African Leadership Drives HIV Prevention Access

AVAC Impact Reports highlight the power of advocacy, research translation, and partnership to advance HIV prevention and global health equity. Read also about how PrEPWatch transforms data into action for PrEP access.

By Grace Tetteh

An estimated 40.8 million people globally are living with HIV, 65% of whom live in Africa. The fight to end the epidemic depends on African leadership that shapes the HIV response, informs research priorities, influences policy and funding decisions, and advances advocacy agendas that respond to community needs. AVAC has been a leading voice advocating for African leadership through mentorship and partnerships, working with the next generation of decision-makers and advocates as they drive the global movement to advance equitable access to HIV prevention.

AVAC’s history of partnership, collaboration and support of partner networks is part of a long-term vision to transition from traditional power structures towards a model in which those with lived experience and field expertise have influence and equal voice in the design and delivery of HIV prevention planning, priority-setting, and decision-making. For three decades, AVAC has developed projects and partnerships that advance these goals, including the Fellows program and the COMPASS and CASPR coalitions.

Now, Access Bridge, a Kenya-based organization incubated over a decade at AVAC, is positioned to responsively and sustainably lead country-level and regional efforts to accelerate new product introduction and access. Wawira Nyagah, Access Bridge’s Executive Director, has over two decades of experience leading global and country-led initiatives to advance HIV prevention, and has built long-standing relationships with Ministries of Health, civil society advocates, and global decision-making bodies.

In May, Access Bridge secured its first grant from the Aidsfonds EmpowHER Fund, to lead a multi-country consortium spearheading national and regional efforts to accelerate access to and uptake of HIV prevention options for women and girls in Kenya, Uganda, and Zambia. The project emphasizes a women-centered approach, ensuring women and girls are meaningfully engaged, informed and that they contribute to design, priority setting, implementation, and accountability for PrEP products. The highly competitive process received more than 250 expressions of interest and awarded just nine grantees. In a testament to the strength of collaboration and partnerships, Advocates for the Prevention of HIV in Africa (APHA), the International Community of Women Living with HIV Eastern Africa (ICWEA) and Copper Rose Zambia – all long-time partners with AVAC – are also among the successful recipients.

The Access Bridge consortium is comprised of alumni of AVAC’s Advocacy Fellows Program who have gone on to found and lead major HIV prevention organizations and activities that advance global access to PrEP for women and girls.  Since 2009, the AVAC Fellows program has supported over 90 emerging HIV prevention champions to hone their skills, shape the HIV prevention research agenda, and influence the rollout of new interventions. Today, alumni hold various leadership roles at the forefront of advancing equitable HIV prevention, nationally, regionally and globally.

Natasha Mwila, Access Bridge Project Coordinator and 2022 Alumni Fellow

Natasha Mwila

“I am incredibly proud to lead this work alongside fellow AVAC Fellowship alumni as we continue to center women and girls in prevention and empowerment efforts.”

Natasha Mwila leads project implementation, providing regional coordination across the consortium. As a Fellow, she advocated for the inclusion of the Dapivirine Vaginal Ring and Injectable Cabotegravir for PrEP as prevention options in Zambia, and, building on the successes of her Fellowship, she supported the planning and launch of Lenacapavir for PrEP (LEN) on World AIDS Day.

“Implementing EmpowHER is a great milestone for Access Bridge and a strong affirmation of the importance of investing in women-led initiatives. The project is deeply meaningful to me, not only as a project lead, but also as a woman who began her journey in HIV prevention advocating for woman-controlled prevention methods. This opportunity is an investment in women’s leadership, voices, and right to make informed choices about their health and futures.”

Ruth Akulu, HopeStone Insight Uganda Founder and 2022 Alumni Fellow

“Before the fellowship, I never imagined I could convene high-level policy dialogues, engage decision-makers, or negotiate for stronger HIV prevention responses.”

Ruth

As an AVAC Fellow, Ruth Akulu mobilized regulatory authorities to prepare for the Dual Prevention Pill (DPP), and secured pharmacy distribution programs for PrEP in Uganda. Today, she says, “I am helping drive conversations and action in my country because I was showed that lived experience, when matched with knowledge and opportunity, can become a powerful force for leadership and change. The AVAC Fellowship has been transformative in my journey. It built my capacity, strengthened my confidence, and helped me recognize my ability to lead and influence change.”

