Podcast: A Little PrEP Talk Inspired by New Mapping Pathways Report

This 10-minute podcast (click to listen) was produced by AIDS Foundation of Chicago (AFC) and is the second in a series of discussions inspired by "Developing Evidence-Based, People-Centred Strategies for the Use of Antiretrovirals as Prevention."

This new Mapping Pathways report was published 19 June 2013 by RAND Europe and AFC.

In this new podcast, AFC staffers and Mapping Pathways team members Jessica Terlikowski and Jim Pickett chat about PrEP - pre-exposure prophylaxis.

Click here for Jessica and Jim's previous podcast - posted June 21, 2013 -  which introduces the report and talks about why it is relevant for multiple audiences.

Keep your eyes and ears open.

Jessica and Jim will be back soon to talk about the other ARV-based prevention strategies that were explored in the report: PEP (post-exposure prophylaxis), TLC+ (testing, linkage to care, plus treatment) and microbicides. And you will find out about it right here.


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Hoover Institution: Reshaping Global Health, Time for a Structural and Philosophical Shift

via Hoover Institution Stanford University, by Mark Dybul, Peter Piot, and Julio Frenk

Excerpt:

However, the focus on specific diseases has imposed and exposed fault lines in delivering services in places where many suffer from multiple health issues at the same time or at varying points in their lives. Although studies have shown that hiv interventions have reduced overall mortality and that malaria and immunization programs have reduced childhood mortality in the near term, it seems highly likely that more lives will be durably saved if a person afflicted by different health problems has access to services for all of them. Although there are limited supportive data, we believe it is likely that an integrated approach focused on the health of a person and community is more cost-effective than a silo approach focused on a specific disease or health threat. Yet, existing global health institutions were designed for specific diseases and have not effectively shifted to embrace a broader vision. It is time for a Bretton Woods-style agreement to guide a new international health strategy and rationalize its structure.

Read the rest.


[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 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.]

The Affordable Care Act's Impact on People Living With HIV

via Associated Press, by David Crary

For many HIV-positive Americans, and those who advocate on their behalf, these are days of anxious waiting as the Supreme Court ponders President Barack Obama's health care overhaul.

This loose-knit community — made up of activists, health professionals and an estimated 1.2 million people living with HIV — has invested high hopes in the Affordable Care Act, anticipating that it could dramatically improve access to lifesaving care and treatment. The act is now in limbo as the high court deliberates on its constitutionality, notably its requirement that most Americans obtain health insurance. A ruling could come in June.

"The HIV treatment community sees the act as a critical step in our fight against the AIDS epidemic," said Scott Schoettes of Lambda Legal, a national gay-rights advocacy group. "People have been counting on it, making plans based on its implementation, so for it to be pulled out from under their feet at this point would be a tremendous loss."

Among its many provisions, the health care law has two major benefits for HIV-positive people: It expands Medicaid so that those with low incomes can get earlier access to treatment, and it eliminates limits on pre-existing conditions that have prevented many people with HIV from obtaining private insurance.

Under current policies, low-income HIV-positive people often do not qualify for Medicaid if they are not yet sick enough to be classified as disabled.

In the view of advocacy groups, this creates a cruel Catch 22 — at a stage when they are still active and productive, these people can't afford the antiretroviral treatments that could help them stay that way. Only when their condition worsens are they able to qualify for Medicaid and get treatment that might have prevented the deterioration.


Read the Rest.


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

The Treatment Action Campaign (TAC) Shapes AIDS Policy in South Africa

via The Guardian, by Pierre de Vos

"The TAC case thus illustrates how social and economic rights can be used by civil society groups to mobilise public support for a worthy cause – even before a court is asked to adjudicate on what will often be very complex legal and moral issues – and that it can enhance democratic engagement and participation."

Shortly after Thabo Mbeki, the former South African president, began his flirtation with Aids dissidence in 2000, the Treatment Action Campaign (TAC) was created to respond to the HIV crisis in the country and the government's reluctance to deal with it.

