Donor nation support for HIV stands firm but investments remain at 2008 levels

via Kaiser Family Foundation

               

U.S. continues to account for more than half of all donor government investments.

WASHINGTON, D.C., July 18, 2012— Donor nation funding in 2011 for HIV in low- and middle income countries returned to prior levels after a drop in 2010, but has been roughly flat since the recession hit world economies in 2008, according to an annual funding analysis from the Kaiser Family Foundation and the Joint United Nations Programme on HIV/AIDS (UNAIDS).

The study found that donor governments disbursed US$ 7.6 billion in 2011 for the AIDS response in low- and middle-income countries. Overall donor government support for AIDS has been flat since 2008, which marked the end of rapid increases in donor disbursements of more than six-fold over the 2002 to 2008 period.

"International investments still account for two thirds of funding for HIV in Africa, the continent most affected by the epidemic," said Paul De Lay, Deputy Executive Director, Programme at UNAIDS. "Although more and more countries are increasing domestic investments for HIV, investments from donor governments remain an essential resource."

"The benefits of early detection and treatment have never been more clear, but countries have never been more challenged to provide needed resources. This is a critical time to keep the focus on the HIV epidemic," said Drew Altman, Kaiser Family Foundation President and CEO.

The two largest donor governments – the United States and United Kingdom – reported funding increases. The United States, the largest donor nation, reported a US$785 million increase in disbursements over 2010, but only returned to 2009 levels after reporting a delay in disbursements as the reason for last year's decline. Australia, Canada, Denmark, France, Germany, Norway and Sweden maintained or slightly increased their support, while Ireland, Italy, Japan and the Netherlands decreased funding.

Read the rest 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.]

IAPAC Summit - If people who need HIV drugs aren’t getting them now, why should the prevention benefit of treatment be the reason that the drugs become available?

via Aidsmap, by Roger Pebody

The issue of ‘treatment as prevention’ raises a number of ethical issues, Richard Ashcroft, professor of bioethics at Queen Mary University of London told the IAPAC Controlling the HIV Pandemic with Antiretrovirals Evidence Summit in London this week.

He reminded the audience that it is rare for a doctor to give a patient a medicine that will primarily benefit a third party. He went on to highlight situations in which, at present, antiretroviral treatment is not universally available to all people who need it for their own health. In such circumstances, why should treatment’s prevention benefit be “the clincher” that convinces funders and policy makers to make the drugs more widely available?

At the same meeting, Kevin Fisher of AVAC noted that the ethical concerns tended to differ in different parts of the world. In settings where there is already good access to HIV treatment, the concerns are often related to individuals experiencing external pressure or compulsion to take treatment. In resource-limited settings, the concerns focused more on the cost of and access to treatment.

Read the rest.

And check out the Mapping Pathways slides that were presented at the same meeting, on the issue of PrEP.

[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.]

Major Budget Cuts Hinder HIV/AIDS Treatment

via Nature News, by Erika Check Hayden

Preventing the spread of HIV used to mean testing people for infection and encouraging them to practise safe sex. Increasingly, it also means prescribing drugs, as studies show that giving infected people or their uninfected partners antiretroviral drugs as soon as an infection is diagnosed can help to check the spread of AIDS.

Yet at this week’s annual Conference on Retro­viruses and Opportunistic Infections in Seattle, Washington, there was growing concern that financial austerity in the United States and elsewhere is eating away at the funding needed for a worldwide prevention effort.

Many scientists and advocates agree that there is now an “awesome possibility to prevent the spread of HIV”, says Sharonann Lynch, HIV policy adviser for Médecins Sans Frontières (MSF, also known as Doctors Without Borders) in New York. “If we decrease the money invested in treatment now, we are squandering the best opportunity we’re going to have to get ahead of the wave of new infections.”

Last month, US President Barack Obama’s 2013 budget request proposed a 10.8% cut to direct international aid for HIV programmes under the President’s Emergency Plan for AIDS Relief (PEPFAR) which, together with previous cuts, would slice more than US$1 billion from the fund’s 2010 level. And last November, the Global Fund to Fight AIDS, Tuberculosis and Malaria said that it would not hand out any more funds for scaling up AIDS treatments until 2014 because of tightening budgets in donor countries.

The shortfalls come as a slew of results presented this week reinforce a growing consensus about the power of early treatment for HIV infections. The latest data are part of a trend that accelerated last May, when HPTN 052, a clinical trial run by the multinational HIV Prevention Trials Network, showed that giving antiretroviral drugs to people who are HIV-positive can stop them from passing the virus to their uninfected partners. In light of such results, the World Health Organization is expected to issue new guidelines for managing HIV in couples soon.

Read the Rest.

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

Five hundred twenty-five thousand six hundred minutes: How do you measure a year?

Original content from the Mapping Pathways blog team

Another year winds down, and it is time to take stock, to reflect on all the moments that have made 2011 an important year for the HIV prevention community – and for all those of us who hope for and work toward the end of the HIV/AIDS epidemic.

