By AVAC team
AVAC’s Look Back at Montreal
Racism, and colonialism
Daily Maverick (South Africa) reports on the protest at the opening session: Activists took over the stage at the opening of the AIDS 2022 conference in Montreal, Canada, last week to protest against the refusal of visas to hundreds of delegates, primarily from Africa, and the inequality and lack of funding that is driving new HIV infections. South African activist Vuyiseka Dubula, former leader of the Treatment Action Campaign, told the conference that activists needed to speak for those who were denied access to the conference…. ‘TB infections are increasing. Our governments do very little to address the opportunist infection cryptococcal meningitis, young women are used in clinical trials to test [HIV] products but, when these products are ready, they are not accessible,’ said Dubula, as the crowd chanted: ‘Another minute, another death! AIDS is not over!’”
CBC (Canada) reports, “It’s time for richer nations to change the way they deal with global health crises like COVID-19 and monkeypox, say some of the experts who attended the recent international AIDS conference in Montreal. ‘It’s about greed and it’s about power and it’s about a system that is deep-rooted in generations and millennia of racist attitudes — and sometimes a subconscious bias — that has now become the norm,’ said Dr. Ayoade Alakija, chair of the African Union’s Vaccine Delivery Alliance….Dr. Madhukar Pai, professor of epidemiology and global health at McGill University, said often global health emergencies are not taken seriously until they affect white people. ‘When this happens decade after decade after decade, there is no explanation on the planet except white supremacy and racism,’ he said, citing examples like AIDS, Ebola, COVID-19, and monkeypox.”
Dr. Alakija also retweeted a photo from a conference session on stigma with empty presenter seats with the words: “A picture is worth a thousand interviews. Here’s the @AIDS_conference news segment right here. No more words needed. #AIDS2022 #EQUITY #JUSTICE.” The original tweet noted: Final session of the day on stigma related to HIV in clinical settings. All panellists were denied entry into the country. Appalling #AIDS2022”
Andre Picard writes in The Globe & Mail (Canada), “Canada’s refusal of visas for hundreds of delegates from low-income countries planning to attend the International AIDS Conference in Montreal has sparked anger around the world, but in the government’s first response, a senior minister has simply brushed it off as unfortunate…. Many activists have accused Canada of being racist, and the world’s top AIDS scientists even called on the Prime Minister to come to the conference to justify the visa denials. Mr. Duclos sidestepped the question of whether the government would apologize, or change its policies, saying simply that it was his ‘personal and professional opinion’ that more people should be at the AIDS conference, and he would raise the issue with his cabinet colleagues.”
Bhekisisa (South Africa) asks “Why is the Aids conference still held in the Global North?, reporting, “Researchers, who reviewed more than 20 years of global health conferences, found that 96% of such events happened in high- or middle-income countries. Fewer than four out of every 10 delegates come from poorer nations — despite the fact that the diseases discussed at such conferences are far more common in Global South countries.” In an interview Ayoade Alakija, co-chair of the African Union’s African Vaccine Delivery Alliance says, “What we need is to reimagine the world of global health and the world of global development. We need to think about what equity looks like and have a conversation about institutional racism that says your voice has more value because you’re a man or because you’re caucasian.” You can watch Mia Malan’s interview with Dr. Alakija here.
Injectable PrEP
An editorial in Nature (UK) argues, “Whether [CAB-LA is a game changer] depends on whether the drug can be rolled out to those most in need, in particular girls and women aged 15 to 24 in the lowest-income countries. Last year, some 250,000 women and girls in this age group were infected with HIV, more than 80% of them in sub-Saharan Africa. Success will require cabotegravir to be offered at the lowest price possible. For this to happen, transparency over how the price is calculated is essential.” Nature notes some calculations of price have been made and ViiV has said it cannot make the drug for close to the price of oral PrEP. ViiV’s commitment to provide the drug at a non-profit price and license to generics “are welcome steps. But the company could go one better: let the world know what the price will be and provide a breakdown of how it was calculated. In the meantime, more researchers could make their own estimates, which would help to provide governments and other funders with a benchmark figure for their discussions on what to pay. The outlook for extra domestic and international funding for HIV/AIDS isn’t good, according to the latest update from UNAIDS, published last month (see go.nature.com/3zkhaix). If cabotegravir cannot be offered at a price comparable to or, ideally, lower than existing oral treatments, nations could face some difficult decisions. Members of the public deserve to know what their governments are paying — and why.”