Ruth’s organization, HopeStone Insight Uganda, is a forward-thinking organization that seeks to influence economic policy to advance equitable health outcomes and access to quality healthcare. In the EmpowHER consortium, she partners with Access Bridge to improve health systems by leading community engagement efforts in two districts in Uganda to accelerate access to HIV prevention options.

Chilufya Kasanda, Ascend Futures Foundation Executive Director and 2016 Alumni Fellow

Chilufya

“My journey in HIV prevention has reinforced one truth: communities are most effectively served when leadership comes from within.”

Chilufya Kasanda is an advocacy leader with over a decade of expertise rooted in her experience as a Fellow. “The AVAC Fellowship helped transform my passion for advocacy into action, equipping me to champion HIV prevention choices for women and young people in Zambia.” As a CASPR coalition partner — an Africa-centered network supported by AVAC to advance the biomedical HIV prevention research pipeline — Chilufya cultivated strong relationships with the Zambian Ministry of Health, elevated the Choice Manifesto as an advocacy tool for women to demand choice in PrEP products, and contributed to wins such as increasing the government’s allocation of DVR for female sex workers.

In 2024, she established Ascend Futures Foundation (AFF) and continues to lead advocacy efforts, including collaborating with Natasha and other partners to support the introduction of LEN in Zambia. “The EmpowHer project gives me an opportunity to partner with AVAC alumni to create impact at national and regional levels.” AFF will mobilize champions for HIV prevention and translate community-generated data into evidence to influence government priorities for AGYW in Zambia.

The future of HIV Prevention is African-led, and the pipeline of new leaders is advancing the needs of women and girls. Access Bridge, Ascend Futures Foundation and HopeStone Insight are proof that investing in partners and advocates fuels not only individual growth, but the growth of an expansive network of African leaders collectively powering the HIV response.

AVAC Year in Review 2025

2025 underscored the vital role that AVAC plays in the global health ecosystem, and why our work and our partnerships have never been more essential.

This report highlights AVAC’s role as a trusted voice, a translator of science and catalyst for action and advocacy. It reflects an organization ready for the future: supporting African leadership, strengthening bridges from R&D to delivery and preparing for a new chapter as we move forward into our fourth decade as an organization. Read the PDF below or view as a webpage.

Download

Avac Event

The Future of HIV Prevention: A People’s Research Agenda for Speed, Scale and Equity

First developed in 2024 in partnership with global advocates and communities, the People’s Research Agenda sets out a people-centered framework for equitable and accelerated R&D and product introduction. The PRA tracks the science, shows where investments align—or fail to align—with community-defined priorities, and spotlights critical gaps in the pipeline of prevention options needed to meet the diverse realities of all populations.

  • Featured speaker Jeanne Marrazzo, CEO of the Infectious Diseases Society of America and AVAC board member.
  • We covered what the People’s Research Agenda tracks, why it matters, and the advocacy priorities that will shape the future of prevention R&D.

View Recording / Download Slides

Avac Event

Influencing the New USG Global Health MoUs and PEPFAR Strategy

We invite you to an urgent and critical webinar focused on the new Memoranda of Understanding (MoUs) governing US Government (USG) global health investments, including PEPFAR, under the “America First Strategy.” These MoUs are currently under rapid discussion with African Governments.

Organized by COMPASS in collaboration with EANNASO and Data ETC, this webinar is designed to equip African Civil Society Organizations (CSOs) with the necessary analysis and advocacy strategies.

The goal is to enable CSOs to proactively influence the priorities for the upcoming five years of USG health investments, specifically concerning HIV, primary prevention, and the crucial role of community-led monitoring and delivery.

Featured Experts

  • Emily Bass: The New MoU and its implications. 
  • Brian Honnermann (amfAR): The New MoU and its implications.
  • Nelson Otuoma (NEPHAK-Kenya): Direct experience from national MoU participation.
  • Munyaradzi Chimwara (ACT-Zimbabwe): Community safeguards for inclusion and accountability.