The year began on a high note: the extremely encouraging results from the IPrEx and CAPRISA trials, announced in 2010, had us “jumping up and down” as Jim Pickett (Director of Prevention Advocacy and Gay Men's Health at the AIDS Foundation of Chicago, chair of International Rectal Microbicide Advocates [IRMA], and a member of the Mapping Pathways team) says in his memorable interview, Success! Now What? These results were the long-awaited proof of concept for new prevention technologies – the “first real ‘win’” after many years of hard work.

The first bump in the road was the discontinuation of the FEM-PrEP trial in April due to futility, when the trial’s Independent Data Monitoring Committee concluded that the study would be highly unlikely to prove the effectiveness of Truvada in preventing HIV infection among the study population, i.e., HIV-negative women who are at risk of infection through sexual transmission.

The unexpected development had everyone expressing their opinions and wondering about the implications – after all, what does “futility” mean exactly? Dr. Linda-Gail Bekker (an expert in the field of biomedical trials and research) cautioned against knee-jerk reactions to the trial closure in her interview with Mapping Pathways: “Wait for the evidence, I think that is the message. Extrapolate at your peril. We know only what we know, and we need to just work within that.”

Then came the HPTN 052 results – and we were jumping with excitement again! The study demonstrated that initiation of ART by HIV-infected individuals substantially protected their HIV-uninfected sexual partners from acquiring HIV infection, with a 96 percent reduction in risk of HIV transmission. In an interview with Mapping Pathways, microbicides expert Joe Romano captured the overall sentiment, saying, “The level of efficacy seen in the HPTN052 study is stunning, and is extremely important on several fronts.”

There was good news for India (a Mapping Pathways target country) too: a UNAIDS report stated that the rate of new HIV infections fell by more than 50% in India between 2001 and 2009, double of the average decline in the world. The PrEP debate in India continued through the year. “There is a lot of concern in the country, especially with global funding not available right now,” explains Anjali Gopalan (Executive Director of NAZ India, a Mapping Pathways partner organization), in Notes from India: Concerns and Challenges Around PrEP. Mapping Pathways also published a short post on what we’ve been hearing in India so far.

Soon after the HPTN 052 results, the FACTS 001 trial was announced in South Africa – a follow-up study to confirm the effectiveness of tenofovir and to verify the CAPRISA 004 results in “larger, more diverse populations.”

Around this time, Mark Chataway (co-chairman of Baird’s CMC, a Mapping Pathways partner organization) was in South Africa (a Mapping Pathways target country). “My visit to the country once again brought into sharp focus for me just how significant South Africa and the rest of the southern African region are in the context of HIV treatment and prevention strategies,” writes Mark in his insightful post about South Africa and the HIV epidemic.

July brought bad news: the drought in the Horn of Africa began, bringing the region into international focus as an estimated 11.6 million people struggled for basic nutrition and sanitation in the humanitarian crisis – experts have warned that this situation could have a serious effect on the health of people undergoing HIV treatment.

Prevention trials continued to stay in the news. The Partners PrEP study and the TDF2 Botswana study both showed that taking antiretrovirals can reduce the risk of HIV infection through sexual intercourse by 62-73 percent among heterosexual individuals and heterosexual couples.

As heartening news continued to pour in, the UK’s House of Lords Select Committee on HIV & AIDS gave us another reason to celebrate as they called for greater emphasis and funding toward prevention. “Prevention must be the key policy,” remarked Lord Fowler, chairman of the committee.

In the US, dollars-and-cents issues remained a key factor. “The entire HIV prevention and treatment landscape overall is also in a state of flux in the US … When we get to the end of the day, there are good ideas, and then there are good ideas that are fully funded,” explains Julie Davids (Director of National Advocacy and Mobilization at AIDS Foundation of Chicago, a Mapping Pathways partner organization) in The Economic Effect: HIV/AIDS in the US.

October brought news that rekindled an old debate: the Lancet published the results of a study conducted in Africa, which seemed to suggest that hormonal methods of contraception could lead to increased risk of HIV infection. “Now whether this is a disaster or not, that needs to be considered very carefully in context. There are huge benefits, particularly in the African region, of avoiding an unwanted pregnancy, not only for the morbidity issues but also for mortality reasons … Firstly, we need to work out whether this result is true or not,” points out Dr. Tim Farley (an expert in HIV and sexual and reproductive health) in Hormonal Contraceptives and HIV Prevention: The Grey Area.

Recently, the VOICE trial hit a speed bump: the oral tenofovir arm and the tenofovir vaginal gel arm were dropped from the study. Both decisions were based on reviews of study data, which concluded that they would not be able to demonstrate effectiveness in preventing HIV among the women in the trial (although both products were found to be safe). The reasons for this are still unclear and will be fully investigated when the trial concludes in the middle of 20112. The study continues to examine the oral Truvada tablet to determine whether it’s effective in preventing HIV in the trial population.

A recent highlight was US Secretary of State Hillary Clinton’s speech on HIV/AIDS – one that earned her both bouquets and brickbats from the HIV prevention community. On the upside, Secretary Clinton focused on scientific evidence and called for immediate action to take advantage of the “historic opportunity” to create an “AIDS-free generation.” Unfortunately, she completely omitted any reference to PrEP and rectal microbicides. The speech also failed to mention gay and MSM populations, two groups that are experiencing catastrophic rates of HIV globally.

