Thursday, October 26 at 11:00 AM ET
This discussion will offer a candid assessment of the current landscape, including the implications for work on the ground. It is intended to redirect anxiety into action and provide a reality check: PEPFAR is not going anywhere any time soon.
MODERATOR: Elisha Dunn-Georgiou, Global Health Council
SPEAKERS:
Jen Kates, Kaiser Family Foundation
Katie Coester, Global AIDS Policy Partnership, EGPAF
Mark Lagon, Friends of the Global Fight
Richard Muko, AVAC
Avac Event
Practicality over Panic: What happens if PEPFAR isn’t reauthorized?
Avac Event
Pioneering Self-care Solutions to Drive Access to HIV Prevention and Family Planning
Thursday, November 9, at 8:00 AM ET
This session will amplify lessons from five self-care interventions in FP and HIV prevention — DMPA-SC, the Caya Diaphragm, the Dual Prevention Pill, HIV self-testing, and Triggerise, an mHealth platform – to highlight successful self-care strategies across settings and discuss the future of self-care in SRH.
SPEAKERS
- George William Barigye, Regional Technical Advisor- Anglophone countries, Injectables Access Collaborative, PATH Uganda
- Alexandra Angel, Technical Advisor, Sexual and Reproductive Health, PSI
- Charlotte Pahe, Director, Reproductive Health/Integrated Portfolio, PS Kenya
- Serah Malaba, Chief Impact Officer, Triggerise
- Kate Segal, Senior Program Manager, Product Introduction and Access, AVAC
MODERATED BY
- Anna Rammou, Interim Manager, SRHR Access, CIFF
- Wawira Nyagah, Director of Product Introduction and Access, AVAC
- Mitchell Warren, Executive Director, AVAC
This session is part of the 2023 Self-Care Learning and Discovery Series. Learn more about the Discovery Series here.
Three HLMs, A Host of Challenges and One Major Victory
For the last year, reforming the global health architecture in the hopes of delivering health more equitably has been top of mind. From the Pandemic Fund launch, to post-mortems on the ACT-A (the global body convened to develop COVID-19 interventions and ensure access to them), to the call for a new Pandemic Accord, a strong consensus had finally emerged that things need to change.
Accordingly, this theme ran throughout the health-related proceedings at the UN General Assembly in September where High-Level Meetings (HLMs) on universal health care (UHC), Tuberculosis (TB), and Pandemic prevention, preparedness and response (PPPR) took place.
Four key takeaways from the week stand out to AVAC:
Multilateralism is threatened.
Tensions between countries are incredibly high. Each day’s proceedings made clear that the spirit of diplomacy from previous years has waned. Given that there have already been UN Declarations on UHC and TB, advocates went into this year’s process thinking that stronger declarations would be relatively easy to negotiate. But countries were at odds during negotiations for all three health-related HLMs. Country representatives disagreed on a host of issues that will impact access to medical products, financing, and who is responsible for addressing health crises. These disagreements upended usual procedure. Typically, the Declaration is finalized weeks before the actual HLM; this year, a final decision on all three Declarations hung in the balance until the minute before the meetings began. Advocates must work hard in the coming year to bring countries together on key issues in the Pandemic Accord.
Access is THE issue.
By far, the question of access to medical products and tools dominated all three HLMs. Tensions around this issue sparked the most heated disagreements during negotiations. During the PPPR HLM, Member States speaking from the UN floor all mentioned their commitment to building more equitable access to medical countermeasures, but richer countries are unwilling to alienate the pharmaceutical industry by including access commitments in international agreements. And lower-income countries are refusing to permit open access to data on new pathogens without access commitments to the products derived from that data. The issue is so fraught it almost derailed any health Declarations at all. Right before HLM week, eleven countries that have been the target of ‘unilateral coercive measures’ (sanctions) sent a letter to the President of the General Assembly refusing to sign on to the declarations because the sanctions prevent them from accessing medical countermeasures — tools, medicines and equipment, needed in a health crisis. The Declarations ended up moving forward anyway with very limited commitments on how best to ensure access to medical countermeasures. It will be imperative for advocates to keep the issue of access front and center and help to navigate toward agreements that all countries can stomach.
Civil society engagement is going backward.
