In its 17th annual report, the Resource Tracking for HIV Prevention Research & Development Working Group documents research and development spending for the calendar year 2021. This report also analyzes funding trends spanning 22 years for the following biomedical HIV prevention options: preventive HIV vaccines, microbicides, pre-exposure prophylaxis (PrEP), treatment as prevention (TasP), voluntary medical male circumcision (VMMC), female condoms and prevention of vertical transmission (PVT). More information at hivresourcetracking.org.
HIV Prevention Research & Development Investments 2021
Evolving Strategies for an HIV Vaccine: One researcher explains where the field is going and why?
May 17, 2023
With several large HIV vaccine trials in the last few years finding no efficacy, the field is in transition. There are diverse ideas in vaccine research, but there’s no clear concept that’s ready to test in a late-phase trial or move towards product development currently. Researchers are back to testing new ideas in early phase research.
In this episode of our Px Pulse podcast, Evolving Strategies for an HIV Vaccine: One researcher explains where the field is going and why?, Dr. Katy Stephenson explores the implications of recent trial results, the big questions driving next generation vaccine development, and new strategies underway in early phase research. Katy is a doctor, a researcher, a professor of medicine at Harvard Medical School, affiliated with Beth Israel Deaconess Medical Center, and part of the Center for Virology and Vaccine Research.
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Investment Trends for HIV Prevention and Cure R&D: Resource tracking reports
New Reports on HIV Prevention and Cure R&D Funding
AVAC and partners are delighted to share two new reports showing investments for HIV prevention and cure research and development (R&D) that were launched this week at the IAS 2023 Conference on HIV Science. Both reports explore a variety of factors influencing investment and detail how investment trends are changing.
In its 17th annual report, the Resource Tracking for HIV Prevention R&D Working Group, a collaboration among AVAC, IAVI and UNAIDS, documents 22 years of investment in biomedical HIV prevention R&D, including HIV vaccines, PrEP, microbicides, voluntary medical male circumcision (VMMC), treatment as prevention (TasP) or undetectable equals untransmittable (U=U), female condoms and prevention of vertical transmission (PVT).
Key Findings and Analysis
- Overall, total 2021 investments (the latest data available) in HIV prevention R&D show an approximate 12% increase for HIV prevention R&D compared to 2020. Money for HIV prevention has not returned to the high-water mark seen in 2012, when total investment was US $1.31 billion, but the figures have inched back up, to $1.25 billion in 2023, from $1.09 billion in 2020.
- Investment in HIV vaccine research declined, but still represents a majority of all HIV prevention research. At approximately $794 million, it is 63.5% of total HIV prevention R&D.
- Funding for microbicides is down for the 7th year in a row, and by 20% from 2020. However, this is in part attributable to several funders shifting to consolidating the PrEP category to include all products using antiretrovirals, including topical microbicides.
- 2021 saw the launch of USAID’s MATRIX Consortium, supporting further research on microbicides and dual prevention options.
- Also launched in 2021, USAID’s MOSAIC program, focused on developing and accelerating women’s access to new HIV prevention products. MOSAIC investments, funded as part of USAID’s long-standing microbicide investments, will be recorded by the Working Group from 2022 onwards.
- PrEP investment saw a two-fold increase, the highest seen since the Working Group began tracking, hitting approximately $270 million in 2021.
- A 30% increase in VMMC in 2021 reversed a decline seen in 2020.
- Funding for PVT decreased from US$25 million in 2020 to US$14.3 million in 2021, the lowest level recorded by the Working Group.
- The ratio of public to philanthropic investment remained the same as 2020, at 81% and 12%, respectively.
- Global philanthropic funding levels increased 16% in 2021 to US$150 million.
- Though the US continues to shoulder the bulk of all funding at approximately $922 million, diversity by geography is on the up. European entities increased their investments by 40%, reaching $161 million. Diversifying the funding base is vital not only for the long-term sustainability of the field, but also to ensure that the research priorities are informed by a diversity of perspectives.