The year wound up with IRMA’s rectal microbicide African strategy meeting and the big ICASA conference in Addis Ababa, Ethiopia in December. (Click here and here to read about some of the important developments at these events.)

All in all, 2011 has been a dynamic year: lots of excellent news as well as some troubling developments. From the Mapping Pathways blog team, here’s to celebrating our achievements, learning from our failures, and working to address the challenges.

Happy New Year!

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

AIDS Battle Risks Being Derailed by Global Financial Crisis

via Nature, by Meredith Wadman

Thirty years after AIDS was first recognized as a human scourge, major recent gains in treatment and prevention risk being derailed by the global financial crisis.

On 23 November, the Global Fund to Fight AIDS, Tuberculosis and Malaria announced that it will not fund new grants for prevention and treatment until 2014, owing to “substantial budget challenges in some donor countries”. The fund's HIV activities run the gamut from counselling and testing pregnant women in India to providing medications to infected children in Kenya.

And on 7 December, a report from Policy Cures in Sydney, Australia, a group that monitors global research and development for neglected diseases, showed that public and private funders last year cut their commitments to HIV/AIDS research targeted at the developing world by US$67.5 million, or 5.9%. The decline was due entirely to cutbacks by wealthy nations, which slashed spending by $72.6 million; poorer countries actually increased funding by $5.1 million. Where research is concerned, “AIDS had a bigger drop in dollar terms than any other disease”, says Mary Moran, the executive director of Policy Cures and the lead author on the report.

The threat comes even as US President Barack Obama last week promised that the United States will step up its worldwide attack on AIDS. Breaking the White House's past reticence on the issue, he urged nations to honour their unmet pledges to the Global Fund.

“Countries that have committed to the Global Fund need to give the money that they promised,” he said on 1 December, World AIDS Day. “Countries that haven't made a pledge, they need to do so,” he added, singling out emerging nations such as China that are recipients of funds “but now are in a position to step up as major donors”.

The United States has given $6.1 billion to the Global Fund since 2004, and last year pledged to contribute $4 billion between 2011 and 2013. Congress approved $1.05 billion in 2011, meaning that allotments must increase substantially in 2012 and 2013 to honour the pledge. Obama has asked Congress to provide $1.3 billion in 2012, but Senate lawmakers have so far resisted the increase.

Obama pledged to increase by 50% — to 6 million — the number of people receiving antiretroviral therapy (ART) worldwide by 2013 through the President's Emergency Plan for AIDS Relief (PEPFAR), the nation's major global treatment and prevention programme. He also said PEPFAR would aim to provide ART to an additional 1.5 million pregnant women with HIV in the next two years. The international promises came with no new money immediately attached. But Obama has asked Congress to provide nearly $7.2 billion — a 6% increase — for PEPFAR in 2012, part of the unfinished budget bills still being debated.

Advocates said that his speech marked a significant turning point. “This is the first time he's signalled that he's going to champion global HIV in this way,” says Jennifer Cohn, an assistant professor of infectious diseases at the University of Pennsylvania in Philadelphia, and a policy adviser in Nairobi for Médecins Sans Frontières (MSF; also known as Doctors Without Borders). “Whether or not this gets translated into the president's 2013 budget request, or what Congress chooses to protect during the 2012 budget negotiations — that's what I'm waiting to hear.”

Read the rest.


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

Mapping Pathways South Africa: What we’re hearing so far

Original content from our Mapping Pathways blogs team

An important part of the Mapping Pathways project is to learn what people think and feel about ARV-based prevention strategies (such as PrEP), not just through academic streams and studies but also through everyday experience and wisdom. What do the people who work daily with treatment and prevention and/or have first-hand experience of living with HIV think? What are their concerns? What information do they need about PrEP, TLC+ (testing, linkage to care, plus treatment), and microbicides? Do they think these prevention tools can be useful for their community or country? Would they use them or prescribe them?

The Mapping Pathways online survey and in-depth stakeholder interviews are important ways for us to gain knowledge on these questions. Both processes took place over the year, and we’re starting to unpack a number of some interesting observations and ideas now that the interviews have finished and the survey is closed. Of course, this data is still preliminary but we thought we’d share some snapshots of what we’re hearing from South African doctors, policymakers, and activists on the ground.

Thoughts on the Mapping Pathways project
Although each person we spoke with had very different views on ARV-based strategies and HIV prevention within the South African context, most agreed that Mapping Pathways was an excellent and timely initiative. People thought the project was “inclusive”, “collaborative”, “captures everything that’s going on at the moment”, “well thought through”, “urgently needed”, “spot on”, and “a project worth doing”. One South African researcher felt it “hits the nail on the head about what needs to be done in the field”, and a South African policymaker said research like this is “the only way forward”. Concerns included the fact that only three countries are participating and that the field may be moving too fast to document everything effectively.