Although closely aligned with the ANC government, the TAC engaged politically and launched various court challenges to force a change of heart on the part of the government and, ultimately, in order to ensure that every HIV-positive person who could not afford it was provided with antiretroviral (ARV) medicine by the state.

The TAC ran a brilliant and strategically astute campaign to mobilise the public, trade union organisations and other civil society groups behind its cause. Its trump card in this campaign was section 27(1) of the constitution , which states that everyone has the right to have access to healthcare services, including reproductive healthcare.

Like other social and economic rights contained in the South African bill of rights – including the right of access to housing, sufficient food and water; and social security – the right to healthcare is not absolute. It requires the state only to take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of each of these rights.

At the time of the drafting of the bill, some politicians and academics opposed the inclusion of these rights, arguing that it would not be possible for judges to enforce these claims as they would be required to make policy choices best left to the democratically elected branches of government. But given the vast discrepancies in wealth – often based on race – caused by apartheid and the fact that many citizens did not have access to basic services at the dawn of democracy, the drafters of the constitution believed that it was imperative to include not only traditional civil and political rights in the constitution, but also justiciable social and economic rights. Otherwise the very legitimacy of the constitutional enterprise would be at risk.

South Africa's constitutional court at first dealt cautiously with the interpretation and application of these rights, making it clear that it would not be feasible to interpret the rights in a way that provided individual claimants with a right to demand specific goods and services from the state.

The court was in a difficult position as it had to respect the separation of powers doctrine and could not dictate to the government how to allocate its budgets. At the same time it was required to ensure that the social and economic rights did not remain rights on paper alone, but were interpreted in a way that signalled their enforceability.

Read the rest.


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

Deadline Extended to December 19 for Nominations for the 2012 Omololu Falobi Award!

Has an advocate for HIV prevention really inspired you to work harder, achieve more, and be less afraid to challenge change in your country?

Outstanding work deserves recognition!

Nominate someone today!

The Omololu Falobi Award for Excellence in HIV Prevention Research Community Advocacy was established by the African Microbicides Advocacy Group (AMAG) and partners in 2008 in honor of Omololu Falobi’s memory and commitment to the field. The Award is presented to a community advocate in recognition of his/her contribution to the HIV prevention research field through community advocacy. The deadline for nominations is December 19!

Contact: omololufalobiaward@yahoo.com
Nomnation forms available at: www.avac.org/omololufalobi

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

Rectal Microbicides & Africa: A Leap Forward

Original content from our Mapping Pathways blog team

Rectal microbicide advocacy has taken a huge leap forward this year, particularly in Africa. An excellent example of this progress is the International Rectal Microbicide Advocates (IRMA)-hosted Project ARM – Africa for Rectal Microbicides  meeting underway now  in Addis Ababa, Ethiopia in advance of the ICASA 2011 conference. “I am so proud of the fact that we’re at a point where we can hold a two-day strategy meeting in Africa, focusing on rectal microbicides research and advocacy in Africa. That’s just huge. A few years ago this would have been impossible – people would have laughed at you for suggesting it,” says Jim Pickett, chair of IRMA, a Director at the AIDS Foundation of Chicago, and member of the Mapping Pathways team.

The rectal microbicides field itself is also expanding, as researchers continue to push boundaries. Until now, there have only been small-scale Phase I trials for rectal microbicides. This year the first Phase II trial was announced – an expanded safety study that will begin in 2012. “The trial will involve 200 individuals, which is almost double the total number of human beings who’ve been in rectal microbicides trials so far,” Jim points out. The study is going to be multinational, taking the research outside the US to countries like Thailand, Peru, and even South Africa.

“Not too long ago, saying rectal microbicides clinical research and Africa in the same sentence would have gotten a huge eye-roll. Now it’s real, it’s happening,” says Jim. “I think that says a lot about how advocacy and science together have elevated the field, creating a great deal of understanding and support for it.”

Stay tuned to the Mapping Pathways blog for news and updates from the IRMA meeting and ICASA conference in Addis Ababa.

Please note: Registration for the AIDS 2012 conference in Washington, D.C. opened yesterday. Get the details here.


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