The 2021 report of the Cure Resource Tracking Group, a collaboration between AVAC and the International AIDS Society, showed an impressive 30% increase in funding for cure research. The report also provides an analysis of the cure research agenda and the scientific questions shaping investment decisions.
- Total funding went from $337 million in 2020 to $439 million in 2021. This increase represents a five-fold increase since tracking began in 2012.
- Approximately $362 million comes from public funders, approximately $40 million comes from philanthropy. Approximately $36 million is invested by industry.
- Only 6% of research sponsors report participant data derived from trials conducted in African countries, even though Africa is home to 68 percent of people living with HIV. There is a growing recognition that research needs to be done among affected communities and conducted in African countries. The establishment of the HIV Cure African Acceleration Partnership (HCAAP) aims to enable stakeholder engagement.
- The US NIH-funded Martin Delaney Collaboratories for HIV Cure Research expanded in 2021 and now include ten collaboratories.
- 2021 data show sustained geographic diversity in cure R&D, with several countries joining the US to increase their funding, including Canada, Switzerland and the Netherlands.
We hope these reports will serve as tools for advocacy and inform public policy. Funding priorities are instrumental to the decisions and commitments that allow scientific progress. All stakeholders need opportunities to understand these trends and advocate where change is needed.
A special thank you to trial participants everywhere. Without their time and dedication, scientific advance would halt, full stop. Also thank you to the individuals who contributed data to the report.
If your organization is a funder or recipient of HIV prevention or cure grants and we don’t know you already, please contact us at avac@avac.org!
Our Take: Are the UN Declaration on PPPR and the Pandemic Accord going in the right direction?
The last few weeks have been filled with high-level negotiations among UN Member States on the way forward for global pandemic prevention, preparedness, and response (PPPR) efforts. Below, please find an analysis of the negotiated language to date in the Pandemic Accord, and the UN Declaration on PPPR, and their implications for equity in PPPR. These analyses were conducted by AVAC and partners working in collaboration to track progress toward equity in these agreements and develop an advocacy agenda for provisions in both that ensure equity in global health advances. The Declaration is an agreement that involves heads of state and potentially a role for all ministries of government. The Pandemic Accord is being negotiated by members of the WHO to strengthen PPPR.
The Pandemic Accord: A look at negotiations to date
The first draft of the WHO-led Pandemic Accord was released in May, containing edits to the zero draft from the Member States. As expected, edits from high-income countries introduced challenges to equity provisions in the text— particularly provisions aimed at ensuring that agreements to share access to data on pathogens is paired with commitments to also share the benefits developed from research using those data (termed pathogen access and benefits sharing). Other equity provisions that were challenged include intellectual property, and language on how the world should allocate vaccines, therapeutics, and diagnostics in the event of a global pandemic threat. Throughout the document, certain high-income Member States inserted caveats or wording, such as “encourage” or “as appropriate”, which would make implementation voluntary or compliance more subjective. Other phrases to weaken the agreements, such as replacing “commit to” with “recognize the importance of”, were also inserted.
Negotiations so far have resulted in weaker, alternative language to several key articles than in the so-called zero draft of the accord. These include articles on technology transfer, the Pathogen Access and Benefit Sharing (PABS) System, health workforce strengthening, and the proposed Supply Chain & Logistics Network. There are, however, some clauses that have been strengthened. Global R&D networks, laboratory networks for genomic surveillance, knowledge translation, and the harmonization of regulation to accelerate WHO pre-approval and authorization all have stronger commitments and more details than before. You can find the first draft here and a closer analysis of the changes made between the zero and first draft here.
The UN Declaration on PPPR: What’s in the Zero Draft?
The zero draft of the UN Declaration on PPPR, set to be adopted at the High-Level Meeting on September 20, was released in June.