The PPPR HLM had no civil society formal engagement mechanism, and the process suffered because of it. Civil society was left out of the loop. They didn’t receive information about the status of negotiations, or details on sticking points. These updates would typically be funneled through a formal mechanism. In addition, the HLM process usually includes two to three days of Multistakeholder Hearings for each HLM to allow civil society to state their priorities and views ahead of negotiations on the draft Declaration. This year, each HLM had just one half-day, significantly limiting the number of civil society organizations and advocates that could get their views in front of Member States. Approvals for registration for both the Multistakeholder Hearings and HLMs came less than a month before the actual event, leaving many advocates too little time to get visas to the US. To add insult to injury, during the HLM, many civil society advocates did not get to make statements from the floor even though time was reserved for civil society – agencies such as Gavi and the Global Fund and pharmaceutical corporations spoke during these slots. Engagement with UN staff is needed to better define what constitutes civil society, and to protect these rare points of access and influence for those who speak for communities.
Policymakers are starting to understand the contributions HIV, TB, and malaria can make to pandemic preparedness.
As the furor to address huge gaps in pandemic preparedness and response capacities ramped up in 2021, it was a slog to get policymakers new to the space, who had not traditionally been involved in health negotiations, to understand the underlying infrastructure and movements that the global responses to HIV, TB, and malaria have built. However, this year’s UN General Assembly showed that advocates have made a lot of progress. The Coalition of Advocates for Global Health and Pandemic Preparedness, of which AVAC is a co-founder, pushed hard for inclusion of these ongoing pandemics in the Declaration on PPPR to great success – two clauses recognizing the existing infrastructure from these responses that can be leveraged for pandemic preparedness and committing to continue the fight to end these ongoing pandemics made it into the final Declaration text. Much more needs to be done to harmonize the PPPR and HIV/TB/malaria architecture, saving advocates and everyone involved in pandemic preparedness extensive time and resources, but the recognition of the interconnectedness of future and ongoing pandemics represents a huge win.
At AVAC, we have put a lot of hope in the processes of the Pandemic Accord, the UN High-Level Meeting (HLM) on Prevention, Preparedness, and Response (PPPR), and the development of a medical countermeasures (MCM) platform. To understand how these three efforts fit together, see AVAC’s Advocate’s Guide to PPPR.
And check out these other important resources:
- AVAC’s Executive Director, Mitchell Warren along with partners from the Coalition of Advocates for Global Health and Pandemic Preparedness penned an essay to make the case of meaningful investment in Pandemic Preparedness while referencing continued failures of the COVID-19 pandemic.
- Sam Rick authored a piece, Who’s Driving this Ship, which takes a critical look at the issues challenging Global North governments in creating a system that is equitable and aims to prevent health threats everywhere and prepare everyone.
- Our Take: Is the UN Declaration on PPPR and the Pandemic Accord going in the right direction? AVAC’s blog explored the drafts of the Pandemic Accord and the UN Declaration on PPPR—and their implications for equity in global health.
- PPPR Advocacy 101: Find out what it means to you: For a deep dive on the diverse initiatives aimed at preparing for the next pandemic. Learn what they commit to, how much they will spend, and how well these plans incorporate equity as a principle.
- The Shape of Pandemic Preparedness is Being Decided. Now is the Time for Collective Action: In this episode of Px Pulse, Chris Collins, the CEO and President at Friends of the Global Fight Against AIDS, Tuberculosis and Malaria, talks about what’s at stake in efforts to re-think the global architecture of pandemic response, which policy-makers get it, why this year matters so much, and what advocates can do.
Avac Event
Results from STI Landscaping Analyses in East and Southern Africa—Part 2
Thursday, November 9 at 8:00 AM ET
Hear results from STI landscaping projects conducted in seven different countries from East and Southern Africa that explored needs for STI vaccines and diagnostics.
Recording / Lesotho Network of AIDS Service Organizations (LENASO) Slides / HIV Survivors and Partners Network (HIVSPN) Slides / Pangaea Zimbabwe AIDS Trust (PZAT) Slides / Nyanza Reproductive Health Society (NRHS) Slides
Avac Event
Results from STI Landscaping Analyses in East and Southern Africa—Part 1
Tuesday, November 7 at 9:00 AM ET
Hear results from STI landscaping projects conducted in seven different countries from East and Southern Africa that explored needs for STI vaccines and diagnostics.
Recording / Latu Human Rights Foundation Slides / ACTS 101 Uganda Slides / Journalists Association Against AIDS (JournAIDS) Slides
A Legacy of Impact: The power and reach of AVAC’s Advocacy Fellows
For more than a decade, alumni from AVAC’s Advocacy Fellows program have been expanding the reach of HIV prevention and advancing global health equity around the world. They are influencing research and strengthening healthcare to become more effective and equitable across the continent of Africa and beyond. A review of their career achievements shows how this unique program is contributing to the strength of a generation of leaders, and how their cumulative efforts are shaping the HIV response for the better.
