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.
Resources
Join weekly CHANGE calls, every Thursday 9 AM Washington DC | 4 PM Nairobi to get involved, send us an email for the link to join: [email protected]
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.
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?
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.
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
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
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?
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?
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]
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
Avac Event
Updates to the PEPFAR Stop-Work Order and the Role of CCM
Join AVAC, COMPASS and other partners to update CCMs on the PEPFAR freeze.
Avac Event
Introducing the Dual Prevention Pill: Lessons Learned and What’s Next for Regulatory, Research, and Rollout
This webinar has been cancelled because funding was pulled by the new US administration. Follow critical developments in US policies and their impact on global health via our new newsletter. Learn more here.
Join the IMPT and guest speakers from AVAC and Population Council for a discussion on the dual prevention pill (DPP)—a single pill that combines oral pre-exposure prophylaxis (PrEP) and oral contraception (OC) to prevent HIV and pregnancy. If approved, the DPP will be the first multi-purpose prevention technology (MPT) to be marketed since condoms.
The discussion will include real-time learnings to inform the broader MPT field on the DPP’s regulatory approval process, acceptability study results in South Africa and Zimbabwe, implementation updates, and lessons learned.
There will be a Q&A session following the presentations.
Much Accomplished, Much to Do
2024–2025 Fellows Progress Update
As we enter a new year, we also enter the midway point of the AVAC 2024-2025 Fellowship program, which runs 18 months. Fellows and their projects are taking giant strides in new areas of advocacy, and realizing strategic wins toward epidemic-bending goals, with much more to come! For more than a decade, Fellows have tackled critical issues for the field, focusing on U=U and new technologies, including long-acting PrEP, the Dual Prevention Pill (DPP) and the dapivirine ring (DVR). 2024-2025 fellows have added new areas of focus including on Pandemic Prevention, Preparedness and Response (PPPR); anal health; and HIV prevention in prisons.
Here are some of their accomplishments of the 2024–2025 Fellows Program
Ezra Meme (Uganda) is AVAC’s first Fellow to advance a Pandemic Prevention, Preparedness and Response (PPPR) agenda. He contributed to the development of the Uganda National Action Plan for Health and Security to bolster public health emergency centers throughout the country. While the billions committed in Ugandan shillings still need to be secured, Ezra will continue to monitor and advocate for this unprecedented public health project. He also successfully advocated for the government’s launch of the Antimicrobial National Action plan. And, he’s been closely monitoring Mpox, advocating for a digital mapping tool to track its control efforts.
Bahati Thomas Haule (Tanzania) is laser focused on scaling up and normalizing U=U and the accompanying need for timely viral load testing and results. She’s gotten buy-in from PEPFAR and UNAIDS to support a substantial U=U media campaign and she’s collaborating with the Elizabeth Glaser Pediatric AIDS Foundation to spread knowledge of their model U=U program for “nationwide utilization.” She’s also in dialogue with Global Fund to support increased lab capacity and provider training. Bahati presented to the UK Parliament on the need to support LEN for PrEP and for World AIDS Day, she published an opinion piece in the Swahili newspaper Mwananchi, advocating for ARV-based prevention.
Mokone Rantsoelaba (Lesotho) is AVAC’s first Fellow to advocate for HIV services in prison. After visiting nearly all his country’s correctional facilities, he released an assessment of HIV services for the incarcerated in Lesotho. His work was so well received that he was asked to integrate many of his recommendations into Lesotho’s Correctional Services Healthcare Policy, including the training of providers and fast-tracking all new prevention methods for scale-up in prisons. Mokone initiated and continues to convene the Southern African Development Community (SADC) regional correctional institutions along with the United Nations Office on Drugs and Crime (UNODC) to share best practices. Mokone has also been invited as a guest columnist for one of Lesotho’s top publications.
Sammy Anyula Gorigo (Kenya) is AVAC’s first Fellow to spotlight anal health. Specifically, Sammy’s been promoting HPV vaccines, screening and treatment for all men, particularly gay and bisexual men and other MSM. Thus far, he integrated HPV screening as a standard of practice into Nairobi County Health Management. He updated two separate guidelines to include anal health care for men—Kenya’s Standard Operating Manual for Prevention and Management of STIs and the National Guidelines for HIV and STI Programming with Key and Vulnerable Populations. He’s been invited to PEPFAR’s COP planning and writing process to develop an anal package of care. Lastly, for World AIDS Day, he published an opinion piece landing in The Nation, The Star and The Standard.
Rhoda Msiska (Zambia) is ensuring a swift introduction of the DPP. She’s earned a leading advocacy role, engaging the Ministry of Health to fast-track and de-medicalize PrEP and ensuring DPP inclusion in the national PrEP implementation plan. She’s working with the MoH to set aside DPP funding through the Global Fund and taking to the radio airwaves to create demand. Importantly, Rhoda has secured a first meeting with ZAMRA, Zambia’s regulatory body, to encourage moving forward with civil society support. And, at R4P Conference in Lima Peru in October, Rhoda spoke on a panel addressing strategies for the delivery of the DPP.
