse on Male Circumcision for HIV Prevention is one component of its ongoing work on increasing informed civil society input on male circumcision for HIV prevention. AVAC has developed a range of tools for advocates in developing and developed countries and continues to convene civil society conference calls, issue-focused meetings, and electronic dialogues as forums for input on this and other issues in HIV prevention.
Family Health International (FHI)
FHI works to address key public health and development needs in developing countries, including family planning, child and maternal health, infectious diseases such as HIV/AIDS, malaria and tuberculosis, and chronic conditions such as cardiovascular disease. FHI also works to strengthen broader health systems. Through a grant from the Bill & Melinda Gates Foundation, FHI and its international partners , the University of Illinois at Chicago and EngenderHealth , are establishing a Male Circumcision Consortium to improve and expand voluntary male circumcision services in Kenya. FHI serves as the webmaster for the Clearinghouse on Male Circumcision for HIV Prevention, and in partnership with WHO, UNAIDS and AVAC, develops and selects content for the site.
Px Wire January-March 2008, Vol. 1, No. 1
This is the first issue of our new quarterly, PxWire, which tracks key developments in the field of HIV prevention research, including the launch of new trials, results of ongoing studies and an up-to-date tally of trials going on worldwide. PxWire is designed to complement AVAC’s other publications and to help advocates stay on top of the ever-changing field of HIV prevention research. It is the first one-stop source for information on the full range of HIV prevention research going on worldwide, including vaccines, microbicides, pre-exposure prophylaxis (PrEP), herpes simplex virus-2 treatment, male circumcision, cervical barrier methods and partner treatment.