Moving the STI Research, Development and Diagnostics Agenda Forward

Despite being one of the world’s most urgent and growing health crises, sexually transmitted infections (STIs) remain underfunded, underdiagnosed, and underprioritized around the world. In response, with support from the Gates Foundation, AVAC launched an STI advocacy initiative in 2023, partnering with seven civil society organizations across East and Southern Africa to build a stronger, more coordinated effort. From national policy landscaping to multi-stakeholder dialogues and technical briefs, this first wave of work laid a powerful foundation for reframing STIs as issues of equity, integration, and community power.

Why STI Advocacy and Why Now?

The global burden of STIs is staggering with more than one million treatable STIs being acquired daily, and new threats like antibiotic-resistant gonorrhea and rising syphilis cases (including congenital syphilis) demanding urgent action. Yet funding, research, and political attention lag far behind the need. 

Civil society voices are critical to closing this gap. AVAC’s STI advocacy partner initiative was designed to support organizations already rooted in HIV and sexual and reproductive health (SRHR) work to sharpen their STI policy agendas, develop actionable priorities, and advance country-level and global conversations, especially around new tools like point-of-care diagnostics and vaccine research. 

Meet the Partners

Nyanza Reproductive Health Society (Kenya)
They identified low STI testing rates due to stigma, lack of awareness, and test shortages, emphasizing the urgent need for local data to inform advocacy and policy change.

Lesotho Network of AIDS Service Organizations (Lesotho)
They found major gaps in STI information and condom access in Mapholeneng, where rapid population growth has strained services. Partners emphasized the need for open dialogue and community engagement.

Journalists Association Against AIDS (Malawi)
Highlighted the lack of up-to-date STI data and outdated policies. To lay groundwork, they mobilized civil society, media, and policymakers to align around a coordinated national STI advocacy agenda.

HIV Survivors and Partners Network (South Africa)
They documented test kit shortages and gaps in HPV vaccination, advocating for civil society leadership in advancing STI literacy, diagnostics, and vaccine access.

ACTS-101 (Uganda)
They found that STI programming is overshadowed by HIV services, calling for targeted STI advocacy and investment in vaccines and diagnostics.

LATU Human Rights Foundation (Zambia)
They spotlighted the treatment gap for key populations and helped integrate STIs into new CAB-LA and Hep B guidelines.

Pangaea Zimbabwe (Zimbabwe)
They exposed gaps in STI prevention and care across nine districts, driven by costs, stigma, and stockouts; urged the creation of an inclusive, well-funded movement for STI services and innovation.

Across all projects, partners identified critical needs: more accessible and accurate diagnostics, better integration of STI and HIV services, updated national guidelines, and increased political will to fund the STI response.  

Learn more and hear these advocates share the results of their work and insights for moving ahead.

What’s Next with STI Advocacy

The momentum continues in 2025, with new landscaping efforts now underway in Kenya, South Africa, and Zimbabwe. These projects aim to map opportunities for building national advocacy networks in countries facing high STI burdens—ensuring that investments in STI research, diagnostics, and services are driven by community priorities and deployed where they are needed most. 

Read a new blog post with three leading advocates: Cleopatra Mpaso of Pangaea Zimbabwe, Mandisa Mdingi of the Foundation for Professional Development (FPD) in South Africa, and Felix Mogaka of the Kenya Medical Research Institute (KEMRI) who are each conducting national STI landscaping assessments. They share insights on the state of STI advocacy, the role of civil society in shaping R&D priorities, and the importance of connecting global conversations to local needs. 

Join Us October 29

Avac Event

Beyond Borders

Join ISSTDR, IUSTI, the STI & HIV 2025 World Congress, and AVAC for a special webinar spotlighting speakers who were not about to join the congress due to financial and political barriers. Presenters will share their findings, debate their results, and discuss the work still ahead for the STI field. Don’t miss this opportunity to engage directly with cutting-edge research and the people driving it forward.

Critical Advocacy: How Civil Society is defending the HIV Response and Global Health 

The upending of US policy by the new presidential administration has collapsed the foundation for global health and the HIV response at every level, from research to program delivery.  

It’s been a desperate scramble for everyone who cares the lives and wellbeing of those impacted by HIV. Wading into the chaos, all over the world are advocates who began organizing within days, even minutes—as soon as the US government federal executive orders started coming down.  

Positive change depends on fierce and effective community leadership, and pressuring powerbrokers to do the right thing.) 