Founded in 2009, the Advocacy Fellows program offers technical and financial support to individuals living in areas where HIV incidence is high, with a particular focus on African countries. The program invests in a select group of advocates who have an interest in improving the HIV response in their communities. The program pairs individuals with a community-based host organization where they pursue an 18-month advocacy project. Both the individual fellow and the host organization develop expertise and advocacy skills, gain access to influential stakeholders and networks, and receive intensive mentoring.
Nearly 100 advocates working with 70+ partner organizations across 15 countries have participated in the program. In that time, Fellows have:
- Founded or leads more than 85 influential organizations, coalitions and campaigns.
- Changed more than 84 national policies in support of HIV prevention or greater equity in public health.
- Won significant funding* increases for more than 83 different high-priority prevention programs and projects.
- Gained approval for over 35 innovative programs (including implementation, service delivery or community projects) and research projects.
- Led nearly 200 high-impact efforts** to create an enabling environment for HIV prevention such as rallies, media placements, and research literacy initiatives.
- Served on at least 150 high-level decision-making bodies, affecting policies, programs and funding at national and global levels.
A look at the careers of three alumni – Kenya’s Grace Kamau, Uganda’s Kenneth Mwehonge and South Africa’s Yvette Raphael – exemplifies the importance of this program in preparing future leaders, and showcases the extensive influence that alumni Fellows have on public health.
Grace Kamau joined the 2011 Fellows program with experience as a peer-to-peer educator for a sex worker advocacy organization, the Bar Hostess Empowerment and Support Programme (BHSP). She describes herself at the time as shy, uncertain of how and when to speak her mind. “I didn’t even apply for a conference scholarship because I was intimidated to travel”. As she worked on her project— raising awareness of PrEP and microbicides research among a sex worker community in Kenya, and engaging with policy makers to support the provision of PrEP to sex workers— elements of the program’s mentoring brought a seismic shift in her advocacy. “The Fellowship builds the whole person, far beyond expertise in HIV prevention, I came out a changed person.” A host of skills came together: mastering a two minute speech in case of encountering a key official in a hall, making quick follow up a standard practice, retaining command of the facts, understanding HIV science and policy trends. “Ever since I came out of the Fellows program, I have stood out. I pinpoint what needs to be said and to whom. I understand the power of my voice to speak out for sex worker rights and welfare. That confidence was built during my fellowship, and I use it to advance a movement.”
Grace’s advocacy has contributed to more than 175,000 sex workers in five countries receiving access to HIV services through the Hands Off Project, which she chairs. Her advocacy has also given voice and visibility to sex workers from 35 African countries on the need for decriminalization, access to care and other anti-stigma work in her current role as Regional Coordinator of the Africa Sex Workers Alliance (ASWA).
Kenneth Mwehonge grew up in a region of Uganda burdened with some of the highest rates of HIV found anywhere in the world. He saw one sister die, unable to get treatment and another finally gain access to life-saving drugs after living with HIV for many years. In 2014, he applied for a fellowship, work with HEPS-Uganda as his host organization. At the tine, he had only local level experience in grassroots organizing and a desire to fight for broader access to treatment. “My Fellowship with AVAC was the turning point in my career.” Kenneth said his exposure to the alumni network, introductions to decision-makers, education about HIV prevention and the research process, and AVAC’s mentoring boosted his confidence and taught him the value of mashalling evidence, working with data, and tracking progress closely. “When the fellowship began I was sometimes quite intimidated to talk to leaders, but overtime that wasn’t true anymore.” By the end of his project, Kenneth had profoundly impacted the HIV response in Uganda, designing and promoting a plan for universal viral load monitoring that was embraced by both PEPFAR and the Uganda government. His leadership and advocacy continued to grow.
Today, Kenneth is the executive director of HEPS, the organization that once hosted him as a Fellow, and it has grown into one of the most trusted civil society institutions in the country. Kenneth is also the coordinator of the Uganda Coalition for Access to Essential Medicines. He devotes significant time to mentoring emerging advocates. “It does take a lot of time, but there is so much work to be done and it is so important to see young people with fresh thinking taking the work across the finish line.” Kenneth’s leadership is also prized at the international level; he currently serves as a member of the UNAIDS Global HIV Prevention Coalition and the lead for coordinating the 2025 roadmap for prevention in Uganda and Tanzania.
