Mapping Pathways VIDEO: New Report's Lead Author Discusses ARV-based Prevention

90 Seconds: Molly Morgan Jones, a Research Leader in RAND Europe, and lead author of the new Mapping Pathways report "Developing Evidence-Based, People-Centred Strategies for the Use of Antiretrovirals as Prevention" discusses how antiretroviral (ARV)-based HIV prevention strategies need to be closely tailored to local contexts and cultures in order to make an impact on new HIV infections globally.

Watch below. Access the report here. Check out the report's Research Brief here.

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Developing multiple prevention strategies, Part II—In conversation with U.S.-Based Jessica Terlikowski

Original content from the Mapping Pathways blog team

“We need to ensure access to all forms of prevention and treatment is readily and easily available for anyone who needs it, so people can reduce their risk, get the prevention and care they need, reduce onward transmission and lead healthy lives.”

Jessica Terlikowski is director of regional organizing at AIDS United based in Washington, D.C. and was most recently a policy manager at the AIDS Foundation of Chicago. Both organizations are Mapping Pathways partners. Jessica is co-founder of the Chicago Female Condom Campaign, and coordinates the National Female Condom Coalition. She was recently honored by the AIDS Legal Council of Chicago  as “Advocate of the year” for outstanding work in making a difference in the lives of people with HIV and AIDS. 

 In part 1 of her interview, Jessica discussed the importance of scaling up interventions we know that work while moving forward with new strategies like PrEP. In part II of the interview, she discusses some of the challenges that have to be overcome in the HIV prevention landscape.

MP: In our previous conversation, you mentioned a lack of political will to invest in resources? Could you elaborate on that?

JT: In the United States, there are a number of state and federal lawmakers who are proposing deep cuts to health care, prevention, and other public assistance programs in the name of “fiscal responsibility.” They claim that by reducing the government’s spending on such programs, we can begin to turn the U.S. economy around. However, such cuts would be devastating to those of us who already struggle financially and have limited to no access to healthcare – the majority of people with HIV. Additionally, decimating health and social safety net programs results in higher future costs which simple doesn’t make good economic sense.

Federal funding for syringe-exchange programs has recently been banned once more, just two years after our Congress lifted a 21-year ban. These programs provide sterile syringes, male and female condoms, HIV and hepatitis counseling and testing, vaccinations, and many other lifesaving services to injection-drug users and their partners.  Syringe exchange is one of the most successful and cost-effective interventions we have. 

We’re in a situation now where we are getting conflicting messages from our leaders. On the one hand, we have Secretary of State Hillary Clinton saying, “we can have an AIDS-free generation “, while at the same time Congress is making decisions that undercut efforts to actually get us to that point.

MP: Why is the work that Mapping Pathways is doing important right now?

JT: Our work especially matters because we have a number of tools now and coming down the pike to stem the HIV epidemic. We have several strategies at our disposal including PrEP and TLC+. While the stakeholder interviews and community input sessions are hugely beneficial to us, they also inform, educate and create a discussion among the stakeholders and the communities they belong to.

Many people’s knowledge of ARV-based prevention strategies is limited. They also have a lot of questions and concerns. . We are creating a space for people to learn and to discuss each of the options and how they relate to each other. Mapping Pathways participants then communicate and discuss the broader issues with their own communities. This is something that we are working on now—the dissemination of the community and expert perspectives we collected in the first year of the project.

Mapping Pathways is also important here in the U.S. because HIV continues to be a big problem here that especially impacts people who are already marginalized: people with low incomes, gay men, transgender women and women of color, people who use drugs. These are communities whose needs must be prioritized if we are to reduce the number of new HIV infections.

Mapping Pathways is all about having conversations about ARV-based prevention strategies. We need to make sure that these strategies are not going to be reserved just for people who already have access to healthcare.  We need to ensure access to all forms of prevention and treatment is readily and easily available for anyone who needs it, so people can reduce their risk, get the prevention and care they need, reduce onward transmission and lead healthy lives.

MP: Is this possible in the U.S. context right now?

JT: It is, but it won’t happen overnight. AIDS is a social justice issue and not just a public health issue. We have to talk about many other issues when we talk about HIV, like sex, drugs, and poverty, which are not things many people feel comfortable talking about. Our job as advocates is to raise these issues with decision makers and educate and organize our communities to build the necessary political will.

  

MP: What is the most satisfying part of your job?

JT: I think the most satisfying part of my job is working with others who share a common passion and drive on these issues. We are all deeply committed to working with our communities to increase political will for greater investment in and attention on HIV prevention, treatment, and care issues.

