The Importance of HPV Vaccination Among People Living with HIV
HPV vaccination prevents 6 types of cancer and genital warts, including cervical cancer. Women living with HIV are up to six times more likely to develop invasive cervical cancer than their HIV-negative peers, but HPV immunization rates among this population remain low. During World Immunization Week, AVAC and TogetHER for Health co-hosted a discussion to learn more about the science behind and implementation challenges specific to expanding access to HPV vaccination for people living with HIV.
Mandisa Dukashe, HIV Survivors and Partners Network
Dr. Betty Njoroge, Kenya Medical Research Institute
We are pleased to announce our 13th class of the flagship AVAC Advocacy Fellows Program for 2024-2025! This group of seven advocates will participate in an 18-month program that supports their advocacy efforts, invests in the further development of their skills, shapes the agenda for HIV prevention research, and influences how quickly new interventions move into policy and programs in their communities and countries.
These Fellows were selected from a pool of 200+ applicants from seventeen countries to pursue evidence-based advocacy on a range of issues related to HIV prevention. The 2024/25 Advocacy Fellows and their host organizations include:
Congratulations to our new class of Fellows and thank you to all the applicants and their proposed host organizations for the time and effort put into the application process, and to the independent review committee of advocates, scientists and former Fellows and hosts who guided our decision-making.
About AVAC’s Advocacy Fellows Program
Achieving successful HIV prevention relies on programs and research shaped by communities and grounded by their needs and priorities. Skilled and informed community advocates drive this process. AVAC’s Advocacy Fellows Program expands and strengthens the capacity of civil society advocates and organizations to monitor, support and help shape HIV prevention research and rapid rollout of new effective interventions in low- and middle-income countries facing substantial HIV burdens.
The program provides intensive support to emerging and mid-career advocates to execute advocacy projects addressing locally identified gaps and priorities. Fellows receive comprehensive training, financial backing, and technical assistance to strategize and execute a targeted 18-month project hosted by an organization within their country.
In its 15-year history, nearly 100 advocates working with 70+ partner organizations across 15 countries have participated in the program. They have influenced policy, championed community perspectives, strengthened healthcare systems, demystified HIV prevention research, advocated for fairness and transparency on local, regional, and global scales and now lead many national and regional organizations. Discover more about the program’s impact here. And view video reflections from Alumni Fellows both here and here.
April Webinars!
This month we will host six webinars on a wide range of important issues, including choice in HIV prevention, PrEP in cisgender women, criminalization and HIV, syphilis in the US and DoxyPEP. Scroll down for what’s coming up later this week and later this month.
Science and real-world experience continue to demand a re-assessment of our collective understanding of the safety and effectiveness of PrEP options for women, including oral, vaginal ring, and injectable options. Join us, Jeanne Marrazzo of NIAID, Joyce Ng’ang’a of WACI Health and Raniyah Copeland of Equity & Impact Solutions for a conversation with The Choice Agenda.
Positive Women’s Network-USA and The Choice Agenda invite you to join us for a webinar featuring leaders in digital technology, HIV advocacy, and abortion criminalization to examine the existential threat of our ongoing blurred boundaries between public health and policing.
Join us for two webinars focused on syphilis and DoxyPEP. These webinars are intended for health care providers, civil society organizations, public health officials, and others working in the STI/HIV fields.
Join AVAC and Professor Moses Kamya of Makerere University to find out why the early results of the SEARCH Dynamic Choice study were some of the most exciting to come out of CROI in 2024.
Conducted in Kenya and Uganda, the study offered oral PrEP, PEP or injectable cabotegravir to both men and women, and an option to switch products.
Join HIVMA, PrEP4All and The Choice Agenda, as we assess some of the key challenges to delivering PrEP in the United States equitably, including cost, the complexities of our health care system, and other factors that inhibit uptake amongst the most vulnerable communities. Strategies to address these challenges will be offered, with lots of time for QA, discussion and much-needed debate. Please join us!
AVAC’s Sam Rick responds to the latest in Pandemic Accord negotiations—member states have engaged in text-based negotiations throughout the end of March. She offered the following position on the state of negotiations as of March 28, 2024 to Politico Pro.
“The draft puts us in serious jeopardy: We are so close to having a sorely needed agreement on how countries will operate in the wake of the next pandemic, yet Global North countries are risking this all to satisfy the interests of pharmaceutical companies. There are places in the draft where it seems countries are finally coming to some baseline consensus, but the textual edits made by Member States this week in the Article on Pathogen Access and Benefits, which is the lynchpin of the entire agreement, show that we are very far from reaching consensus. Without a shift in the US delegation’s position, we’ll have no agreement at all. The US seems to have taken a knife to the text, rendering it toothless. It seems that if the US has its way in this Article, there will be no system to compel benefits sharing, which is the whole point of the Article. The US delegation must compromise and permit an opt-in.”