Thoughts on TLC+
Nearly everyone we spoke with agreed that TLC+ was scientifically valid – that is, to expand treatment access for people living with HIV as a way to reduce onward infections to others. “The prevention benefits of treatment are absolute,” said one South African clinician. However, some felt that it was tough to implement TLC+ in a resource-limited setting like South Africa, and there were concerns about infrastructure, cost, staffing, and sustainability. One South African pathologist said it was “a quantum leap”, a policymaker mentioned it was “operationally far away”, and an activist said that “financial sustainability in this context is unlikely”.

Others thought it could be done. “The programme will pay for itself,” stated a South African pathologist. Another added, “Keeping patients well is always a good thing financially.”Many people felt more research still needed to be conducted on such as side-effects, resistance, drug delivery, and adherence/acceptability. One South African epidemiologist pointed out the importance of operational research: “We do know enough to start finding out how we can do it.”

Thoughts on oral PrEP
There was a fair amount of concern about how oral PrEP could work within the South African context, especially given the country’s limited resources and high incidence rate. People were also confused by the seemingly conflicting results from various trials. (Read Daniella Mark’s thought-provoking interview on this here and here.) One South African researcher said, “The iPrEx and FEM-PrEP results have left us wondering.” Some people felt rolling out oral PrEP to high-risk populations was the right step; however, there were concerns expressed on how these populations would be defined and traced, e.g., adolescent girls, sex workers, and truckers.

Thoughts on microbicides
Microbicides evoked interesting and varied reactions from the people we spoke with. Most agreed that there still needs to be more evidence on their efficacy. “We’re not there yet,” said one South African epidemiologist. Some people felt a microbicide might be easier to implement than oral PrEP. One South African activist felt microbicides have the potential for much greater use. “If they’re like condoms and can be handed out freely to everyone, it would be easier,” said a South African policymaker.

Others thought differently, saying that a microbicide might be more difficult to implement than oral PrEP since it is a new modality and people are not used to topical prevention. “It might be difficult to know if you’ve put on enough,” said one South African pathologist. There were also concerns about acceptability and adherence. Read more about this here and here. What was also interesting was the view that a vaginal microbicide is female-controlled. “We’ve been seeking a female-controlled prevention methodology for a long time,” said a South African activist. “It is some small degree of female empowerment,” added a South African policymaker.

[Editors note: the VOICE trial announced November 25 the closure of its study arm testing tenofovir gel. The decision was made due to futility – while tenofovir gel was found to be safe, the trial was not able to prove the gel worked to prevent HIV. See the statement from the Microbicide Trials Network for more information. The Truvada tablet arm in the trial is continuing.]

Thoughts on HIV prevention funding allocation
The consensus on funding seemed to be that there was no “silver bullet” and South Africa should focus on multiple, concurrent strategies. “A one-size-fits-all approach won’t work,” said one South African researcher. There was also a general feeling that funds should go into proven, effective strategies. “Funders should think about where they will get the ‘biggest bang for their buck,’” said a South African policymaker. One South African activist remarked that the country doesn’t yet have a proper prevention strategy or prevention targets, which “leads to a scattergun approach and we miss people”. Some people strongly felt that the focus should be on treatment first. Others felt that funds should go to strategies that are female-controlled.

For more analysis on South African reactions towards ARV-based prevention  and HIV prevention in general, read our two-part interview with Daniella Mark from the Desmond Tutu HIV Foundation, a Mapping Pathways partner organisation: In Conversation with Daniella Mark: It’s a question of “how” in South Africa and In Conversation with Daniella Mark – Part 2: Climbing “Mount Everest”.

Mapping Pathways is presenting two posters at the ICASA 2011 conference showcasing some of the data collected. Stay tuned to this blog to see the actual posters – next week.

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

Global Fund to Fight AIDS, TB and Malaria Cancels Funding

via The Guardian, by Sarah Boseley

"If we lose the ground we have gained, we will be back to square one – all that effort and investment, lost. The decisions you make here today will determine the outcome."

In what must be seen as a serious setback in the progress made against the major infectious diseases in poor countries, a board meeting of the Global Fund to Fight Aids, TB and Malaria in Accra, Ghana, has effectively cancelled its next round of grant-making.

The fund has been staring at a financial black hole ever since its big replenishment meeting in New York a year ago failed to deliver the sums it hoped for. It wanted $20bn. It got $11.7bn. That was in spite of exhortations to donors to pledge money from the UN secretary general, Ban Ki-moon, who warned that the stakes were high and that lives would be lost if pressure on the big killer diseases was not maintained.

It once seemed unthinkable that the money would not continue to stream into programmes to treat people with Aids, TB and malaria and to prevent others becoming infected. But that is what is happening. There is no doubt that people who could have been spared will instead fall ill and die as a result of the drying up of funds. There is also a Damoclean sword hanging over the heads of people who are alive and well thanks to drug treatment for their HIV infection. The Global Fund – together with Pepfar (the President's Emergency Plan for Aids Relief) – has been the main source of money to pay for drugs. Those who start the combination treatments to prevent HIV causing Aids must stay on the drugs for life. If they stop, there is a danger the virus will become resistant to the drugs they are on.

The Global Fund's board is buying time by telling governments not to put in new applications for funding for round 11, which is supposed to provide money for 2011 to 2013. It is offering a "transitional funding mechanism", which will allow countries to ask for money to cover essential needs. In recognition of the danger of stopping HIV treatment, this should allow countries to continue to supply drugs to people who are already taking them.