Elina Mwasinga (Malawi) is dually focused on HIV prevention for pregnant women and lactating mothers and HIV cure research. Thus far, she’s secured commitment from the National AIDS Commission to integrate cure into Malawi’s Technical Working Group on Research to coordinate activities and ensure a robust cure research portfolio. Likewise, Elina secured integrated PrEP-family planning services with specified inclusion of pregnant and lactating mothers, as reflected in the MOH’s EMTCT Accountability Roadmap. And, she presented on the use of broadly neutralizing antibodies (bNAbs) to prevent vertical transmission during a WHO consultation and on advocacy as a panelist speaker at the 2024 International AIDS Conference.
Pamela Fuzile (South Africa) is focused on boosting youth engagement in prevention and supporting young champions. She’s establishing a national level youth platform for new technologies in nine provinces where members can influence decisions in the HIV and PrEP technical working groups at SANAC. A key objective is youth advocacy for the inclusion of injectable PrEP and the dapivirine ring in all public health facilities responsive to the needs of young people.
Congrats to all the Fellows on their impressive work thus far. We’ll report on their total accomplishments in late 2025.
AVAC’s Most Downloaded Resources of 2024
From the implementation of DoxyPEP to the game-changing trial results of lenacapavir for PrEP, 2024 has been a landmark year for advancements in HIV and STI prevention. AVAC’s most downloaded resources capture these pivotal milestones, offering essential insights and tools to power your advocacy. Dive into the highlights and stay informed about the strategies shaping the future of HIV prevention.
AVAC’s Top 10
This episode of PxPulse looks at 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 graphic shows currently available options for HIV prevention, newly approved and recommended treatment, and those in development.
This plan provides a broad view of all the moving parts and identifies actions and actors responsible for ensuring time is not wasted and opportunity not squandered.
This PxPulse podcast episode goes deep on LEN for PrEP. Recorded just days before Gilead’s announcement that PURPOSE 2 also found very high efficacy, Dr. Flavia Kiweewa, a principal investigator of the first trial to announce efficacy, lays out the research findings and what they mean. And Chilufya Kasanda Hampongo of Zambia’s Treatment Advocacy and Literacy Campaign and Mitchell Warren of AVAC talk about how to change a long history of squandered opportunities to get rollout right.
This report examines disbursements by the U.S. NIH and the Bill & Melinda Gates Foundation and is one of few reports to track funding trends in vaccine and diagnostics R&D, and pipeline investments for some of the most common STIs.
Led by AVAC alongside a network of partners, the People’s Research Agenda puts forward recommendations to diversify and strengthen the HIV prevention pipeline, enhance investment and financial support for HIV prevention research and development, and guide an advocacy strategy that truly addresses the needs of communities across the prevention pipeline.
This roadmap aims to build on existing progress while accelerating the pace of HIV prevention. With anticipated regulatory approvals and production scaling, this plan targets over 2.5 million LEN users in low- and middle-income countries by 2027. It focuses on structural barriers and integration of generics into national programs.
Good Participatory Practice Guidelines have been shaping and improving clinical research since 2007. They provide a global reference guide for ethical and effective stakeholder engagement, helping ensure the priorities of trial participants and their communities are centered in clinical trials and broader research agendas.
DoxyPEP is a post-exposure prophylaxis used to prevent the acquisition of some bacterial STIs after sex. This advocates’ guide addresses questions regarding who will benefit most from DoxyPEP and how to implement this strategy broadly to ensure equitable access.
In 2024, Gilead Sciences released findings from the PURPOSE 1 and PURPOSE 2 trials testing lenacapavir (LEN) as HIV prevention. This advocates’ primer provides background on the product and trials; a summary of the early findings of PURPOSE 1 & 2; key questions and next steps.
Avac Event
Conference on Retroviruses and Opportunistic Infections 2025
The 32nd annual Conference on Retroviruses and Opportunistic Infections (CROI) that took place from March 9–12 in San Francisco, CA convened researchers, advocates and others under drastically altered circumstances, as the new US Administration’s assault on global health and research devastates the HIV response. Foreign aid programs are frozen, US agencies championing science and global health are being dismantled, and US leadership around the world is receding at a critical moment.
The CROI Community Liaisons, AVAC and the European AIDS Treatment Group organized a series of daily Community Breakfast Clubs which were open to all. These live webinars featured researchers and advocates exploring some of the most consequential science and discussions from CROI.
Topics included:
Breaking New Ground: The latest advances in HIV cure
The inaugural edition of the African Workshop on HIV & Women will take place in hybrid format on 27 – 28 February 2025 in Nairobi, Kenya.
The time zone that will be used for this meeting is East Africa Time (EAT). If you need to convert the times to your timezone, this website might be of interest to you: www.WorldTimeBuddy.com.
This exciting new initiative is a regional workshop paired to the annual “International Workshop on HIV & Women”. It is an outstanding opportunity for both local and international healthcare providers, researchers, government, industry, and community representatives to discuss and further increase their knowledge on the issues related to HIV and women living in Africa.
The primary purpose of this workshop is to support changes that will provide a better quality of life for women living with HIV and reduce HIV transmissions in the region.
The format of the workshop enables attendees to learn from renowned HIV experts, discuss challenges, gaps, and opportunities for further learning and research. The debates and roundtables are an especially important vehicle to discuss issues and challenge dogma.
The workshop also provides a forum for early-career investigators to present their research and to personally meet with experts they view as mentors and inspiration for their work.
The meeting organizers hope this workshop will catalyze forming a community, where attendees continue to participate yearly and form valuable relationships and partnerships that lead to collaborative projects and positive changes.