“For the first time, we have options—PrEP, the ring, and cabotegravir as an injection. But advocates from my hometown, where [HIV] prevalence is 17%, don’t even know these options exist! In the years ahead I will be working to see every proven option for HIV prevention is scaled up and rolled out.”
A veteran human rights activist, Yvette Raphael joined the AVAC Advocacy Fellowship cohort of 2014, with the Centre for Communication Impact (CCI) as her host organization. As a woman living with HIV, she wanted to develop a program to mobilize young women to fight for HIV prevention. She said the fellowship taught her how to implement advocacy, create a process, and be accountable to a grant. She emerged from the program with a laser focus and has since become one of the most prominent advocates for HIV prevention on the national and global stage. To name a few of her roles: Yvette is the Executive Director of South Africa’s Advocacy for Prevention of HIV and AIDS (APHA), an organization she co-founded with two other Fellow alumni – Ntando and Brian Kanyemba. She also serves on the South Africa National AIDS Commission. She was the keynote speaker at the 2023 Conference on Retroviruses and Opportunistic Infections. In the Journal of the International AIDS Society, Yvette recently co-authored Antibodies for HIV prevention: the path forward with world renowned scientists, issuing a call to action for a research agenda focused on ensuring equitable access.
She co-founded the African Women’s Prevention Accountability Board, which engages industry, research and government on ongoing and future research and is leading efforts to advance The HIV Prevention Choice Manifesto. She has helped to shape numerous programs and campaigns aimed at reaching vulnerable populations with HIV prevention and she mentors young advocates.
“The Fellows program took a chance with an unpolished, street smart activist and turned me into a boardroom eloquent and knowledgeable advocate. It was mentorship , contacts, support from the team, and solidarity with other fellows. I look down the road and I see there’s a chance to end this epidemic, but greed and power hoarding will derail all this, without advocates who are prepared and committed. I will be among them, with young advocates I am mentoring now, and so many fellow alumni by my side.”
For a comprehensive understanding of the impact of the Fellows program in its first decade, please see the AVAC Advocacy Fellows Program Evaluation, conducted in 2020.
Significant funding*- This data comes from advocacy that won funding increases from PEPFAR, Global Fund, philanthropy, bilateral government entities, and private industry for programs with extensive reach and impact, such as PrEP for AGYW and Community-led monitoring.
High-impact efforts**- This data reflects initiatives that were covered by the media, media placements in national press, social media campaigns that went viral.
Advancing Choice in HIV Prevention
In recent weeks, important new resources for advancing choice in HIV prevention have been announced. Don’t miss these highlights from the field. They point to an HIV response in transition, and help to define the role advocacy must play. As policy, practice and budgets strive to keep up with advances in research, advocacy around choice becomes a cross-cutting priority—so that the promise of new options in HIV prevention won’t be squandered in siloed programs, or by poorly-planned supply chains, or because of disconnected policy decisions. People have diverse needs and face complex challenges; ending HIV depends on finding the option that works best for each individual.
The Choice Manifesto
The African Women’s HIV Prevention Community Accounability Board (AWPCAB) launched the HIV Prevention Choice Manifesto, calling for increased political and financial support to ensure every proven method of HIV prevention is integrated into the HIV response, so that all women who need prevention will have access to the options that will make prevention possible for them. At the launch event in Kampala, UNAIDS Executive Director Winnie Byanyima gave a keynote address in support of the Manifesto’s call for all stakeholders to commit to the budgets and strategies that will make choice possible.
“I congratulate you for the HIV Prevention Choice Manifesto. It’s about pushing everyone towards people-centered, women-centered and women-led approaches to HIV prevention. You have fought with your lives to get here. You are fearless feminists. Women must lead for themselves.” – Winnie Byanyima, UNAIDS Executive Director
Learn more about the HIV Prevention Choice Manifesto and other advocacy resources for choice in our latest AVAC blog, Reclaiming Choice: The launch of the HIV Prevention Choice Manifesto and what that means.
The Dual Prevention Pill (DPP)
The DPP Consortium created a multiyear strategy to frame priorities and next steps in the development and delivery of the dual prevention pill (DPP), which is being developed to prevent HIV and unintended pregnancy. This multipurpose prevention technology (MPT) combines oral PrEP with an oral contraceptive. The updated strategy consolidates two years of progress toward preparing the field for new MPTs. The strategy addresses additions to the MPT pipeline, the potential role of the private sector in delivering a future DPP, recommendations for provider counseling on the use of the DPP, market research on potential DPP users, the latest analysis on cost, and more.
Stay tuned for more resources and updates to come on the DPP, the Choice Manifesto, and tools for connecting choice to HIV prevention, ending the epidemic and the role of choice in global health equity in HIV, and beyond.