Many provisions in the draft Declaration are positive, recognizing and affirming key points related to human rights and inclusive provisions that prioritize vulnerable and marginalized populations. The draft recognizes vaccine inequity as a vital concern, affirms key principles of equity and non-discrimination and the need to ensure adequate support for both health workers and the WHO. However, there are very few, if any, concrete targets set, leaving little to hold countries accountable. Missing from the Declaration, in particular the section on Overarching Health Related Issues, is the need for countries to prioritize and commit to building on the global responses to ongoing epidemics, including HIV/AIDS, TB, malaria, polio, other neglected disease outbreaks such as Ebola, Marburg, and cholera, and antimicrobial resistance (AMR).
This is a missed opportunity with enormous implications. It signals a troubling and serious global inability to build on existing health and community infrastructures, integrate responses, and avoid erecting isolated pillars in global health architecture. Many of the capacities needed for PPPR already exist in the response to these other health threats. They can and must be expanded and strengthened for broader pandemic preparedness. In addition, the history of the responses to HIV/AIDS, TB, and malaria have made clear that community leadership in the response and civil society engagement are essential to achieve success in PPPR. The current response to existing health threats, which through trial and error have built resilient and effective systems, should serve as the foundation for any future pandemic preparedness and response efforts. The Declaration’s silence on this issue is gravely concerning.
The Declaration’s clauses relating to agreements on pandemic-related tools and products are strong, and notably stronger than those in the first draft of the Pandemic Accord. But equity provisions, and access to those tools, could be strengthened further, by including compulsory licensing and transfer of know-how when necessary.
It’s vital for advocates to engage with these processes, and leverage their power to influence the emerging architecture in global health. Decisions being made now will have implications for years to come. And the voices of advocates are having an influence. For example, the US government’s contribution to the current draft of the UN declaration recently added specific recommendations from AVAC and partners on the inclusion of Good Participatory Practice. It’s up to all of us to make sure GPP and other provisions that ensure equity in global health are in place when the drafts become final.
You can find the Declaration zero draft here and see our analysis and the changes we call for here.
What’s Next
These negotiations are setting the direction for pandemic readiness for years to come. As discussions continue in the weeks and months ahead, it’s imperative for advocates and countries to be raising their voices and calling for language and commitments that will ensure equity in PPPR. Building on the lessons the world has learned from ongoing epidemics, and integrating the response must be a priority to ensure the tragic results of inequity in global health are not repeated, again and again.
AVAC will be sharing these analyses with our partners and governments with whom we work with. For more background, read AVAC’s Advocates Guide for PPPR. And you can take action now by sending these resources to your country’s UN representatives and other influential voices in your networks!
IAS Science 2023 Conference: What you need to know
The 12th annual conference of the International AIDS Society (IAS) on HIV science takes place July 23–26 in Brisbane, Australia, and virtually. This year’s conference will offer the latest on vaccine and cure science, research updates on broadly neutralizing antibodies, important discussions on trial design in the era of PrEP, the potential of community-led models of care and the importance of integrating services for HIV and sexual and reproductive health (SRH). AVAC and partners will be there! Read on for an overview.
Just ahead of the conference, UNAIDS released their annual state of the epidemic report, The Path that Ends AIDS. The report charts a path that can end AIDS, and documents important progress, but challenges remain. Among them, global resources for HIV are marking another year of decline. With anti-LGTBQIA+ legal actions increasing in the US and in several African countries and reduced resources, efforts to end the epidemic will fail. See AVAC’s new graphic on the issue.
IAS Resources
- Use AVAC’s Roadmap to find sessions where prevention, pandemic preparedness and the larger issues of global health equity are in the spotlight. You can download it as a sortable spreadsheet or PDF.
- Follow events in real time, AVAC will offer comments and updates on Twitter, and our friends at NAM/AIDSMAP will be reporting throughout the conference. Join the conversation using the conference hashtag #IAS2023.
Satellites, Sessions and Panels Featuring AVAC and Partners
All times listed are local in Brisbane, Australia. Click for a time zone converter.