Two veteran global health leaders from civil society join us to talk about how civil society is responding. Amanda Banda is Strategic Advisor to the COMPASS Coalition and Asia Russell is Executive Director of Health Gap, and both are members of CHANGE, a coalition with more than 1,500 people, from organizations in nearly every continent, working in coordination to defend global health and the HIV response.

Hosted by Kenyon Farrow, AVAC’s Director of Communications.

Resources

Research Matters – Resources to Protect Research Funding 

For more than 30 years, AVAC and partners have worked to protect the infrastructure and funding that drives lifesaving HIV and biomedical research. Today, that mission is more urgent than ever. 

Funding from the National Institutes of Health (NIH) fuels innovation, drives the economy, and saves lives. Cuts to this support will make America—and the world—poorer, sicker, and less prepared for future health threats. 

Tomorrow (Wednesday, April 30), the US Senate Appropriations Committee will host a hearing on Biomedical Research: Keeping America’s Edge in Innovation at 10:30am ET. Click here to watch the hearing. 

And be sure to read the written statement to the Committee from AVAC and The Federal AIDS Policy Partnership (FAPP) Research Working Groups, which provides a strong, urgent appeal to Congress to reject future funding cuts to the NIH and shows the importance and impact investments in biomedical research have had on lives and livelihoods. 

Resources for Researchers 

In addition, AVAC, TAG and the HIV Medicine Association (HIVMA) co-created a new resource hub, Research Matters, to support researchers advocating for sustained NIH funding. These tools include an Advocacy Toolkit  to help move our collective efforts forward. Please share this link with any researchers who have received NIH funding—we will continue to update the hub with resources to support continued advocacy for biomedical research.  

Share Your Story 

Additionally, AVAC and partners are collecting stories of impact—if you know someone willing to share their story about how NIH cuts are affecting their work, contact John Meade Jr. at [email protected]. This Huffington Post piece by Katie Edwards at the University of Michigan is a terrific example of a researcher sharing the real-world toll on scientists, trial participants, communities, research and public health. 

Thank you for standing with us to protect science, health, and progress. 

Global Health in the Lurch: What’s happening now and who is pushing back?

 KFF’s Jen Kates and AVAC’s John Meade break it all down on PxPulse Live.

A snapshot of global Health in the first weeks of the Trump Administration, this episode covers the impact of the US freeze on foreign aid to critical federal agencies and the HIV research pipeline and explores action in Congress and among civil society to push back.

Resources

PxWire Volume 15, Issue No. 1

In this special edition of Px Wire, AVAC is going beyond a quarterly update of biomedical HIV prevention. In this issue, we look at how the new US Administration’s attack on global health can be expected to devastate HIV prevention, including the capacity to deliver existing PrEP options, the scale up of new PrEP products, and the paralyzing impact on research and development. A PDF version of this report is also available.

From Research to Rollout: The impact of USG global health pullout

New Vision newspaper frontpage thumbnail

The United States’ presidential regime has launched a sustained, multi-pronged attack against foreign assistance, scientific inquiry, due process and good governance. It threatens economies, human rights, international partnerships, global health at large, and the rule of law. For HIV prevention, a single sentence, issued in a February 6 advisory from the US Department of State, has derailed the entire field, potentially setting back the HIV response by years, if not decades. Read on for resources to support your advocacy and fortify our solidarity at this critical time.

Progress in PrEP Uptake: Threatened

global PrEP uptake and PEPFAR's role

PEPFAR has been pivotal to accelerating PrEP uptake, significantly expanding HIV prevention coverage. The freeze on foreign aid prohibits funding to PEPFAR’s PrEP programs and poses a serious threat to global efforts to control the epidemic.

AVAC’s Global PrEP Tracker has documented cumulative PrEP initiations on a quarterly basis for nearly a decade. This graph presents the final data collected while PEPFAR was fully operational—PEPFAR support was responsible for 79% of PrEP uptake globally in the last year and reached 83% by the end of September of 2024. Data on the fourth quarter of 2024 is inaccessible since PEPFAR was taken offline in late January.

At the time of the foreign aid freeze, PrEP uptake had reached 8 million initiations since 2016, an achievement that’s taken almost 10 years to reach—too slow and too small to reach UNAIDS targets, but a robust foundation to finally accelerate PrEP uptake with next-generation PrEP. Current US policies, instead of expanding PrEP coverage, are leading to the closure of programs, and will reverse global progress against HIV.