Gus Cairns reports in AIDSMAP (UK) reports, “In the setting of the South African HIV epidemic, long-lasting injectable PrEP using the antiretroviral drug cabotegravir (CAB-LA) cannot cost more than US$15 per injection in conditions of lower coverage, or $9 per injection in conditions of high coverage, if it is to be cost-effective compared to using oral tenofovir disoproxil/emtricitabine (TDF/FTC)…” according to a model presented at the conference. The model finds “Without any extra PrEP other than what’s already being taken, the total number of people with HIV on antiretroviral therapy would be about 6.6 million by 2037. Oral PrEP would only reduce this total by about 2%. CAB-LA PrEP would reduce it by 4-8%, depending on coverage and duration, and the number on ART would peak by about 2032, thereafter declining as fewer people acquire HIV…. The sting in the tail of this model is that despite these reductions in HIV cases, AIDS deaths and ART coverage, putting this number of people on injectable PrEP would cost the South African health system a great deal.”
Sarah Boseley writes in The Guardian (UK), “CAB-LA is discreet and highly effective. The obvious comparison is with long-lasting injectable contraception. Young women may be able to get a jab every two months that will protect them from HIV, without anyone in their family or community knowing. PrEP in pill form has been targeted at sex workers and gay men, risking criminalisation in countries with homophobic laws. That inadvertently fed stigma, deterring young women from seeking it out.” She quotes Asia Russell: “It [CAB-LA] is not a magic bullet but it is extraordinarily effective. And ViiV is pricing it out of reach of the exact communities who need it. A product that should be an option, as the people’s prevention shot frankly is, instead being treated like a luxury good.” She reports, “Mitchell Warren, who runs the advocacy group Avac, is close to HealthGap, and collaborates – without taking funding – with ViiV. He says that Avac is part of a new coalition announced at the conference, with the WHO, Unitaid, UNAids and the Global Fund. The coalition will work out how to fund CAB-LA and get it to those who need it. He thinks they could talk out their differences. ‘I’m sad that we don’t find ways to the conversation more strategically. The activists raise really important issues,’ he says. ‘I wish more people would engage with the conversation. I don’t think any of us are that far apart.’”
Nature (UK) reports, “The WHO’s cabotegravir announcement — and ViiV’s licensing deal — garnered both praise and criticism from many attending or following the conference, which ended on 2 August. ‘Affordability is the most significant barrier to global implementation,’ said Iskandar Azwa, an infectious-disease specialist at the University of Malaya in Kuala Lumpur, at the conference…. In an open letter to ViiV’s chief executive, Deborah Waterhouse, a group of more than 70 politicians, civil-society activists, researchers and heads of philanthropic organizations urged the company to set the price of cabotegravir “as close as possible” to that of existing HIV prevention medicines, which they say is around $60 per person per year — equivalent to $10 per cabotegravir dose. A ViiV spokesperson said in an e-mail to Nature that a $10 price is not realistic because cabotegravir is more complex and therefore more expensive than ‘a simple white tablet’. Moreover, a low price could prevent generics manufacturers from coming forward.”
Laura Lopez Gonzalez reports in AIDSMAP (UK) An injection every two months of the antiretroviral cabotegravir is the most effective way to prevent HIV that the world has ever seen. Making it affordable will depend, in part, on how many generic manufacturers will invest in producing it — and for that, the world must show the promise of markets: millions of otherwise healthy people who will line up at a pharmacy or clinic for a quick injection every two months. The question is: how do you create a market for a product that most of the world has not yet seen?… the market will have to grow large enough to accommodate at least three additional generic suppliers that will be ready to distribute their products in around five years. But in five years’ time, an experimental, twice-a-year HIV prevention injectable called lenacapavir might also be coming to market, possibly unseating cabotegravir or reducing the market for generic versions of it. ‘What if you invest tens of millions of dollars and begin to see this low-price cabotegravir coming off the line — and all of a sudden, lenacapavir shows safety and efficacy?’ Warren asks. ‘It’s a risk.’ It’s also why he says the quest for access to an HIV prevention injection can’t just be about cabotegravir.”
The Body Pro (US) reports, “Long-acting injectable cabotegravir (CAB-LA) as pre-exposure prophylaxis (PrEP) took the 24th International AIDS Conference by storm through announcements of late-breaking efficacy and safety results, incorporation into World Health Organization (WHO) guidelines, a voluntary licensing agreement, and a global coalition to spur rollout of CAB-LA worldwide.” Nkosi argued as the conference began, “At the centre of the meeting must be the recognition that criminalisation, stigma and discrimination remain some of the biggest threats to the HIV response….The data is clear. The HIV response is less successful in countries that criminalise same-sex sexual acts, sex work, and drug use.”