The Coalition of Advocates for Global Health and Pandemic Preparedness, a group of organizations advocating for an integrated and holistic approach to preparedness that emphasizes equity, inclusion, and synergies of multiple global health programs in advancing preparedness, published their considerations and asks in these negotiations.
Avac Event
We Can’t End HIV in the United States Without Equitable PrEP Access: Strategies for success
A collaboration between HIVMA, PrEP4All and The Choice Agenda, this webinar assessed some of the key challenges to delivering PrEP in the United States equitably, including cost, the complexities of our health care system, and other factors that inhibit uptake amongst the most vulnerable communities. Strategies to address these challenges were offered included a Q&A, discussion and much-needed debate.
Speakers: • Dr. Lorraine Dean, Johns Hopkins University, Department of Epidemiology • Dr. Rupa Patel, Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention • Dr. Patrick Sullivan, Rollins School of Public Health, Emory University
The Coalition to build Momentum, Power, Activism, Strategy & Solidarity in Africa (COMPASS) has finalized a transformative and power-sharing approach to the governance and leadership of South-North coalitions. This new approach represents innovation that harnesses the power of the coalition. It is redefining and strengthening South-North relationships, and it offers a model for a field seeking to decolonize global health. The effort was built on a founding principle of power-sharing, and a commitment that COMPASS would ultimately be led by an African-based organization. Pursuing this vision has involved a multi-year, member-led process for creating a participatory governance framework. And it has resulted in reimagining COMPASS leadership, with African organizations in control.
This case study explores the COMPASS approach that made these changes possible, the growing pains that informed the process for instituting change, and what others can learn from this experience.
Tune in for a podcast from AVAC!
Hear from COMPASS partners on the pioneering approach to power sharing, and from Dr. Madhukar Pai on the global context.
COMPASS was founded in 2017 as a data and evidence-based South-North civil society coalition. The coalition from its beginnings has been dedicated to advancing strategic advocacy campaigns to influence policies, programs and funding for the HIV response in East and Southern Africa, with a particular focus in Malawi, Tanzania, and Zimbabwe, and at the global level. In December 2023, Pangaea Zimbabwe signed a new two-year, $4.9 million grant agreement with the Bill & Melinda Gates Foundation as the new secretariat of COMPASS Africa, a role previously served by AVAC. In recent years, AVAC was part of a coalition-wide effort to develop a clear transition plan for COMPASS to be led by African civil society organizations.
Since 2017, with a grant from the Bill & Melinda Gates Foundation, 29 COMPASS partner organizations have launched dozens of campaigns and logged 31 significant advocacy wins, with many multi-year campaigns still in progress. To name just a few of the wins from COMPASS campaigns:
Tanzania has changed the legal age of consent to access HIV services from age 18 to 15 and uptake has since seen a marked increase in testing, and increased awareness of HIV status among people 15 and older from approximately 60% to 82%.
Zimbabwe and Tanzania piloted community-led monitoring (CLM), which funds communities to track data on HIV services and report back on progress toward country targets, and whether services are meeting community needs. CLM was so successful, PEPFAR expanded the program in Zimbabwe and rolled it out globally.
Malawi’s once marginalized civil society now serves on technical working groups, influences the allocation of PEPFAR dollars and has become an essential partner to the national government in planning for HIV policies and programs. All three countries have secured funds for key population programs.
In the initial three years, results like these were delivered from a coalition with centralized leadership. Africa-based partners identified priorities, activated strategic relationships, navigated in-country challenges and executed co-created campaigns. US-based COMPASS partner organizations shared expertise on data and other technical assistance and leveraged access to global-level decision makers, with AVAC holding the primary grant and coordinating the coalition Secretariat. Coalition guidelines, partnership agreements and a robust process for co-developing strategy kept the coalition on track, but with success came challenges.
Partners wanted more opportunities to share lessons learned from each other’s campaigns and to lend capacity to one another. Roles and responsibilities needed more clarity. Partners sought broader participation and transparency in coalition decision-making, in selecting new members, and having a more formalized governance. Partners also sought to improve the existing channels for sharing feedback and resolving conflicts transparently and equitably.
Coalition members were ready to see power structures rearranged, redistributed, formalized and documented.