But, as Secretary of State Hillary Clinton said in her recent address, the need now is to step up the fight against HIV by providing more drugs – not less. Scientific studies showed this year that treatment makes people with HIV less infectious. Failure to keep rolling out the drugs to more and more people will waste an opportunity to deliver what she and others have hopefully termed "an Aids-free generation".

Read the rest.


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

An AIDS Free Generation: Running Toward the Dream of a Lifetime

via The Chicago Tribune, by David Ernesto Munar

When I tested positive for HIV in 1994, I never would have imagined an AIDS-free generation to be possible in my lifetime.

I also didn't think I would live past 35.

And yet, I am 42 years old today and we have arrived at the precipice of that dream. With recent medical advances, and the promise of more soon to come, an AIDS-free generation is possible. Achieving this goal, as eloquently outlined by Secretary of State Hillary Clinton earlier this month, would save millions of American dollars and countless lives around the world.

The question is whether we have the political and social will to make it a reality.

No one is talking about what the deficit-reduction talks or the attempts to dismantle health care reform mean for stopping AIDS in this country. Now is the time for that conversation. Cutting funding for HIV/AIDS services, treatment and research would be devastating to our progress in defeating this 30-year-old epidemic.

And the full implementation of the Affordable Care Act is necessary to provide access to treatment for the thousands in our country who are on waiting lists because they cannot afford life-saving medications.
We need our political leaders to lead. We stand at the precipice of the AIDS-free dream but we're stuck. If HIV/AIDS funding is cut through the deficit reductions, our progress could, in the haunting words of poet Langston Hughes, "dry up like a raisin in the sun."

Backing up, why have the AIDS conversation now?

HIV/AIDS is no longer a death sentence. The drugs are better and those who take them are living longer, relatively normal lives. So, what's the problem?

The reality is that more than 1 million people still live with HIV in the United States, and more than half of them do not receive regular medical care that could save their lives and curb new infections. The rate of infections remains unchanged. The cost for antiretroviral drugs is exorbitant, ranging from $1,500 to $3,000 a month.

In fact, government programs to help HIV-positive people obtain lifesaving HIV medications are hamstrung by dangerous, growing waiting lists across the country. As of earlier this month, more than 6,000 people in 12 states were on the waiting lists for the AIDS Drug Assistance Program. Illinois does not have a waiting list, but state legislators recently approved a change in the program that will make fewer people eligible for assistance.

And stigma and systemic injustices also fuel new HIV infections.

Read the rest.


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

Gay men/MSM & the HIV Epidemic: Microbicides, Funding, and Sex

* Original content from our Mapping Pathways blog team

Three interesting bits of news in the world of HIV prevention and treatment for gay men and other men who have sex with men (MSM):

Project GEL: According to the Centers for Disease Control, gay men/MSM constitute more than half the HIV cases in the US. In an effort to address the HIV vulnerability of the gay community, the US government recently began funding Project GEL, which aims to develop a more effective method of preventing HIV infection among gay/MSM. Already in three locations – Boston, Puerto Rico, and Pittsburgh – the project isfinding out and assessingwhy so many people don't use condoms each time they have sex. The end goal is to address this gap in HIV prevention by developing a microbicide product and applying it to a real-life setting.

Project GEL has three main phases:

• Study the sexual health of young gay men/MSM, particularly men of color.
• Examine how gay men/MSM feel about using the proposed gel prior to anal sex and whether or not they would actually use it before engaging in sexual activities.
• Research the microbicide gel itself, including side-effects and responses.

To know more about Project GEL, check out their website or this recent article about their work.


New funding resource from amfAR’s MSM Initiative: The Foundation for AIDS Research (amfAR)’s MSM Initiative provides financial and technical support to community-based organizations fighting HIV among MSM in low-and-middle income countries. Through this initiative, amfAR also “builds global understanding and awareness of HIV epidemics among MSM, and advocates for effective policies and increased funding”.

In October, the MSM Initiative launched a new fundraising toolkit to assist community-based organizations that provide HIV-related programs and services for gay and bisexual men, other MSM, and transgender individuals. It includes information about relevant donors and funders, snapshots of grant programs, and how to contact and approach funders. Read more and download the guide here.


Men’s Sex Study: The Journal of Sexual Medicine recently published study results on the sexual behavior of gay and bisexual men. The community report assessed responses from nearly 25,000 users of Manhunt and DList – online social forums for gay and bisexual men. The parent company of these websites is now communicating this scientific data in a user-friendly manner through a creative yet informative website.

The effort has won a lot of praise in the HIV prevention community as well; the format makes it easy to understand serious study data on gay men’s sexual behavior – the first step in developing real-world HIV-prevention methods for MSM. The results also suggest that some popular misconceptions and stereotypes need to be examined and addressed. (You can also read the full report here.)

