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AVAC Report 2018

No Prevention
No End

AVAC Report 2018: At a Glance

In just about 24 months, the world will arrive at the deadline for the UNAIDS "Fast Track" goals for ending the epidemic. The primary fast-track goal for HIV prevention is reduction in new diagnoses from roughly 2,000,000 a year, to less than 500,000. There's no chance this goal will be achieved.

That's the bad news. The good news, such as it is, is that the reasons why the world is going to miss the target are obvious and can be tackled. This year's AVAC Report is dedicated to diagnosing the problem, and proposing actionable solutions.

With this year's Report, we get specific and practical. The crisis is coming, the message is clear. Here's our proposal for exactly what to do and why.

No Demand Creation, No Impact


THE PROBLEM: Today's primary prevention and treatment strategies need new approaches to "demand creation". While there's innovation in this field, it's applied unevenly across interventions. Data gaps on the costs and cost-effectiveness of demand-side thinking are pervasive; the funding gap for primary prevention makes this necessary work seem like a luxury.


THE RISK: The perfect can become the enemy of the good. The risks in arguing for intentional and thoughtful introduction plans are that access gets slowed down in pursuit of an unattainable ideal and that expectations of the program design approach are overinflated.


THE PATH TO A SOLUTION: Understand not everyone can do demand creation. It’s a science, not a set of slogans. This is true for treatment; it’s the bedrock of primary prevention. Find the people who can do it, the programs that have done it before and work with them to do it consistently. Reaching the right people is more important than reaching all people. Limited resources should be allocated to tailored demand-side thinking.

No Choice, No Prevention


THE PROBLEM: Informed choice is easy to advocate for and hard to implement. Cost, provider time and public health priorities can all work against investment in services that offer and support choice in strategies.


THE RISK: Embracing informed choice in biomedical prevention is tricky. There isn’t enough money for primary prevention basics like male and female condoms and VMMC. Advocating for more choices such as PrEP, multiple testing approaches, etc. means finding ways to do more with existing resources and also demanding additional funds.


THE PATH TO A SOLUTION: Identify, cost and adapt best practices in informed choice programming and monitoring from family planning and HIV programs as part of planning for new biomedical tools.

No Radical Action, No End


THE PROBLEM: There is a primary prevention crisis. The emphasis on ART-based programs to reduce incidence has drawn attention and funds from primary prevention for too long; the 2020 global target for incidence reduction will be missed.


THE RISK: So much has been accomplished in the fight against AIDS; so much is left to do. Emphasizing failure can hurt morale and momentum, yet so can over-promising and failing to deliver.


THE PATH TO A SOLUTION: Tailor today’s prevention approaches to specific communities and contexts; sustain research and prepare for results. ART scaled up in the context of flat funding by looking for efficiencies; biomedical prevention hasn’t nearly exhausted the potential to do the same.