Ulanda Mtamba, a COMPASS member based in Malawi, put it this way: “For us partners in the South, it could feel like someone else is driving the vehicle from afar, while all the work is happening here.”
These sentiments reinforced the founding plan to shift management of the primary grant to an African-based partner. Just as important, these considerations informed an effort to re-shape the coalition and create structures to support an African partner-led, multi-country, multi-continent coalition.
Coalition Governance: Transparency, Participation and Trust
To create the needed structures and support for greater transparency and power-sharing among all partners in the coalition, COMPASS spent one year developing a governance manual that increases accountability and consistency, formulates the coalition structure, clarifies roles and responsibilities, and establishes a process for determining who holds the Secretariat.
Thirty-six volunteers from across the COMPASS Africa responded to an open call to develop a comprehensive, participatory governance framework. The volunteers selected a two-chair leadership team and a steering committee to run the development process.
“Partners were given a chance to select the leaders of the process. It was important that the process was community-led and participatory, so coalition members truly felt ownership of COMPASS. That itself was something very important,” said Francis Luwole, COMPASS country coordinator in Tanzania.
As four working groups tackled issues such as sub-granting protocols, new membership and definition of roles and responsibilities, the steering committee focused on overall goals to be reflected in the governance manual: prioritize transparency; ensure accountability to COMPASS values; maximize opportunities for members to participate in decision-making; and ensure the country coalitions had ample opportunity to review, provide feedback and validate the manual. Through regular in-person and remote meetings, anonymous surveys and country visits, the co-chairs fostered a shared ownership of the coalition’s structure, purpose and future.
“Before now… there were no guidelines to answer questions such as ‘who we are, why we’re here, or who are we doing this for—there was no clarity in some of the roles and responsibilities of members in the coalition, especially for new members. The expectation now is for the governance manual to provide an outline of what the structure of the coalition is and the roles and responsibilities of all coalition members,” said Ulanda Mtamba.
The case study found that the participatory nature of the process ensured that diversity and inclusivity were at the forefront of the new COMPASS governance structure by allowing the opportunity for as many voices as possible to have their opinions and inputs considered. It also fostered a shared sense of ownership that empowered many coalition members to invest and believe in the change to create an African-led coalition.
The 63-page governance manual now covers, among other things: member obligations and benefits; a protocol for conflict resolution; a selection process for new members; guidelines for meetings; sub-grant management; an M&E framework; a process for ending coalition membership and terminating the secretariat; and defined principles and core values. It also establishes a governance committee to serve as a decision-making and strategy-setting body with representatives from every COMPASS country, global partners, and key constituencies such as adolescent girls and young women, key populations and people living with HIV. The governance committee will be the primary leadership structure of COMPASS going forward, with coordination support from Pangaea Zimbabwe as the coalition secretariat.
“It speaks to inclusion. It speaks to equity. Our core values and principles have been reflected in the way we have structured the coalition. I’m very optimistic that, once we fully operationalize the governance manual, we are going to come up with something really beautiful, something that other partners or other coalitions may want to adapt,” said Maureen Luba, Malawi-based COMPASS member.
For more on the colonial legacy of global health, The Choice Agenda held a discussion examining the historical legacies and power dynamics that continue shaping global health. Watch the recording.
Shifting the Secretariat
As of December 2023, coalition member Pangaea Zimbabwe became the primary grant-holder and COMPASS Secretariat. In this role, Pangaea Zimbabwe will make sub-grants, convene the coalition, and be the primary point of contact for the coalition with its donors, support campaign tracking & evaluation, and administer the process that selects coalition leadership and new members. Dedicated teams comprised of in-country partners with expertise on data analysis and monitoring & evaluation will provide technical assistance across the coalition. AVAC is now a sub-grantee partner of COMPASS, continuing to coordinate the team that provides strategic and technical support to partner campaigns, provide status updates and background on the R&D pipeline for HIV prevention, support COMPASS partners in their engagement with PEPFAR and the Global Fund, and link the coalition to global platforms and advocacy initiatives.
“From our earliest conception, we outlined a vision of collective power and shared decision-making that has been central to COMPASS’s success. For that success to be sustainable, AVAC and the COMPASS coalition at large pursued a future in which governance would be centered among African-based partners,” said Mitchell Warren.
“Since 2017, we’ve been breaking new ground under COMPASS. We’ve expanded our networks and brought together the superpowers of seasoned advocates with diverse strengths to develop and share technical expertise and winning strategies,” said Imelda Mahaka, Executive Director of Pangaea Zimbabwe. “COMPASS has built a strong foundation based on collaboration, knowledge-exchange and trust that can and will accelerate innovative advocacy under African leadership.”