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

House of Lords Committee on HIV & AIDS calls for prevention prioritization

As encouraging results from recent PrEP and microbicide studies revolutionize the HIV/AIDS prevention landscape, the House of Lords Select Committee on HIV & AIDS in the UK has called for greater emphasis and funding toward prevention. The UK government spends up to £750 million each year on treatment, but less that £3 million on prevention campaigns. The committee reports that current efforts to fight the epidemic are “woefully inadequate” and that this failure can have “potentially huge cost implications”.

“I know these are difficult times, but if you were to try to find one good investment, it would be to spend more on prevention, because that investment prevents the treatment costs … Prevention must be the key policy,” says Lord Fowler, chairman of the committee. (Incidentally, Lord Fowler was Health Secretary back in 1986, when he led the Don’t Die of Ignorance campaign on AIDS.)

The committee recommends a new national HIV campaign; failing that, it advises the prioritization of prevention messaging – especially testing. Additionally, it also highlights the need for greater funding for prevention efforts targeting gay men and Africans.

In a significant move for those working on new prevention technologies, the committee recommends that research into the use of PrEP to prevent infection in HIV-negative people needs to be a funding priority for the National Institute for Health Research and the Medical Research Council.

To read aidsmap’s detailed story on this development, click here.

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

Calling all our Indian Readers!

We request all Indian readers to take a few moments and read the facts below:

FACT: HIV prevalence in India is only about 0.3% – however, because of its massive population, India has the world’s third-largest population suffering from HIV/AIDS.

FACT: A fractional increase in prevalence (0.1%) would mean over half a million more people living with HIV.

FACT: While new HIV infections have declined drastically in India over the last 10 years, it’s not time to celebrate quite just yet – about 2.4 million Indians are still living with HIV.

FACT: At present, India spends about 5% of its health budget on HIV/AIDS. The World Bank has stated that India will have to scale up prevention efforts in order to avoid spending more of its health budget in the future.

India stands at a critical juncture in its fight against HIV/AIDS. Policy and funding decisions about treatment and prevention over the next few years could alter the entire course of this epidemic.

The Mapping Pathways project has recently launched on online survey to collect input from individuals in our target countries – one of which is India.

We encourage all Indian citizens who are interested in new ways to prevent transmission of HIV – and want to help shape our project goals and deliverables – to take a few minutes and fill in our survey.

Your efforts will be greatly appreciated!

Take the survey now.


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

Kaiser/UNAIDS study finds drop in overall disbursements for AIDS response in 2010, seven out of 15 governments report reductions

Via the Kaiser Family Foundation.

Funding disbursements from donor governments for the AIDS response in low- and middle-income countries fell in 2010, dropping 10% from the previous year’s level, according to an annual funding analysis conducted by the Kaiser Family Foundation and the Joint United Nations Programme on HIV/AIDS (UNAIDS).

The study found that donor governments disbursed US$ 6.9 billion in 2010 for HIV prevention, treatment, care and support--US$ 740 million less than in 2009. The decrease was due to a combination of three main factors: actual reductions in development assistance, currency exchange fluctuations, and a slowdown in the pace of U.S. disbursements, which was not a budget cut.

Of the 15 governments surveyed, seven--Australia, Germany, the Netherlands, Norway, Spain, Sweden and the United States--reported a year over year decrease in their disbursements as measured in their own currencies. The figures presented in the report are in US dollars, consistent with international standards and other reporting mechanisms.

Due to currency fluctuations, when measured in US dollars, Australia showed a slight increase in its AIDS funding contribution even though it contributed less in its own currency. Conversely, there was a slight decrease in Denmark’s contribution despite the country’s increased funding level in its own currency.

"AIDS is a smart investment even in this difficult economic environment. We have to look beyond the near-term costs and recognize the long-term benefits," said Michel Sidibé, Executive Director of UNAIDS. "Donors need to make and follow through on commitments today to reduce costs in the future."

The overall drop in disbursements was primarily attributed to a reduction in disbursements by the United States, the largest donor nation, which accounted for 54% of total donor disbursements in 2010. While the United States Congress appropriated similar levels of funding for the AIDS response in 2010 as in 2009 (approximately US$ 5.5 billion in each year), disbursements from the United States declined from US$ 4.4 billion in 2009 to US$ 3.7 billion in 2010. This slowdown stems from new requirements established by Congress for the United States President’s Emergency Plan for AIDS Relief (PEPFAR). Some funds appropriated in 2010 will be disbursed in later years.

"With U.S. funding delayed but not eliminated to this point, this year’s drop in spending may be a temporary blip, though its impact on services may be real," said Drew Altman, Kaiser Family Foundation President and CEO.

Read the rest here.

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

Notes from India: Concerns and Challenges Around PrEP

At present, India has approximately 2.4 million people living with HIV out of its total population of approximately 1,210 million people (a prevalence of 0.03%). In 2009, close to 1.2 million people were newly infected. According to a recent United Nations report, there has been a 50 percent decline in the number of new HIV infections in the country over the last decade.

India has made significant strides in tackling HIV/AIDS in recent years, with the government’s efforts actively being supported by the Bill & Melinda Gates Foundation, the World Bank, and the United States Agency for International Development. Many Indian NGOs work to provide care facilities, ARV medicines and education for people living with HIV. There has also been consistent work towards spreading awareness, from communicating key messages though concerts, radio shows, and TV spots with famous Bollywood stars to innovative initiatives such as promoting condom use through kite flying during popular festivals.

