World AIDS Day: What We’re Grateful For

December 1, 2016

Every year on World AIDS Day, December 1, we pause to take stock. We take stock of how much energy goes into “days” that note this issue or that one—and of how little attention HIV gets, relative to its ongoing impact in so much of the world, on other days. This year, many of us will also be considering how to move forward in a world where acceptance, equality and a commitment to human rights are under threat.

Here is what we know: we need to work together. We need to remain steadfast. And we need to take note of the things that we are grateful for. On this World AIDS Day, AVAC is drawing strength, as we always do, from our partners and from these issues, individuals and developments that shine light on the road ahead:

1) Launch of the HVTN 702 HIV vaccine trial – Earlier this week, the first participant enrolled in HVTN 702, the largest HIV vaccine trial ever to take place in South Africa, and the only vaccine efficacy trial currently taking place worldwide. HVTN 702 will test the safety and efficacy of an HIV vaccine strategy based on the combination evaluated in the RV144 trial, which took place in Thailand and reported results in 2009. RV144 found modest benefit using a two-vaccine combination. This has been updated and adapted for the genetic variants of HIV circulating in Southern Africa. The efficacy trial, which is scheduled to run through 2020, is just one important milestone in the larger HIV vaccine research and development agenda. Gratitude, encouragement and thanks to volunteers and trial staff!

2) A step forward in HIV prevention for women – This week’s New England Journal of Medicine includes the final results of the International Partnership for Microbicide’s Ring Study, which evaluated the safety and efficacy of the dapivirine vaginal ring. These results (first presented at CROI back in February) stand alongside the ASPIRE results (which also evaluated the dapivirine ring) to show that the ring is safe and partially protective. There is still much to understand from both of these studies and additional work that is ongoing and planned, as nicely summarized by Adaora Adimora in her accompanying editorial, Preventing HIV Among Women: A Step Forward, but Much Farther to Go. The results, commentary and a NEJM video summarizing results from both trials are all online.

3) UNAIDS’ timely and urgent prevention-focused resources developed for World AIDS Day – For the past several years, AVAC and other prevention advocates have urged UNAIDS to shine a light on the yawning gaps in funding and strategy for comprehensive HIV prevention. Starting with its Prevention Gap report—released in July 2016—the agency has taken this issue on. The materials released for World AIDS Day include print materials, prevention-focused stories and an investment update. The update outlines age and population-specific gaps and quantifies the funding needs.

4) Dynamic civil society engagement with clinical trial conductGilead’s Phase III trial (known as DISCOVER) of the drug F/TAF for oral PrEP has raised concerns among advocates that stakeholder engagement has been insufficient. The study plans to enroll 5,000 participants from 92 sites across the US and Europe. Participants will be randomized to receive either daily TDF/FTC (Truvada), which is a proven prevention option approved by the US FDA for PrEP in 2012, or daily F/TAF, which is a different version of the drug combination that has been approved for treatment but the efficacy for prevention is unproven.

Given the complex messaging of this trial—one that compares an approved option with an experimental one—community engagement over the course of trial planning and execution is imperative. A group of advocates, representing a range of organizations, submitted a public letter to Gilead on November 16 demanding substantial and meaningful improvements to the process of stakeholder engagement, as outlined in the Good Participatory Practice Guidelines. This is the right thing to do and history has shown this process improves the chances for the trial’s success.

5) Uncompromising AIDS activism and advocacy – In the United States, the presidential election has raised major concerns about the full range of issues affecting the domestic and international HIV response. Will research continue to be funded? Will healthcare be extended to all who need it, and will communities respond with love and action to outbreaks of hate and discrimination? Will overseas programs continue to be strategic and sufficiently funded? Nothing can be taken for granted. We are grateful to our allies in the US and abroad who are committed to fighting for what is right, just and sound public health. The Federal AIDS Policy Partnership and the Global AIDS Policy Partnership, along with the Congressional HIV/AIDS Caucus, are hosting a Congressional reception in recognition of World AIDS Day. Health GAP and other activists are planning an event on the Capitol Hill lawn to demand Speaker of the House Paul Ryan and the Republican Congress preserve funding that supports global health programming and the Affordable Care Act. More info here.

6) The life and legacy of Jacobus Witbooi – Jacobus Witbooi, coordinator of Pan African ILGA, died in late November, leaving a community in mourning and a remarkable legacy as a human rights defender. In his work for Pan African ILGA and in a wide array of other roles, Jacobus sought with strength and joy to ensure that LGBT rights were viewed as human rights at community, national and international levels. He was a member of AVAC’s PxROAR Africa program where he helped define strategies for integrating biomedical HIV prevention and human rights agendas. He was a beautiful soul, inside and out, a great friend and an inspiration to us all. We are grateful for having known him, even as we grieve his untimely loss.

Together, we’ve accomplished so much, but we have so much more to do. We hope you’ll continue to fight alongside us. Not just on World AIDS Day, but every day.