Sunday, July 23
- Taking prevention to the next level: Packaging PrEP with primary health care services as a pathway to achieving 2030 HIV prevention and universal health coverage goals — satellite session, 11:30-12:30 pm AEST, Plaza Auditorium Channel 4
- Regaining lost ground for HIV prevention: Acting on lessons learned from oral PrEP scale-up new PrEP method mix — satellite session, 1:00-2:30 pm AEST, Plaza Auditorium Channel 4
Tuesday, July 25
- Next Gen HIV Prevention research: Clinical Trials in an era of highly effective standards of care — satellite session, 6:30-8:00 pm AEST, Plaza Ballroom Channel 3
- bnAbs: From prevention to cure — satellite session, 6:30-8:00 pm AEST, Boulevard Auditorium Channel 7
Wednesday, July 26
- Our bodies, our science: Empowering and promoting community engagement and practices in science — symposium session 17, 10:30-11:30 am AEST, Plaza Terrace Room/Channel 2
- Immune responses critical for viral control and approaches to harness them in vivo — Symposium session 20, 10:30-11:30 am AEST, Auditorium/Channel 7
Poster Presentations
- No Data No More: A tool to end the exclusion of trans and gender-diverse people in HIV research
- Raising New Voices in HIV Cure Research: A review of an advocacy-for-cure academy and grant program
- The Value of Measuring Outcomes of HIV Advocacy: Utilising a novel and participatory approach for advocacy evaluation
- HIV Prevention Research & Development Investments 2001-2021: Shifting investment priorities fund innovation in a challenging global health landscape
- Revolution of Transgender Health Programming: The role of transgender activists in Health programming for Malawi
While many will be gathering in Australia for the IAS conference, the 27th International Society for Sexually Transmitted Diseases Research (ISSTDR) is happening in Chicago at the same time – and AVAC will be there, too. Stay tuned for an update later this week for AVAC’s STI Roadmap and dedicated STI conference page. Advocates, implementers and researchers in both fields have much work to do together.
STI & HIV World Congress Kicks Off July 24
Follow The Conversation!
Next week, the STI & HIV World Congress (also known as ISSTDR) kicks off in Chicago, Illinois, USA and AVAC will be there. This is the first major face-to-face meeting of STI & HIV professionals since 2019 and one of the only spaces the global STI community comes together to promote ongoing STI research efforts and exchange information on current investigations. This is also the first time AVAC is attending ISSTDR in hopes of expanding STI advocacy and community engagement.
STI & HIV World Congress Resources
Use AVAC’s Roadmap to find sessions where prevention, pandemic preparedness and the larger issues of global health equity are in the spotlight. You can download it as a sortable spreadsheet or PDF. The full conference program is also available.
Follow events in real time with the official hashtag, #ISSTDR2023, AVAC will offer comments and updates on Twitter.
Visit STIWatch.org, our updated and expanded online resource for the sexual and reproductive health and rights (SRHR) community to better understand and advocate for STI vaccine and diagnostics research, development and rollout.
STI & HIV World Congress 2023 Highlights
Check out some AVAC-featured sessions below.
The STI Prevention Pipeline: Where Are We, and What Will It Take to Move Forward Faster?
Monday, July 24 11am–2pm in the Mayfair Room
Join us to explore the current development and implementation stages of STI vaccines and diagnostics and identify ways to accelerate research through advocacy.
Symposium: New Vaccine Approaches to STI Prevention STI Vaccine Acceptance and Equity
Tuesday, July 25 2:30pm-4:00pm at Chicago 6
Join AVAC’s Alison Footman to dive into the topic of STI vaccines and equity as new interventions come into reach.
Setting Up a Remote/Home Testing STI Programme: A Practical Toolkit
Tuesday, July 25 2:30pm-4:00pm in Sheraton IV/V
Join us to explore the power of remote testing to affordably curb STI acquisitions.
Community Happy Hour
Monday, July 24, 6:00pm-8:00pm at Lizzie McNeill’s
Join AVAC and partners for a no frills happy hour for the STI community. All are welcome!