In a Bhekisisa (South Africa) opinion piece Claire Waterhouse and Lebohang Kobola write, “South Africa’s diversity makes it the ideal place for pharmaceutical companies to test how well their new medicines work on different groups of people. This is a crucial bargaining chip that the government continually underplays in deliberations with drug corporations for access to medication that has been trialled locally. And it comes at a huge cost to our people.” The cite South Africa’s participation in both trials of CAB-LA and argue, “Once a trial is over, rules set by the country’s medicines regulator, the South African Health Products Regulatory Authority (Sahpra), allow people who were part of the study to get the medicine that was tested. But it’s not enough — everyone in the country who needs the tested drug should have the right to access it at an affordable price. This is where the health department should be pushing the envelope: change the rules to include all people in South Africa at a reasonable rate.”
In a JIAS (Switzerland) Viewpoint, WHO’s Heather-Marie Ann Schmidt,Michelle Rodolph,Robin Schaefer,Rachel Baggaley,Meg Doherty write, “The WHO recommendation on offering CAB-LA as HIV prevention for people at substantial risk for HIV will provide an additional choice for HIV prevention. CAB-LA also provides us with a unique opportunity to leverage the excitement for this new option to strengthen and expand HIV prevention programmes. But to achieve the full potential of CAB-LA, all sectors––communities, ministries of health, clinical providers, researchers, implementers, donors and manufacturers––must work together to conduct meaningful implementation science as part of PrEP scale-up programmes and ensure that provision of CAB-LA enhances the availability, accessibility, acceptability and affordability of effective HIV prevention services.”
AIDSMAP (UK) reports, “Injection of long-acting cabotegravir and rilpivirine into the thigh muscle led to mostly mild side effects and a pharmacokinetic profile comparable to that of standard buttocks injections, according to a study presented last week at the 24th International AIDS Conference (AIDS 2022) in Montreal. Another research team found that a higher-concentration formulation of injectable cabotegravir had similar safety and produced drug levels comparable to those of the current version. Both studies could help pave the way for self-administration of cabotegravir plus rilpivirine for HIV treatment or cabotegravir alone for PrEP (regular medication to prevent HIV infection), which could overcome one of the main barriers to wider adoption of the long-acting agents.”
Cure
While much of the mainstream media has focused on the City of Hope patient, AIDSMAP and Science’s coverage of the Barcelona patient and XXXX provide more details on promising but more difficult to understand research. AIDSMAP (UK) reports, A woman in Barcelona has maintained an undetectable HIV viral load for more than 15 years after stopping antiretroviral therapy, according to a case report presented on Friday at the 24th International AIDS Conference (AIDS 2022) in Montreal. Her HIV has not been completely eradicated, so she cannot be considered cured in the strictest sense, but she appears to be in prolonged remission without antiretrovirals, sometimes called a ‘functional cure’. While this woman is an exceptional post-treatment controller, and her experimental regimen would not be suitable for widespread use by people living with HIV worldwide, her case may provide clues to help researchers develop more broadly applicable strategies for long-term remission.”
Gus Cairns reports for AIDSMAP (UK) “The 24th International AIDS Conference (AIDS 2022) in Montreal heard on Friday that for the first time scientists have developed a sensitive gene assay that can specifically find the tiny subset of ‘reservoir’ cells that harbour silent HIV infection by using nanotechnology to detect their distinct genetic signature. ‘The holy grail of HIV cure research is to find a biomarker for the reservoir,’ Professor Sharon Lewin, president-elect of the International AIDS Society told a press conference. This study is an important step towards finding such a biomarker, she said…. At present this is all lab-dish science. But we finally have an assay that may enable us to target HIV cure and immunomodulatory therapies much better.”
Jon Cohen writes in Science (US), “Curing HIV infections remains one of the most formidable challenges in biomedicine, in part because cells that hold the viral DNA in their chromosomes persist in the face of powerful drugs and immune responses. A research team has now, for the first time, isolated single cells from these stubborn viral reservoirs and characterized their gene activity, suggesting potential new cure strategies…. At the AIDS conference, Eli Boritz, an immunologist at the National Institute of Allergy and Infectious Diseases (NIAID), described his team’s effort to better understand HIV’s hideouts by analyzing single cells with the viral DNA in a latent state. Previous studies have isolated HIV inside of single cells in the reservoir, but scientists could not evaluate the host cell’s gene activity because of a Catch-22: They could only identify whether a cell was infected by prodding the virus to copy itself, which, in turn, likely altered the cellular gene expression. The new work dodged this dilemma by using a technique that isolates single, infected cells as tiny amounts of blood move through three microfluidic devices …In essence, the devices push the blood through channels in microchips that trap individual cells in droplets, allowing them to be cut open so that other instruments can read their genetic material.”