Read the first part of Jessica’s interview here, and learn more about the Mapping Pathways learnings from the U.S. here. 

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position. Please look for us on Facebook here www.facebook.com/MappingPathways and you can follow us on Twitter @mappingpathways as well.]

Developing multiple HIV prevention strategies - In conversation with U.S.-based Jessica Terlikowski

Original content from the Mapping Pathways blog team

 

“We must build the political will for investment in each these HIV- prevention strategies”

Jessica Terlikowski is director of regional organizing at AIDS United based in Washington, D.C. and was most recently a policy manager at the AIDS Foundation of Chicago. Both organizations are Mapping Pathways partners. Jessica is co-founder of the Chicago Female Condom Campaign, and coordinates the National Female Condom Coalition. She was recently honored by the AIDS Legal Council of Chicago  as “Advocate of the year” for outstanding work in making a difference in the lives of people with HIV and AIDS. 

 MP: How did you get involved in the field of HIV prevention?

JT: I got involved in the field of HIV prevention through my commitment to women’s reproductive health and rights, which is where I got my professional start. I have been a staunch reproductive rights advocate ever since I can remember.  When I moved to Chicago, there was a position available at the AIDS Foundation of Chicago and microbicide education and advocacy education was a part of the job.  I didn’t have an in-depth knowledge of the field at the time and was eager to learn.  

 MP: Is there a prevention strategy that you are especially passionate about?

JT: I think the key is to have as many prevention strategies available as possible. I am, however, extremely passionate about female condoms as they are an important tool for any receptive partner—woman or man—to reduce their risk of HIV and other STDs. They are particularly important for women though as female condoms are the only HIV and STI prevention options that also prevents unintended pregnancies. The global South has recognized the value of this tool for quite some time and the U.S. is starting to get there now too. We are seeing more and more community based organizations, clinics and health departments prioritize female condoms as a result of increased advocacy from a handful of us. The U.S. female condom movement is growing and building momentum.

What I am really concerned about is making sure that people are aware of what prevention strategies exist, so they know what is out there and can access what they need when they need it. We owe it to the communities to push for both existing tools like male and female condoms, sterile syringes, PEP, as well as emerging biomedical tools like microbicides and PrEP.

MP: What Mapping Pathways activities have you and AIDS United engaged in recently?

JT: We adapted the analyses from stakeholder interviews and online survey the Mapping Pathways team conducted in 2011 and created a PowerPoint slide deck which provides  a strong overview of the Mapping Pathways methodology, definitions of ARV-based prevention terms and an overview of ARV-based prevention strategies (read more about the presentation here). We conducted community input sessions with stakeholders at the CDC’s National HIV Prevention Conference and with a number of stakeholders at and AIDS United convening of southern grantees.  

A key finding  was that when we talked about ARV-based prevention strategies, people’s minds would go straight to PrEP instead of thinking of the full portfolio of ARV-based prevention strategies—TLC+, vaginal and rectal microbicides, and PEP. We also learned that there is a real need for developing a common vocabulary around these options to ensure we are all talking about the same thing. At times stakeholders would interpret use the term “treatment as prevention” to refer to PrEP when it is actually referring to TLC+.

A major theme arising from the stakeholder interviews, the survey outcomes as well the community input sessions was that though people are excited about the possibilities of ARV-based prevention strategies as a whole, they are also concerned about how the vast majority of the people who need these options could pay for them.

MP: What are some of the issues, financial and otherwise, that keep coming up in the field of HIV prevention?

JT: I think one of the biggest issues that keep coming up is that of resource allocation. Many are asking where the HIV field can and should invest its resources in order to have the most impact. Since HPTN052, some say that we should pull resources from traditional prevention programs to invest in TLC+ and suggest that people don’t use condoms anyway. Others say that due to resource limitations, it simply isn’t feasible to get everyone who is HIV-positive on treatment.

The reality is that there is no magic bullet that is going to turn the tide on the epidemic in the U.S. or around the world.  We need as many options available as possible and we need to scale up the interventions that we know to work, including increasing availability to sterile syringes and male and female condoms, while also continuing to invest in research for emerging options ensuring that HIV-positive people who need treatment can access it. We can’t afford to play either/or here. Instead, we must build the political will for investment in each these strategies.

Check back next week for part II of the interview in which Jessica discusses ways we can make HIV prevention and treatment a reality for the people who need it most.