ISSTDR Advocacy Zone
Tuesday, July 25 to Thursday, July 27 in the Exhibit Hall
Visit the Advocacy Zone, a space to ask important questions, connect with fellow STI advocates, and begin to chart next steps in advancing STI R&D.
Global Investment in HIV Cure Research & Development in 2021
A decade of progress
Language for HIV Cure
This document shares up-to-date, community-preferred terminology within cure research.
Avac Event
ICASA 2023
Join AVAC and partners for the biennial International Conference on AIDS and Sexually Transmitted Infections (ICASA), in Harare, Zimbabwe December 4-9. More than 30 of our partners will convene at the meeting to champion community leadership and amplify their role in shaping local, national and global responses and delivering impactful advocacy. Community leadership on a range of issues are instrumental to:
- Accelerate and expand access to proven prevention options that people want and need.
- Dismantle the structural barriers to health faced by key populations.
- Intensify demands for robust domestic and global funding for health.
- Integrate HIV services with sexual and reproductive health.
- And much more.
Scroll down for a roadmap to ICASA’s prevention program, and details on sessions and events that you won’t want to miss.
- Download the ICASA Prevention Roadmap
- Visit us and our CASPR partners at booth #9
- Check out our partners at the Women’s Networking Zone in the Community Village
- Follow the conversation on Twitter
Sessions of Interest
Sunday, December 3
- Biomedical Prevention Forum
9:00-15:00 GMT
The Biomedical Prevention Forum will be held as a hybrid event bringing together advocates, civil society representatives, researchers, government officials and front-line providers to explore and discuss the latest advancements, challenges, and opportunities in biomedical HIV prevention, while emphasizing the importance of choice and its transformative impact on HIV prevention efforts. This is an open event. Register here.
- Key Populations Preconference
9:00-15:00 GMT
The Africa Key Populations Experts Group (AKPEG), African Sex Workers Alliance (ASWA), the African Network of People Using Drugs (AfricanPUD) and African Queer Youth Initiative (AQYI) Advocates for Prevention of HIV and AIDS in Africa (APHA), Global Black Gay Men Connect (GBGMC) and partners will host a safe platform to deliberate on the state of the HIV epidemic among Key Populations and to determine the stumbling blocks for progress on the path that ends AIDS for Key Populations.
Monday, December 4
- Empowering Intergenerational Leadership for Women-Controlled HIV Prevention Options: A Path to Ending AIDS by 2030
10:40-11:20 GMT
This satellite session, hosted by ICWEA and APHA, is dedicated to exploring the critical role of women-controlled HIV prevention options. Partners will share and discuss the recently launched HIV Prevention Choice Manifesto, a call for political will and financial investment to ensure access to the prevention options that women and girls in Africa say that they want and need. - Shaping the future of choice in prevention: Gearing up for the rollout of the Dual Prevention Pill, the newest MPT in the toolbox
12:25-13:10 GMT
The Dual Prevention Pill (DPP), a daily pill combining oral PrEP and combined hormonal oral contraception for dual pregnancy and HIV prevention, could be introduced in the next two years and would be the only other MPT available in addition to male and female condoms – and the first MPT containing PrEP. This session will discuss the latest learnings from the DPP Consortium, a coalition of organizations preparing for the introduction of the DPP in Zimbabwe, South Africa and Kenya.
