Long Waits and Long Queues: Hurry Up! – Day 2 at AIDS 2016

July 18, 2016

It’s Day 2 of the daily updates… and the conference has just barely begun with the official opening on Monday evening. Nevertheless, delegates have already covered a lot of ground—taking to the streets for a vibrant, sun-baked, song-filled March for Health.

Not everything is in motion, though. Long queues to undergo security screening are keeping people standing in place or, at best, shuffling along. While shuffling ourselves, we overheard an activist wondering why there wasn’t a “fast track” lane for people living with HIV. Perhaps the queue slowed down for US Global AIDS Ambassador Debbi Birx, who participated in the march—and raced into a press conference 15 minutes late. The security lines do have an upside though… they’ve provided our theme for today: “Hurry up!”

Hurry up, Part I

Two consecutive sessions on voluntary medical male circumcision (VMMC) started the day off. The first introduced the new UNAIDS Strategic Framework for VMMC—which recommends positioning VMMC in the context of a comprehensive platform of services for adolescent boys and young men. This shifts VMMC away from a campaign-based model that provided a basic package of services at the time of the procedure—but didn’t seek to use the procedure to anchor people to a broader health platform. Given the absence of youth-friendly health services for adolescent boys and girls (not to mention those individuals who don’t fit into gender-binary categories!)—this is a welcome recommendation. But it’s not clear what this shift will cost or how it will impact the goal of roughly doubling VMMCs annually from 2.5 million to five million in order to meet the global target. The sole presenter who addressed cost indicated that Swaziland’s approach to providing VMMC within a program of comprehensive services for young men cost about US$180 per procedure, compared to less than US$100 for a standard approach. Moving to the UNAIDS-recommended model is going to cost money, and the money is not on hand. At the same panel, a representative from the GFATM reported that six VMMC priority countries requested a total of US$9 million for VMMC from dedicated funds during the last round. However, an additional US$65 million for VMMC was in the “above allocation” wish-list—e.g., money they wanted but weren’t likely to get. So—the model is changing, costs could be rising, and the money is missing. That’s the challenge for delivery of the most effective HIV prevention available for HIV-negative men today. It needs to be resolved. Fast. Hurry up.

Hurry Up, Part II

A lively discussion took place in an afternoon session on HIV prevention for pregnant and breastfeeding women. Participants considered PrEP, including daily oral TDF/FTC, which is available today, as well as emerging strategies like the vaginal dapivirine ring and perhaps long-acting injectable ARVs. At issue was the best way to offer PrEP to HIV-negative women in antenatal settings. Does additional safety information need to be gathered even though there are years and years of experience using TDF/FTC-containing regimens in pregnant women living with HIV? Or should daily oral PrEP be part of antenatal services offered to women who are at substantial risk? Opinions were heated and diverse. Could over-crowded, under-resourced and under-staffed antenatal clinics accommodate the required counseling associated with PrEP initiation and successful follow-up? Was it ethical to hold off on offering PrEP for women who would definitely receive ART if they returned with an HIV-positive result? “There is some deep level of inequity, of sexism…” one participant opined. “If men could get pregnant this would be a really different discussion.” The questions standing in the way of routine provision of PrEP for women at risk in ANC clinics need to be addressed ASAP. Hurry up.

Hurry Up, Part III

The session on fast track prevention targets also got our attention. As seen in the Lancet HIV, global targets will fail to control HIV if the rate of new infection continues to march along at current levels. There’s been too little investment, focus and commitment on prevention. The scale of the effort has been too small and the quality of implementation uneven. The UNAIDS–Lancet Commission on Defeating AIDS—Advancing Global Health reported that updated UNAIDS targets to reduce new infections below 500,000 by 2020—a 75 percent reduction from 2010 requires a full complement of prevention and treatment strategies scaled to reach a significant percentage of high-risk populations. Prevention advocates are pushing program targets for a worldwide plan that could spell the difference between success and failure. Hurry Up!

If you don’t want to read the whole the Lancet HIV piece see how Peter Piot and Mitchell Warren cast it here.

Hurry Up, Part IV

AVAC has been closely following the development of DREAMS, the PEPFAR-led, public-private partnership focused on adolescent girls and young women. AVAC was present in force and cheered on former AVAC Fellow Anna Miti, who served as the moderator at today’s update on the DREAMS partnership. One highlight, PEPFAR and DREAMS Partners announced the winners of their Innovation Challenge Fund, which is handing out a total of US$85 million to 56 groups. The call for applications encouraged groups to cover priority areas not fully addressed in the ten country work plans. The news is in and some of it is exciting: of those awarded, nearly half have never received PEPFAR funding. The organizations cover six main focus areas, including community capacity strengthening and keeping girls in school. Just four of the grants (7 percent of the total) are focused on PrEP—and it is not clear that all of these four are involved in providing services. The majority of the organizations are in Kenya, South Africa, Uganda and Tanzania. While 36 of the organizations are small in revenue, several on the list are large international NGOs and it remains to be seen what resource allocation will look like across the 56 organizations. DREAMS has an essential goal—reduce the incidence of HIV in adolescent girls and young women by 40 percent in 2017. Nothing could be more important and we support it 100 percent. Hurry up!

And here’s a look at some of what tomorrow will bring:

Tuesday at the Research Literacy Networking Zone

In addition to having a Help Desk (have a question about prevention research or looking for a resource—stop in!) and a comfortable space to rest your feet, come check out all the programming in the RLNZ (Global Village, Booth 606). See Tuesday’s schedule below:

11:00 – 11:45 – Understanding HIV Prevention Research and Clinical Trial Process (WRHI)
11:45 – 12.45 – Breaking Down Silos-Implementing GPP Across Diseases and Research Phases (AVAC, WRHI)
13:00 – 14:00 – CUREiculum & Gene Therapy (Martin Delaney Collaboratory CAB)
14:45 – 15:45 – Ask the Researchers: Antibodies for Prevention & Treatment (HVTN, PxROAR)
16:00 – 16:45 – A Conversation about HIV with Emilio Emini, Director of HIV, Gates Foundation
16:45 – 17:45 – PrEP Prepositions 4 Prevention (DTHF, WRHI)
17:45 – 18:30 – AVAC Advocacy Fellows Info Session (AVAC)

A Few Sessions We’ve Starred

See below for a highly selective list of sessions for all the data geeks out there! Check them out in-person or find them on the webcast archive the following day.

11:00 – 12:30 – PrEP: New Drugs, New Questions, Session Room 11, Data on maraviroc as PrEP, dapivirine ring and rilpivirine long-acting injectable
11:00 – 12:30 – Progress in HIV Vaccines and the Road to the Clinic, Session Room 5, Review of P5, the AMP Study, Janssen’s ad26/MVA and new HIV vaccine concepts
13:00 – 14:00 – Late Breaker Session, Data from the HVTN 100 vaccine trial, SAPPH-IRe PrEP demonstration project in FSWs in Zimbabwe, ATN 113 PrEP demonstration project in young Black men in the US and Truvada as PrEP utilization data in the US
14:30 – 15:30 – New Evidence: Why Do Young Women in Africa Have High Rates of HIV Infection?, Session Room 1