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

FDA Reports that Truvada May Be A Safe and Effective HIV Prevention Method

via Bloomberg, by Ryan Flinn and Shannon Pettypiece

Gilead Sciences Inc. (GILD)’s pill Truvada was safe and effective when used to protect uninfected people from getting HIV, U.S. regulators said in a report indicating the main concerns are when and how it should be used.

Truvada was “well tolerated” and its ability to reduce the risk of infection was backed by two studies, the Food and Drug Administration staff said in a report today. Gilead, based in Foster City, California, is seeking to sell the drug as the first pill to keep people from becoming infected.

The FDA asked its advisers to suggest who should get Truvada; what testing would be needed for administration; and what educational material should be used for patients and doctors. The advisers will meet May 10 to discuss the drug, the subject of debates over its appropriate use and cost.

Decisions to prescribe Truvada “should carefully weigh the individual risks for acquiring HIV, their understanding of the importance of adherence to medication, and their potential for development of renal toxicity,” the FDA staff said today in a report on the agency’s website. Education and counseling will be “critically important.”

Gilead fell less than 1 percent to 9:57 a.m. New York time. The FDA isn’t required to follow what the advisory panel suggests.

Read the Rest.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

The Importance of Having New Prevention Technologies

via AllAfrica.com

One would wonder why at a time when financing for HIV and Aids is decreasing such that governments are failing to provide treatment to all in need, others continue to channel millions into trials for new prevention technologies.

Others have argued that the world already has preventive interventions that have been proved to work and the billions earmarked for these new interventions for prevention should, for now, be channelled towards scaling up already existing strategies for effective response to the HIV and Aids pandemic.

Statistics from the National Aids Council show that Zimbabwe has 1,2 million people living with HIV and Aids with a prevalence rate of 14,26 percent.

About 60 percent of these are women.

About 347 000 people are on life-prolonging anti-retroviral drugs (ARVs) against a total of 593 168 with CD4 count level of 350 who are in urgent need of treatment.

In terms of funding for treatment, Government says the gap continues to widen in line with set targets. This year alone, Government will need about US$9,1 million to provide treatment to 66 532 people in dire need of ARVs. Some strategies that have already been proved to work include the male and female condom, which is between 94 and 97 percent effective.

Male circumcision and the Prevention of Mother to Child Transmission (PMTCT) have also been proved to prevent HIV transmission by 60 and 50 percent respectively.

Other interventions known to work effectively in combating HIV are behavioural change and blood screening

Read the Rest.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

AVAC Launches Research Literacy Database!

via AVAC

AVAC is pleased today to launch the Research Literacy Database at www.avac.org/researchliteracy, an important new resource for the biomedical HIV prevention field.

The Research Literacy Database is the first central portal for educational resources on biomedical HIV prevention including:

• Global and country-specific materials;

• Resources specific to given prevention interventions including AIDS vaccines, ARV-based prevention and
voluntary medical male circumcision; and

• General information on clinical trials and the research process.

The tools featured in the database were developed by a range of stakeholders worldwide to meet specific needs. We will continue to expand the database and encourage our users to share their favorite materials on an ongoing basis. The database focuses on materials that won’t necessarily change substantially over time; for trial updates, timelines, recent results and their implications and current issues, please see other areas of the AVAC website.

Using an innovative design, the database allows users to search for what they need based on key criteria. For example, a journalist in South Africa who wants to learn more about the basics of microbicide research can use the database to find relevant fact sheets, e-learning courses and other helpful tools. Research organization staff members who need tools for training and outreach to wider audiences can use the database to get a tailored toolkit according to location, audience and specific content.

We all know that the science behind HIV prevention research is challenging. AVAC believes that building
basic research literacy among key stakeholders is fundamental to effective advocacy, to moving research forward as quickly and ethically as possible, and ultimately to getting new prevention options to people who need them. Whether you are a researcher, advocate, journalist, policy maker or someone interested in learning more about clinical trials and new ways to prevent HIV, we hope this database will make learning and outreach efforts easier and more effective.

The database is an iterative tool, and will be constantly updated with new materials and other user input. We need your help in ensuring that useful materials are available and used! Please contact us at researchliteracy@avac.org with any and all feedback you have as you use the database—and we are especially keen to receive additional relevant resources to be shared with the field.

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

British HIV Association: Revised Guidelines for Antiretroviral Therapy

viaHivandHepatitis.com, by Liz Highleyman 

The British HIV Association (BHIVA) has issued revised guidelines for antiretroviral therapy (ART) for adults and for pregnant women and prevention of mother-to-child HIV prevention. Comments are currently being accepted.