Putting in the Time: Sustaining the partnerships
The development of the manual and Pangaea Zimbabwe’s assumption of the Secretariat involved a phased, transparent multi-year transition plan to guide the handover of the secretariat and sub-grants management. AVAC and Pangaea Zimbabwe held weekly calls on the process, COMPASS partners contributed feedback to the plan, and the entire coalition was able to track milestones defined for the transition process.
“Partners stressed to us repeatedly the importance of not rushing the process. All coalition partners needed time and opportunity to meaningfully participate in designing the new governance framework. Integrating this input into the governance manual was more important than finding quick solutions. We found the same was true in the process of transitioning the secretariat. Pangaea Zimbabwe wanted an appropriate on-ramp to get comfortable in their new role, with plenty of support and other partners also wanted to know how AVAC was supporting the relationship between Pangaea Zimbabwe and the project’s donor. We all invested time in building trust and confidence. For those in power who are now looking for a sustainable way to shift that power to others, my message to you is that you can’t just throw the bag and run,” said Justine MacWilliam, AVAC’s senior program manager.
“This process has showed how to share power and take away the dominance of power. The desire for social justice has underpinned these values, the desire to equalize power, and the desire to contribute to something that is a legacy,” said David Kamkwamba of the Network of Journalists living with HIV (JONEHA) in Malawi.
As COMPASS campaigns continue apace with a freshly inked grant from the Gates Foundation, coalition members, and Pangaea Zimbabwe are referencing the manual, testing its strength, making changes and sharing their insights. It is bold, careful and imperative work to build and use structures for collective power and effective action.
“AVAC and COMPASS have set new benchmarks in effective civil society mobilization, advocacy and collaboration between global North and South. AVAC’s commitment to empowering African leadership within the coalition reflects a profound dedication to ensuring sustainability and maximizing impact. Coalition members are beginning a new chapter, founded on their inspired, tireless commitment to deepening the impact of COMPASS under African leadership,” said Uganda-based COMPASS member, Kenneth Mwehonge.
“This is givinghope, especially to global south partners, especially in these times when we are talking about decolonizing global health. It’s timely and strategic. It’s proving to each other our readiness to say ‘This is possible. We can have leadership in the Global South where the work is happening, where the epidemic is being fought,” said Luba.
The COMPASS Coalition understands that doing business as usual will not advance HIV prevention or global health equity. And this new power-sharing model cannot turn the tide all by itself. But COMPASS partners hope fellow travelers who see the necessity of decolonizing global health will be interested in this model and will follow its progress. The work will certainly change and evolve based on what is learned in the months and years ahead, but there’s no going back.
New Podcast Episode: Decolonizing Global Health
Dear Advocate,
Investing in the long-term success of African leadership is essential to breaking cycles that perpetuate inequity and that stall progress in the HIV response. In our newest episode of PxPulse, we explore why and how the decisions that shape global health must be made by those facing the greatest risks. As the world evaluates the pandemic response and debates on decolonizing global health gain momentum, equity in global health has never been more urgent.
For more than seven years, COMPASS Africa, a civil society coalition of 29 organizations working in three countries as well as regionally and globally, has used data-driven advocacy to improve the HIV response with high-impact campaigns. In January, the coalition underwent a major transition, with Pangaea Zimbabwe assuming the role of secretariat (previously held by AVAC), marking a historic milestone in the development of innovative models for power-sharing in coalition and an important step toward decolonizing global health. These changes in COMPASS come as other efforts, such as negotiations on the Pandemic Accord, are struggling to advance, uphold or safeguard equity.
Funding for HIV Survives Extreme Cuts Proposed By House Republicans
Final FY24 Bill Includes Calls for HHS/CDC to Increase PrEP Access
21 March 2024 – PrEP4All, AVAC, HIVMA, and the PrEP in Black America coalition celebrate Congress’ decision to both fund domestic HIV programs at the same level as last year and to lift up calls for a National PrEP Program. The final 2024 Health and Human Services bill rejects extreme cuts to HIV funding proposed by House Republicans in July of last year. The organizations have led the charge on the #SaveHIVFunding campaign following efforts to eliminate $767M in critical funds to end HIV as an epidemic. We additionally thank House and Senate LHHS Appropriations Subcommittee leaders Senators Tammy Baldwin (D-WI) and Shelley Moore Capito (R-WV) and Representatives Robert Aderholt (R-AL) and Rosa DeLauro (D-CT) for working to ensure an effective and ultimately bipartisan outcome.