The Architecture for Pandemic Prevention, Preparedness, & Response (PPPR): Views from Civil Society Leaders on the UN High Level Meetings (Guest Essay)
AVAC’s Executive Director along with partners from the Coalition of Advocates for Global Health and Pandemic Preparedness penned an essay to make the case of meaningful investment in Pandemic Preparedness while referencing continued failures of the COVID-19 pandemic. Read the full essay here.
PEPFAR at 20: Keeping the promise
Our latest episode of Px Pulse is out, PEPFAR: Keeping the promise.
PEPFAR is one of the greatest US foreign policy and global development achievements of the century. The program has saved upwards of 25 million lives since it launched in 2003. But as PEPFAR marks its 20th anniversary, it’s also fighting for its future.
The US Congress needs to reauthorize PEPFAR for another five years by September 30 and reaffirm its commitment to this lifesaving program. Until a couple of months ago, most in global health and development expected smooth sailing for a five-year reauthorization of the program, as has happened throughout the past 20 years. PEPFAR has enjoyed deep and broad bipartisan support since its founding. Evangelical Christians, staunch conservatives and progressive liberals, Democrats and Republicans, HIV activists, civil society advocates and public health leaders have all championed PEPFAR, year in and year out. But a handful of Republicans, including past PEPFAR allies, are pulling reauthorization into high-stakes partisan politics.
In this episode, Px Pulse talks to some of the people who put PEPFAR dollars into action and to global health leaders who explain why PEPFAR’s approach has been so effective, and what’s at stake in this debate.
Tune in to hear:
Ilda Kuleba from Mothers 2 Mothers talks about the impact of PEPFAR on their work across 10 countries, training and employing HIV positive mothers as peer healthcare workers.
Dr. James Mukabi of World Vision’s Kenya program talks about how this Christian relief organization has changed the lives of thousands of orphans and other populations who are vulnerable to HIV.
Tom Hart, President of the ONE Campaign, which was co-founded by the rock star Bono, to be an early champion of PEPFAR and other poverty fighting efforts talks about PEPFAR’s accomplishments at the global level and what’s next as Congress debates reauthorizing the program.
PEPFAR’s supporters have a job to do, to make sure everyone understands that the world has a lot to lose if PEPFAR is weakened and so, so much to gain if US policymakers unite in their support. We hope you will listen and pass on the episode, download the resources and, most especially, add your voice in support of PEPFAR.
Announcing the New AVAC.org and Digital Resources
We are delighted to share the new and improved AVAC.org! On our new site, you can easily access all the great data, policy analysis, tools and resources that you’ve come to expect from AVAC, including our much-loved infographics, podcasts, Weekly NewsDigest and Pandemic Watch, webinars, research literacy materials and so much more!
The updated AVAC.org also reflects the expanded vision and practice of our dynamic programs. AVAC will always work to accelerate ethical development and equitable delivery of effective HIV prevention options. But, we also know that responding to HIV and preparing for future pandemics requires a comprehensive, integrated, and sustained response that is rights-based, people-centered and evidence-informed.
To AVAC, this means connecting the dots between HIV prevention, sexual and reproductive health and rights, pandemic preparedness, strengthened health systems, research engagement and community leadership. It means recognizing that resilience in global health requires us to confront the threats posed by disparities in access, entrenched stigma, discrimination, criminalizing key populations and inadequate responses to other sexually transmitted infections.
Visit the new AVAC.org for resources, tools and analysis that make these connections as we continue to track and translate the field, including:
- Information on the entire pipeline of biomedical prevention strategies being investigated today
- Our projects, which showcase the incredible partnerships and collaboration that underpin everything we do
- Our podcast, PxPulse, which will deepen your knowledge and help you “check the pulse” of this fast-paced field and the urgent challenges still ahead
- PxWire our quarterly update on where we are in biomedical prevention research
- Our HIV clinical trials database, where you can find details on all biomedical prevention trials and our broader resource database containing fact sheets, infographics, blog posts and more on HIV prevention and the broader issues surrounding global health equity
- Links to our newsletters—Pandemic Watch, Weekly NewsDigest, and our Advocates Network
And be sure to check out three vital AVAC resources that give you all the information you need on PrEP access, STI vaccine and diagnostics R&D and HIV prevention R&D funding.
We are immensely proud to share these resources with you. We hope these tools and analyses will help to power your advocacy, accelerate ethical development and equitable delivery of effective HIV prevention options, and advance global health equity.