AIDSMAP (UK) also provides a great overview of the City of Hope case.
Engaging communities
Yogan Pillay writes in The Daily Maverick (South Africa): “The Aids 2022 conference held recently in Montreal, Canada highlighted yet again the need for community activism and the importance of the involvement of young people. While these calls are not entirely new, they come at a time when the global HIV response appears to be faltering in the wake of the Covid-19 pandemic, the Russia/Ukraine war, and the general economic downturn….Aids 2022 can be a global watershed event if, from now onwards, the balance of power for decision-making, implementation, and monitoring is shared between technical experts and community and youth-led organisations working at every level of society — globally, nationally, and locally.”
State of the HIV pandemic and the response
News24 (South Africa) reports, “Young South African women continue to account for most of new HIV infections in the country. Speaking at the 24th International Aids Conference in Montreal, Canada, Health Minister Dr Joe Phaahla said while the country had made remarkable progress against HIV and Aids, new infections remained high. He said: ‘Additionally, early sexual debut and age-disparate relationships are common for adolescent girls and young women. Genotyping shows that such relationships fuel the cycle of HIV transmission in South Africa.’”
Kerry Cullinan writes for The Daily Maverick (South Africa), “HIV is one of the most studied diseases of all and an arsenal of treatment and prevention tools has been amassed over the past 40 years — the latest being an antiretroviral injection taken every eight weeks that can prevent 99% of infections. However, HIV is still spreading — primarily among people who have been deemed criminals or invisible by their governments. Some 70% of new infections last year were in groups designated by UNAIDS as “key populations” for their vulnerability to infection: men who have sex with men (MSM), sex workers, transgender people, people who inject drugs and prisoners. Adolescent girls in sub-Saharan Africa, many of whom are infected during coerced sex, are another vulnerable group. ‘We have the tools. We know what we are supposed to do. But we need a people-centred approach to meet people where they are,’ Professor Linda-Gail Bekker, head of the Desmond Tutu Health Centre and an infectious diseases expert, told the International Aids Conference in Montreal.”
DW (Germany) reports, “The coronavirus pandemic has changed a lot in a very short space of time, including our global strategies to slow the spread of — and help treat people with — HIV and AIDS. And we were doing so well.” The story gets some key things wrong, reporting that injectable CAB for PrEP “can be injected every 2-3 months” and noting success of PrEP programs in Kenya says “But the pill only works in men.”
Stigma
AIDSMAP (UK) reports, “According to research presented at the 24th International AIDS Conference in Montreal, people living with HIV in Africa, especially key populations and adolescents, are experiencing stigma in healthcare settings while accessing care. What’s more, even staff living with HIV in health facilities conceal their status for fear of being stigmatised by their colleagues. A South African qualitative study explored the manifestations of HIV-related stigma in clinical settings. Most participants were living with HIV, had a median age of 25, and included key populations (sex workers, lesbian, gay, transgender and bisexual persons). Professor Leickness Simbayi from the Human Sciences Research Council reported that the majority of the key populations and youth faced discrimination in health centres.”
HIV and COVID and Monkeypox
In a twitter thread Gregg Gonsalves writes that after a participating virtually in a panel discussion on “’Learning from pandemics: From COVID-19 and HIV to future pandemics’…I feel deflated…. @UNAIDS’ new report says we’re ‘in danger’ of backsliding on HIV (an understatement), the world is still battling #COVID19 and now #monkeypox, but we were being asked to discuss what we’d call in the US ‘motherhood and apple pie’–things no one is going to disagree on. I mean we’re losing ground on AIDS (not to mention TB…), COVID is still ravaging us, monkeypox is on the march, but clearly conference organizers didn’t want to “pull the fire alarm” and say, what the heck is happening? How can we be 3-0 against these epidemics since 1981?…. There is something deeply structurally wrong and it’s time to look into the abyss and describe it, in detail, with forensic focus, and have that conversation one day at these gatherings. ‘Cause otherwise, we’re sorta just going through the motions.”