ART for Adults

 

The draft for adults includes guidance on starting ART in treatment-naive patients, supporting people on treatment, and managing people who experience virological failure. The guidelines also cover special considerations for specific patient populations.

The guidelines are available on the BHIVA website, which features an online form for comments, and published in the January 2012 issue of HIV Medicine. The deadline for feedback is March 5, 2012.

As described in an overview by Aidsmap, the revised guidelines recommend that clinicians should discuss with all HIV positive patients the growing evidence that effective ART reduces the likelihood of HIV transmission to sexual partners. However, evidence to date -- for example, recent findings from study HPTN 052 showing a 96% risk reduction -- mainly concerns heterosexual couples having vaginal sex.

Patients should be informed of the prevention benefits of ART even if they do not yet need treatment for their own health because their CD4 T-cell count has not fallen below 350 cells/mm^3.

Unlike the latest U.S. guidelines -- which raised the treatment initiation level to 500 cells/mm^3 -- BHIVA kept the 350 cells/mm3 threshold for most patients, though people with certain coinfections and other risk factors (e.g., hepatitis B or C, HIV-related kidney disease or neurocognitive impairment) may benefit from starting sooner.

BHIVA came down in favor of tenofovir/emtricitabine (the drugs in the Truvada combination pill) as the favored dual nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) component of ART. U.S. guidelines also deem tenofovir/emtricitabine as the "preferred" NRTI combo, although the new European AIDS Clinical Society (EACS) guidelines rank tenofovir/emtricitabine and abacavir/lamivudine (the drugs in Epzicom) as equals.

BHIVA and the U.S. panel both demoted abacavir due to concerns about lower effectiveness for people with high viral load and elevated cardiovascular risk; tenofovir, however, has been linked to kidney impairment. All guidelines authorities agree that individual risk factors should be taken into account when selecting antiretroviral drugs.

BHIVA lists drugs in 3 classes as preferred third agents: the NNRTI efavirenz (Sustiva), the boosted protease inhibitors atazanavir (Reyataz) or darunavir (Prezista), and the integrase inhibitor raltegravir (Isentress).

Read the Rest.

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

Tricky Terminology in HIV Prevention: "Abstinence" and "Being Faithful"

In the HIV/AIDS prevention world, terminology can be a tricky thing. Over time, certain words have taken on different implications and nuances across various communities.

Take “abstinence” and “being faithful” – two conventional HIV-prevention methods that have been the subject of a long-running debate in the public health community. These terms were at the forefront of discussion once again last month, sparked off by NAM’s new HIV prevention resource where they were at the top of the non-alphabetical list of HIV-prevention methods. NAM swiftly clarified that the order was the same as in previous printed editions, with newer sections being added in later. An organizational representative emphasized that NAM has tried to capture the pros, cons, and complexities of each prevention method and that the organization stays away from editorializing.

The debate, however, continues. Many see “abstinence” and “being faithful” as loaded with sexual morality, inextricably tangled up with conservative ideas of virtue and marriage, and reinforcing social taboos against pre-marital sex and polygamous relationships. On the other hand, in many patriarchal cultures, postponing sexual activity can actually be seen as empowering for women who are often pressurized into early sex. Similarly, remaining unmarried is not a realistic choicefor women in many countries – in such a context, reducing unsafe sex with multiple, concurrent partners would be an important aspect of HIV prevention.

A great step would be promoting the usage of alternative terms that focus on behavior rather than “values”. For instance, why not replace “being faithful” with a more neutral phrase, one that brings open, honest non-monogamous relationships within its ambit? Unfortunately, “monogamy” seems to have supporters and detractors in equally large numbers, and the same goes for “mutual fidelity”. While some see these options as objective behavioral descriptors, others perceive them as morally loaded phrases. It seems almost impossible to come up with a term that works for everyone – this is perhaps inevitable considering the widespread geographic and cultural differences within the HIV prevention community!

Of course, many people in the HIV prevention field question the very effectiveness of both these measures, making the debate even more heated. Abstinence is commonly perceived as a “failed” method, and being faithful/monogamy/mutual fidelity seems like a non-option when being married is often an independent HIV risk factor for women in many communities (conversely,others point out that the latter takes place precisely because the women’s husbands may have multiple,concurrent relationships).

The majority point of view, however, seems to be that no single option is equally valid for every person, community, or country. Offering these conventional prevention methods as part of a bouquet is valuable: they can work for people who are ready, prepared, and happy to use them consistently (like any other prevention option).

Coming soon: another “Tricky Terminology” post on the important distinction between “oral PrEP” and “microbicides” in HIV prevention discourse.

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]