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There has never been an AIDS conference like the one currently underway this week—AIDS 2020 Virtual. As a global collective of people concerned with HIV, we also check the daily updates on COVID-19. Both demand real, urgent solutions. Here is AVAC’s take from the early sessions of AIDS 2020 Virtual and the actions that can make a difference right now, and in the future.
As the world works to make sense of the news from AIDS 2020 news, advocates, activists, scientists and global leaders must ensure that COVID-19 doesn’t further exacerbate or distract from the primary prevention crisis in HIV.
UNAIDS’ annual update, released yesterday, shows no change in the global total of new HIV infections. There were roughly 1.7 million infections last year. Five years ago, UNAIDS’ Fast-Track campaign set global sights on slashing rates of infections to 500,000 per year worldwide. At that time, there were roughly 2 million infections per year. Instead of meeting the goal, the world has made marginal progress—a reality that’s been clear for some time. While there are pockets of progress, the picture—even before COVID-19—is one of crisis and unfinished business.
To effect immediate change, AVAC calls for the following five actions:
1. UNAIDS and WHO must lead the call for a “Pandemic Policy-Change Agenda” in which law- and policy makers remove policies that criminalize sex work, drug use, same-sex behavior and HIV status. These policies are barriers to HIV prevention and to accessing prevention and treatment for other pathogens, including COVID-19.
2. National AIDS programs—working with WHO, PEPFAR, GFATM and civil society—must develop and implement differentiated service delivery of oral PrEP, including multi-month scripting with provision of self-test kits at each refill, using the same supply points to offer male and female condoms and contraceptive refills. As just announced new data from the SEARCH study show, access to PrEP is a powerful tool to bring down incidence at the population level. For more on differentiated service delivery (DSD) and the advocacy to go with it, see the satellite session convened by AVAC, IAS and PATH: Bringing PrEP closer to home: Why is now the time for differentiated PrEP?, available on-demand at aids2020.org. And read our recent blog entry on the topic.
3. UNAIDS must coordinate the funding and implementation of a rapid assessment of best practices to expand local community health cadres. Among these cadres, peer networks of people living with HIV are especially important to provide safe and local capacity to offer adherence support and to help connect people to food and income assistance and other social support in the context of concurrent pandemics. This rapid assessment should be used to drive funding to civil society and activist groups to implement strategies adapted for local contexts. At AIDS 2020, AVAC is proud to be presenting work from the COMPASS coalition, a vibrant locally grounded, transnational activist effort that provides a model for tying this type of data-driven work to action. (See a related poster to this work, Translational Activism for an Effective, Comprehensive HIV Response, at the On-Demand Poster Channel Track F.)
4. WHO, ViiV and other product developers, must work with regulatory agencies to advance a comprehensive, clearly articulated plan for acting on promising research findings. AIDS 2020 brought news that injectable cabotegravir is highly-effective in reducing HIV risk in men who have sex with men and transgender women. In the HPTN 083 study, participants who received the injection had significantly fewer infections compared to those who received daily oral PrEP—even though early analysis suggests relatively high rates of oral PrEP adherence. This is exciting and challenging news given that current data have yet to show efficacy in cisgender women, and rates of new HIV infections in adolescent girls and young women are persistently high. (A study in that population, HPTN 084, is underway.) Recently, the US FDA licensed F/TAF for people excluding those who have vaginal sex, prompting confusion and concern. It also spurred mobilization, led by cisgender women seeking clarity and equity in HIV prevention. At the same time, the EMA’s regulatory review of the dapivirine vaginal ring for HIV prevention is ongoing for this important prevention tool. For products that work in all bodies and all genders to reach the people who want and need them, the following must happen:
- Product developers must work with communities to ensure that introduction plans developed for CAB-LA and the dapivirine ring are clear, comprehensive and contextualized—so that the knowns, unknowns and timelines are explicit for the growing array of PrEP options available for different groups.
- ViiV, the manufacturer of CAB-LA, must move quickly to work with regulatory agencies. This work should be shared with community and reflect that input on plans for seeking review and developing a timeline for incorporating data from the ongoing HPTN 084 study of CAB-LA in cisgender women.
- WHO must simultaneously launch a parallel consultative process to support guidance for CAB-LA and the dapivirine ring, so there will be no delay in rolling them out once regulatory review is completed.
5. Civil society engagement must be regarded with the same urgency as the research itself for COVID-19, HIV and more. Clinical trial results don’t translate into action without meaningful stakeholder engagement at every stage of a trial, including design, implementation, data analysis, and eventual access to new interventions. AVAC is working with numerous partners on the leading edge of engagement for COVID-19 research to apply the Good Participatory Practice Guidelines and establish a COVID Advocates Advisory Board for these critical times. It is essential for civil society and national governments to have the funding and the space—virtual or otherwise— to make this vital work a success.
In the coming days, AVAC will be bringing more updates on AIDS 2020 news and its relationship to these core recommendations. In the coming months and years, we will be working with advocates worldwide to ensure that the critical issues raised in this moment of “virtual” convening and “paused” activities translate into real and dynamic change.