Without primary prevention, the HIV epidemic is poised to rage on, with incidence among adults on track to triple over the next ten years. This HIV Synthesis model, developed by the HIV Modelling Consortium, estimates the impact of stopping all HIV prevention services across Africa from now through 2036—including PrEP, voluntary medical male circumcision (VMMC), and free condom distribution.

For the last 8 years, AVAC has proudly worked with PEPFAR to document PrEP uptake and its impact around the world. That stopped in January with a stop work order from the US government. But protecting access to PrEP is vital. Are you leading a PrEP program? Whether supported by PEPFAR or not, we invite you to work with us to ensure global data on PrEP is not lost. Find us at [email protected].

PrEParing for New Products: Is rollout still possible?

Wired magazine headline: this new drug could help end the epidemic—but US funding cuts are killing its rollout

Read more in The Gears of Lenacapavir for PrEP Rollout.

The chaos in foreign assistance programs (including discontinuation of major PrEP programs), cuts in staffing and new demands on donor commitments will make decisions on the procurement of LEN for PrEP more complex and uncertain. In December 2024, the Global Fund and PEPFAR announced a plan to reach 2 million people with LEN for PrEP over three years. Exactly how funding to support this unprecedented introduction program will move forward, in the absence of significant US investment, is far from certain. The other stakeholders, including Global Fund, Gilead, CIFF and the Gates Foundation expressed commitments to the deal, but major questions remain. In the meantime:

The Latest R&D in the Prevention Pipeline: Supported or undermined?

Representative headlines from the New York Times and Science magazine.

The stop-work orders have disrupted USAID-supported HIV prevention research, halting critical investigations in vaccine and next-generation PrEP strategies.

  • The BRILLIANT and ADVANCE projects’ clinical, preclinical, and experimental trials testing HIV vaccine candidates have been suspended.
  • The MATRIX projects’ driving innovation with next-generation PrEP and MPT products, fast-dissolving inserts and vaginal films and rings, have been forced to stop their clinical trials.
  • The MOSAIC projects’ have suspended all implementation science activities, including the CATALYST study, investigating choice among oral PrEP, injectable cabotegravir and the dapivirine vaginal ring. Other implementation studies are continuing, but access to the commodities, much of which was procured by PEPFAR is questionable. See AVAC’s Integrated Study Dashboard for details.
  • The Coalition to Accelerate and Support Prevention Research (CASPR) has also been paused. Led by AVAC in partnership with a number of leading African civil society organization, CASPR focuses on building an enabling environment for HIV prevention R&D. (Note: In early February, AVAC lead a lawsuit against the State Department seeking emergency relief from the freeze on foreign assistance, including funding for CASPR. The case, AVAC v. United States Department of State, is pending.)

These disruptions delay the development of urgently needed HIV interventions and threaten the sustainability of research infrastructure all over the world, with particularly egregious impacts on the research capacity of regions most impacted by the epidemic.

The abrupt suspension of these trials also raises serious ethical concerns. Stopping trials mid-course undermines trust in research, jeopardizes community engagement, and abandons participants who volunteer their bodies for scientific discovery. It will take years to build back this critical infrastructure—for HIV research and beyond—as well as the community partnership and trust needed to ensure smooth and ethical research.

Prevention Playlist

AVAC develops a wide range of resources to inform decision making and action. Check out the latest:

Join

  • Subscribe to Global Health Watch: AVAC’s weekly newsletter dedicated to breaking down critical developments in US policies and their impact on global health. avac.org/signup
  • Seeking Visuals and Videos: Leading groups in Washington, DC, are urgently trying to collect videos and photos documenting the impact of the US government’s foreign aid freeze, such as clinic closures despite the waiver. Non-professional phone videos and photos are welcome. Send to [email protected] for more details
  • CHANGE: In response to the unfolding crisis, more than 1,300 people from civil society organizations around the world have launched CHANGE—Community Health & HIV Advocate Navigating Global Emergencies—a coalition formed to support urgent action. [email protected]

Use

Watch/Listen

Read

  • AVAC v United States Department of State. On February 10, 2025, AVAC and another nonprofit organization sued the new US Administration, seeking emergency relief from an Executive Order that inhumanely froze all funding for foreign assistance, AVAC