However, much remains to be done. “Most importantly, the government needs to step in because we need better laws – laws that will enable behavior change and help us fight HIV effectively. There are some draconian laws that stigmatize sex workers and intravenous drug users, making life very unsafe for them. MSM community building is nearly impossible due to the hostile environment. Sex education also needs to be made legally mandatory in the school system. These steps would help bring about real change,” says Anjali Gopalan, Executive Director of NAZ India, a Mapping Pathways partner organization.

How is India responding to pre-exposure prophylaxis (PrEP)? Says Anjali, “My sense is that many people are still very uncomfortable and not quite able to figure out why we’re talking about PrEP in the Indian context. Many senior people in the field feel the focus needs to be on TLC+.” There could be a few reasons for this view. First, India is a low-prevalence country, and people in the HIV prevention field believe this makes it very different from places like South Africa where the prevalence among the general population is very high. Second, there have been great difficulties in procuring ARV drugs for people living with HIV recently. “There are massive stockouts – the government is saying they don’t have the money to buy more drugs – we’re trying to move drugs from centers where they are less utilized to others where they are needed more. There is a lot of concern in the country, especially with global funding not available right now,” explains Anjali.

When it comes to PrEP, the common view in India (and elsewhere) appears to be that to take away dwindling funding and hard-to-get ARV drugs from HIV-positive people and directing them toward HIV-negative people is not a realistic or justifiable step. Of course, others are quick to point out that it is not a case of either/or – PrEP is simply one more new tool with which to prevent HIV infections. The public health community is still in the phase of gathering data on PrEP and figuring out the best possible way to utilize this new option in a variety of regions with different target populations.

Cultural differences may also play a part. For instance, homosexuality is still largely taboo in India and drug users are commonly seen as people who “knowingly put themselves at risk”. Discordant couples face a similar issue: No-one sees a problem with giving ARV drugs to people who are infected. But some doctors and social workers have indicated an aversion to giving drugs to those who are not infected on the assumption that they may indulge in high-risk behavior.

There are other significant questions for India, and for other countries contemplating whether they will implement PrEP or not: How does one ensure compliance among people who are healthy?  How does one ensure that side-effects, if any, are taken care of? How would one follow up? Will private practitioners be involved? India is still grappling with basic infrastructural and supply-chain issues, which makes these extremely important concerns.

“The Mapping Pathways team is trying to help answer these very questions,” says Jim Pickett, Director of Prevention Advocacy and Gay Men's Health at the AIDS Foundation of Chicago, chair of IRMA (International Rectal Microbicide Advocates), and a member of the Mapping Pathways team. “It’s time to gather all of this new data that’s pouring in and make sense of it, see how it can be applied in real scenarios. PrEP might make sense for some communities and situations, and it might not for others. Our end goal is to give decision-makers all the information they need to make informed decisions.”


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

The Economic Effect: HIV/AIDS in the US

At the CROI conference earlier this year, Julie Davids asked a question that lies at the very heart of HIV prevention – “What needs to happen to ensure that PrEP doesn’t become a hard-to-get intervention?” Now, halfway through the year, we checked in with her. Below, Julie shares her thoughts on how dollars-and-cents issues have serious repercussions with regard to the HIV/AIDS situation in the US.

“While there has been much debate over the use of antiretrovirals (ARVS) for HIV prevention, the entire HIV prevention and treatment landscape overall is also in a state of flux in the US. In the era of the National HIV/AIDS Strategy, many questions have arisen. Perhaps the most important is this – what prevention/treatment methods can be brought to scale for population-level impact? There has been lots of effective work that has helped prevent HIV and save lives, but what can be scaled up to a point where it can start to reduce incidence? There are initiatives that work very well but are too expensive to bring to larger scale. People are also wondering if there are targeted ways of delivering PrEP to ensure maximum impact without incurring enormous amounts of expenditure.

The global economic crisis has only exacerbated the situation. The effects of the sustained downturn in the US are deep and hard to untangle. In some areas, the impact is specific and tangible: many organizations and initiatives that provide HIV prevention, treat and care are shutting down and others are under lot of duress. So, understandably, when it comes to using ARVs for prevention, people are saying, “We’ve been told not to expect any new money – in fact, we’ve braced ourselves for cuts in funding. If we’re talking about adding something new, where is the money going to come from? And is this the best use of the available resources?”

But the effects are also larger and more intangible, in terms of a generalized anxiety and fear. The recession is hitting the most marginalized the most severely. One of the main drivers of HIV incidence in the US is poverty – and we’re seeing a sharp increase in poverty and homelessness. People are scrambling to find housing and put food on table, to retain a sense dignity as they struggle to provide for their families. These factors create vulnerability to health challenges and in this regard HIV/AIDS is more the rule than the exception. We may sharpen and tailor HIV prevention to be more effective, but I fear this could be counterbalanced by the effects of the downturn, leading to persistently high HIV incidence.