“Our movement for a National PrEP Program and to end HIV as an epidemic remains strong,” says PrEP4All Executive Director Jeremiah Johnson. “The final bill ultimately shows strong bipartisan support for HIV funding, including PrEP, and rejects the flawed effort by some House Republicans to zero out the Ending the HIV Epidemic Program. We created the #SaveHIVFunding campaign in collaboration with AVAC, HIVMA, and PrEP in Black America knowing that everyone in Congress needed to hear from community advocates in order to be successful in fighting these unnecessary deep cuts. Without this work and the concerted and brilliant efforts of so many HIV organizations within the Federal AIDS Policy Partnership, this win would not have been possible.”
The outcome means that a previous $25M increase going toward CDC’s efforts to improve equitable PrEP access will be preserved, which is critical as advocates continue to engage with CDC on ways to establish a foundation for a National PrEP Program using existing funds. Congress also included final report language directing CDC to increase access to PrEP and cited previous calls from the Senate to establish the “building blocks of a national program to increase awareness of PrEP, increase access to PrEP medication, [and] laboratory services…”
“This outcome is a win for Black communities across the nation who are disproportionately impacted by HIV. Making life-saving treatment and prevention a reality for Black Americans is a possibility because of our relentless advocacy work to #SaveHIVFunding,” says Raniyah Copeland, Founding member of the PrEP in Black America Coalition and Founder of Equity Impact Solutions.
“This has been a long process, and we are grateful to have an outcome that leaves us on firm footing to realize the vision of a National PrEP Program,” says Andrea Weddle of HIVMA. “However, the fight for FY25 is already upon us following this prolonged budget process; meaning that advocates will have to remain vigilant, fight to protect our existing funding, and continue to ensure a clear, immediate, and fully funded pathway toward equitable PrEP access.”
“This is very encouraging news for PrEP advocates, especially following the President’s reintroduction of his proposal for a National PrEP Program last week.” Explains John Meade, Senior Program Manager for Policy at AVAC . “Combined with HIV/AIDS housing advocates’ victory in achieving an FY24 funding increase, I am so proud of our movement and our ability to rally in the face of these threats.”
A National PrEP Program would be a cost effective means to achieve our national goal of Ending the HIV Epidemic by 2030. Pre-Exposure Prophylaxis (PrEP) is a 99% effective use of medication to prevent HIV. Unfortunately 64% of people who could benefit from PrEP do not have access to it. A new study shows that states with the highest PrEP coverage showed an annual percentage decrease in HIV diagnoses of 8% from 2012 – 2021. In contrast, states with low PrEP coverage increased 2% annually. A National PrEP Program will increase access among people who could benefit and address major disparities in access related to race, gender and geographic location. “In the current political environment, this Congressional action is especially noteworthy. But we must never confuse this progress with success; our fights for funding, equity and impact in treating and preventing this epidemic must continue, and funding and implementing a national PrEP program at scale and with urgency remains a huge priority,” said Mitchell Warren, Executive Director of AVAC.
Developments in the HIV Biomedical Prevention Pipeline & PrEP Implementation Issues
An Update for Community Educators and Advocates
The European AIDS Treatment Group published a report covering two online discussions on the HIV biomedical prevention research & PrEP implementation issues for community educators and advocates. The report covers developments from the PREVENIR Cohort study, on long-Acting intramuscular PrEP, DoxyPEP, vaccine, as well as STI-PEP research. It also reviews challenges in the uptake of PrEP among women and in particular migrant women from sub-Saharan Africa and trans people.
Decolonizing Global Health: Dr. Madhukar Pai and COMPASS Africa Tell Us Why and How
Produced and hosted by Jeanne Baron.
Investing in the long-term success of African leadership is essential to breaking cycles that perpetuate inequity and that stall progress in the HIV response. In January, The Coalition to build Momentum, Power, Activism, Strategy and Solidarity (COMPASS Africa) announced a major transition, with Pangaea Zimbabwe assuming the role of secretariat and the launch of a decentralized approach to governance across the coalition. These changes come as other efforts, such as negotiations on the Pandemic Accord, are struggling to advance, uphold or safeguard equity.
In this episode of PxPulse, we talk about why and how the decisions that shape global health must be made by those facing the greatest risks. As the world evaluates the pandemic response and debates on decolonizing global health gain momentum, equity in global health has never been more urgent.
This conversation features global health leader and critic, Dr. Madhukar Pai. And two members of the transnational coalition COMPASS Africa, Francis Luwole and Barbra Ncube, offer an up-close look at the coalition’s pioneering new model for power-sharing.