Tuesday, December 5
- Advancing Integrated Biomedical Prevention: Best Practices from Zimbabwe (Session 2)
8:45-09:30 GMT
This satellite session will discuss best practices and lessons learned from the delivery of biomedical HIV prevention and Voluntary Medical Male Circumcision services as we work to further universal health coverage and robust health systems. Partners will launch a global call to action to unite, mobilize, and advocate for continued prioritized funding, sustained commitment, and strategic integration of VMMC into national and global prevention strategies. - Catalyzing a sustainable HIV prevention agenda: Approaches to expand local action on global commitments
10:45-11:30 GMT
Leveraging new strategic plans for HIV prevention, including the PEPFAR’s 5-year Strategy and UNAIDS’ Prevention Road Map, this satellite session will discuss combination prevention in the context of a sustainable HIV response and highlight a variety of approaches and models that leverage country and stakeholder-led innovations to meet the challenge. - Coordinating Implementation Science for CAB for PrEP: BioPIC’s Implementation Study Tracker
12:25-12:35 GMT
In this oral abstract session, AVAC will present a new dashboard, which reflects all currently known activities relating to implementation research, modelling, clinical research, and landscaping for new late-stage biomedical HIV PrEP options, including cabotegravir for PrEP and the dapivirine vaginal ring. - Policy, Politics and HIV Management
13:05-13:50 GMT
In this oral abstract session, Princess Mharire from Pangaea Zimbabwe AIDS Trust (PZAT) will present, Beyond Metrics: How the Simple Participatory Assessment of Real Change (SPARC) Tool Provides a Holistic Approach to Advocacy Measurement, and Joseph Njowa of PZAT will share the COMPASS MERL model in a presentation, Innovative tools for planning, monitoring, and evaluation of advocacy campaigns.
Wednesday, December 7
- A Whole Government Approach: Addressing a Multi-layered Challenge of New HIV Infections, SGBV and Adolescent Pregnancy (Triple Threat)
12:05-12:50 GMT
This concurrent session will feature AVAC’s Grace Kumwenda, Regional Program Manager for Research Engagement.
Friday, December 8
- Strengthen integration for better SRHR outcomes
10:45-11:30 GMT
This concurrent session will feature Advocates for Prevention of HIV and AIDS in Africa’s (APHA) Yvette Raphael and will explore linkages between unintended pregnancies, unsafe abortion, and HIV. - HIV Prevention-Right Place, Right time
13:05-13:50 GMT
This concurrent session will feature Maureen Luba of AVAC, Definate Nhamo of PZAT and Yvette Raphael of APHA.
AVAC and Partner Poster Presentations
Tuesday, December 5
- Maximizing private pharmacies for PrEP delivery to increase uptake: Lessons learnt from the Community Retail Pharmacy Distribution Point, Ruth Akulu
Wednesday, December 6
- Journalist Training: A Key Advocacy Strategy, Catherine Madebe
- Perceptions on the new biomedical HIV prevention methods among adolescent girls and young women in tertiary institutions in Zimbabwe, Cleo Makura
- Lessons from Crisis Response from TaNPUD in Enhancing Harm Reduction from 2015 to 2018, Marineus Mutongore
- Implementing Community led Monitoring for improved quality of HIV services in Tanzania, Mathew Kawogo
- Impact of social media exposure on HIV services uptake among Tanzanian Young people: Implications for enhancing the HIV response, Marineus Mutongore
- Effective Strategies for Operating COWLHA support groups of Adolescents Living with HIV: Case of Mangochi and Chikwawa Districts of Malawi, Harry Madukani
Thursday, December 7
- Understanding Choice of HIV Prevention Options among Adolescent Girls and Young Women (AGYW) in Zambia, Natasha Mwila
- Leveraging HIV to Build a Global Health Research and Development (R&D) Equity Advocacy Agenda, John Meade
- Championing advocacy for domestic resource mobilization for health research and development in Africa, Ethel Makila
Friday, December 8
- Rural Youth: Underserved and Unsafe When Seeking Care, Liyema Somnono
- Redefining Coalition Governance and Leadership in Support of Decolonizing Global Health: The Evolution of the COMPASS Coalition, Roberta Sutton
- Collaborative Monitoring & Evaluation to Support Learning and Strengthen Advocacy Coalitions: The MERL Hub, Grace Tetteh
- Realities faced by street children predisposing them to HIV and STIs in Dodoma and Dar es Salaam Cities in Tanzania, Simon Shilagwa
A Comprehensive Approach for Progress
Ending the Epidemic