I believe that it is a political, economic and human tragedy that the first time our country has had a national HIV/AIDS strategy is exactly at the same time that we’re being told there are no resources to put it fully into place. We’re being told that other things in the country, such as the income of bankers, remain more important than people’s health. We are, in significant ways, being restrained from putting our best minds and hearts at the forefront of this effort. When we get to the end of the day, there are good ideas, and then there are good ideas that are fully funded. In the history of the HIV/AIDS epidemic, there have been some excellent ideas but they have languished because they just aren’t resourced at the appropriate level – I think we may see a lot of this in the next few years. The impact of economic injustice, which was already driving the epidemic, will remain a deciding factor in the HIV/AIDS context for some time to come.”

Julie Davids is the Director of National Advocacy and Mobilization at AIDS Foundation of Chicago, a Mapping Pathways partner organization. She coordinates the HIV Prevention Justice Alliance (HIV PJA).

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

Bloomberg Editorial: After 30 Years of AIDS, Push Harder for HIV Prevention

via Bloomberg

AIDS has been with us, officially, for 30 years, since the U.S. Centers for Disease Control and Prevention reported the first cases. This unhappy anniversary is perhaps as good a time as any to spell out why the global response to AIDS is in need of serious adjustment.

Annual spending on AIDS worldwide has risen to $15.9 billion. The bulk of this money goes to the treatment and care of indigent people who are HIV-positive. Without question, the investment in anti-retroviral therapy, or ART, has saved lives. Today, the treatment is provided to about 36 percent of those in the developing world who qualify for it under World Health Organization guidelines.

United Nations member states have pledged to raise that to almost 100 percent. Universal treatment has become the principal mission of many AIDS organizations around the world; governments and philanthropies have followed their lead.

The idea of treating everyone who has the human immunodeficiency virus, regardless of ability to pay, is laudable. The problem is, the laudable runs the risk of crowding out both the practical and the doable. As programs for treatment have grown, those focused on prevention have languished or gotten short-shrift.

Read the rest.

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

Lancet: Towards an improved investment approach for an effective response to HIV/AIDS

via The Lancet

Summary

Substantial changes are needed to achieve a more targeted and strategic approach to investment in the response to the HIV/AIDS epidemic that will yield long-term dividends. Until now, advocacy for resources has been done on the basis of a commodity approach that encouraged scaling up of numerous strategies in parallel, irrespective of their relative effects. We propose a strategic investment framework that is intended to support better management of national and international HIV/AIDS responses than exists with the present system. Our framework incorporates major efficiency gains through community mobilisation, synergies between programme elements, and benefits of the extension of antiretroviral therapy for prevention of HIV transmission. It proposes three categories of investment, consisting of six basic programmatic activities, interventions that create an enabling environment to achieve maximum effectiveness, and programmatic efforts in other health and development sectors related to HIV/AIDS. The yearly cost of achievement of universal access to HIV prevention, treatment, care, and support by 2015 is estimated at no less than US$22 billion. Implementation of the new investment framework would avert 12·2 million new HIV infections and 7·4 million deaths from AIDS between 2011 and 2020 compared with continuation of present approaches, and result in 29·4 million life-years gained. The framework is cost effective at $1060 per life-year gained, and the additional investment proposed would be largely offset from savings in treatment costs alone.

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

The end of AIDS? Are We There After 30 Years?

Thirty years on, it looks as though the plague can now be beaten, if the world has the will to do so...

via The Economist

Excerpt:

If AIDS is defeated, it will be thanks to an alliance of science, activism and altruism. The science has come from the world’s pharmaceutical companies, which leapt on the problem. In 1996 a batch of similar drugs, all of them inhibiting the activity of one of the AIDS virus’s crucial enzymes, appeared almost simultaneously. The effect was miraculous, if you (or your government) could afford the $15,000 a year that those drugs cost when they first came on the market.

Much of the activism came from rich-world gays. Having badgered drug companies into creating the new medicines, the activists bullied them into dropping the price. That would have happened anyway, but activism made it happen faster.

The altruism was aroused as it became clear by the mid-1990s that AIDS was not just a rich-world disease. Three-quarters of those affected were—and still are—in Africa. Unlike most infections, which strike children and the elderly, AIDS hits the most productive members of society: businessmen, civil servants, engineers, teachers, doctors, nurses. Thanks to an enormous effort by Western philanthropists and some politicians (this is one area where even the left should give credit to George Bush junior), a series of programmes has brought drugs to those infected.

The result is patchy. Not enough people—some 6.6m of the 16m who would most quickly benefit—are getting the drugs. And the pills are not a cure. Stop taking them, and the virus bounces back. But it is a huge step forward from ten years ago.

What can science offer now? A few people’s immune systems control the disease naturally (which suggests a vaccine might be possible) and antibodies have been discovered that neutralise the virus (and might thus form the basis of AIDS-clearing drugs). But a cure still seems a long way off. Prevention is, for the moment, the better bet.

There are various ways to stop people getting the disease in the first place. Nagging them to use condoms and to sleep around less does have some effect. Circumcision helps to protect men. A vaginal microbicide (none exists, but at least one trial has gone well) could protect women. The new hope centres on the idea of combining treatment with prevention.

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