Across Treatment U=U and prevention programs, peer navigators, mentor mothers and lay counselors are recognized as essential to good services. Yet many countries don’t have clear schemas for quantifying the number of individuals needed, budgeting for their remuneration and defining the roles and responsibilities that lead to impact. Activists are working to ensure clarity by demanding from governments, funders and implementers.
Peers are Primary: Towards a systematic approach to lay cadres
Towards a Demand Creation Cascade
Many countries report low initiation and continuation of PrEP. This doesn’t mean people don’t want the product. They might not want the program that’s offering it; or they might not be being reached. A “demand-creation cascade” such as the one proposed here for PrEP is one way to evaluate the program and the product. It would measure how many people received the full suite of demand-side activities the program hopes to deliver at a given stage. The precise set of steps would depend on the service-delivery design and strategy in question.
Phases of Informed-Choice PrEP Counseling
This flow chart emerged from socio-behavioral research, including surveys and in-depth interviews with Kenyan and South African women. The research team set out with the goal of adapting the informed-choice approach used in family planning programs for use in PrEP, a prime example of fields learning from each other. The result is very clinic-centered; AVAC has added the column at the far right to reflect additional elements. However, it is a step towards much-needed exploration of how to make informed choice a reality in HIV prevention today.
Public Health is Personal
What gets measured gets funded, the adage goes. What would happen if communities demanded measurements of individual and collective health and well-being that have nothing to do with a retrovirus or a specific sex act, and everything to do with human dignity, comfort and safety in one’s own skin—a comfort that’s hard-fought in racist, sexist, homo– and trans-phobic nations? Imagine a world in which this cascade counted as much as 90-90-90. Let’s work to make it a reality.
Putting Women at the Center: Informed choice in 2018 and beyond
We need to give women the choice to use DTG or not and to use contraception if indicated and desired. We need to support choices across options, with risk reduction—not use of a specific product—as the primary outcome. We need to give women the choice to use DMPA-IM or –SC or not, and to use HIV prevention as desired.
PrEP Initiations by Country in Africa
AVAC tracks global PrEP use by conducting quarterly surveys of ongoing oral PrEP demonstration and implementation projects, and collecting data from manufacturers and government agencies. This graphic shows data on PrEP initiations in Africa. For more trends in oral PrEP uptake, check out the Oral PrEP Enrollment Snapshot slide deck and visit PrEPWatch.
A Global Look at PrEP Introduction
The introduction of PrEP took many years to reach current levels of acceptance and availability. The next phase of distribution is on track to move faster. This is an updated version of a graphic appearing in AVAC Report 2017: Mixed messages and how to untangle them.
Map of HIV Prevention Research and PrEP Demonstration Sites in Kenya
This map demonstrates the breadth of HIV prevention research and demonstration projects in Kenya by site and type (e.g. daily oral PrEP, preventive Vaccines, etc.). This map was developed by Wits RHI with support from AVAC as part of the Coalition to Accelerate and Support Prevention Research.
Map of HIV Prevention Research and PrEP Demonstration Sites in Malawi
This map demonstrates the breadth of HIV prevention research in Malawi by site and type (e.g. ARV-based vaginal rings, long-acting injectable PrEP, preventive Vaccines, antibodies). This map was developed by Wits RHI with support from AVAC as part of the Coalition to Accelerate and Support Prevention Research.
Map of HIV Prevention Research and PrEP Demonstration Sites in Uganda
This map demonstrates the breadth of HIV prevention research and demonstration projects in Uganda by site and type (e.g. daily oral PrEP, preventive Vaccines, etc.). This map was developed by Wits RHI with support from AVAC as part of the Coalition to Accelerate and Support Prevention Research.