Bay Area Reporter (US) reports, “Despite remarkable gains in HIV treatment and prevention, barriers stand in the way of universal access. Key populations including gay and bisexual men, adolescent girls and young women, transgender people, sex workers, and people who use drugs continue to face stigma that keeps them from accessing the tools they need. And now, monkeypox poses a new threat to some of the same communities hard hit by AIDS.” Reporting on a media roundtable on Monkeypox, Liz Highleyman says, “Reporters asked numerous questions at the media roundtable, but Dr. Marina Klein of McGill University in Montreal acknowledged that many of them don’t yet have answers. The exact mechanisms of transmission aren’t known, nor is it clear whether the respiratory route is important or whether people can transmit the virus before they develop symptoms. There’s little data showing how well the new Jynneos vaccine works or whether treatment with TPOXX (tecovirimat) reduces symptoms or lessens viral shedding.” She also reports on activists storming the stage during a Monkeypox symposium: “The activists’ list of demands includes ‘decisive leadership’ from WHO and the United Nations on global monkeypox vaccine and treatment access, including efforts to scale up production. They called for ‘immediate transfer of intellectual property, know-how and technology’ to manufacturers around the world that can make vaccines, treatments and diagnostics. The activists also demanded that higher-income countries make good on their commitment to be a ‘vaccine arsenal for the world.’ Advocates are loath to see a repeat of the inequitable global distribution of COVID-19 vaccines.”
Other news
Code Blue (Malaysia) reports on a session with top HIV journalists. A roundtable on HIV media coverage revealed the different challenges between Asian, and Western and African countries in reporting on the HIV/AIDS pandemic that has spanned four decades. While top health and science journalists from the United States, the United Kingdom, and South Africa highlighted decreasing press coverage of HIV/AIDS as the once-deadly disease is now perceived as a chronic condition due to wide access to treatment in those countries, CodeBlue pointed out that patient stories are still uncommon in Malaysia due to rife stigma and discrimination…. Science Magazine senior correspondent Jon Cohen – who is based in San Diego, the United States, and has covered every international AIDS conference since 1989 – said AIDS journalism used to be really vibrant. ‘AIDS journalism, when I began doing this at the international AIDS conferences, was a newsroom filled with hundreds of journalists – all the major television stations, radio stations, print, magazines. The newsroom today is kind of empty.’”
Gus Cairns reports in AIDSMAP (UK), “It is 13 years now since RV144 became the only HIV vaccine ever to produce a (marginally) positive result in a large efficacy trial. And it’s eight years since aidsmap.com said that the vaccine’s results were “real – and could be made to work better.” An analysis presented yesterday at the 24th International AIDS Conference (AIDS 2022) of the immune responses created by the Imbokodo vaccine, one of the successors to RV144, confirmed that the first half of that statement was true: it is possible to induce an antibody response to HIV with a vaccine, and the one produced in Imbokodo was essentially the same as that produced by RV144. Unfortunately, the second half has not come to pass: no efficacy trial since has produced a result even as positive as the 31% reduction in infections seen in RV144. In fact, there have only been two such trials: Uhambo, which closed in February 2020, and Imbokodo, which closed in August 2021. Neither worked.” He notes the data presented at the conference tell us “13 years on, we are at essentially the same place with efficacy, though we know a lot more about why that efficacy is poor. We know that the vaccines we have do generate a degree of immunity to HIV; but in the large majority of people, that response is too weak, and above all too specific, to translate into useful efficacy.”
UNAIDS released its HIV prevention 2025 road map.
Kerry Cullinan writes in Health Policy Watch (Switzerland) reports, “People with mental health conditions are more likely to get HIV, while people with HIV often struggle with depression and other mental health issues – but few countries offer psychosocial support as part of their HIV services. ‘As a result of systemic inequalities, mental health issues keep coming up and you have to deal with them head-on,’ said Lucy Njenga from Positive Young Women Voices, who works with women and girls with HIV in some of the poorest communities in Kenya….Aside from mental health, few HIV programmes include screening and treatment for a host of other non-communicable diseases (NCDs) that prey on people with HIV – including diabetes, hypertension and cervical cancer. In South Africa, which has the biggest population of people living with HIV in the world, more people are now dying of diabetes than AIDS. People with HIV are living longer thanks to antiretroviral treatment, and having to confront a range of NCDs.”
AIDSMAP (UK) reports, “A history of intimate partner violence and/or sexual abuse was associated with lower adherence to HIV treatment among adolescents living with HIV in South Africa, according to research presented at the 24th International AIDS Conference (AIDS 2022). Another study presented at the same session found that adolescent girls and women in sub-Saharan Africa who had recently experienced intimate partner violence were over three times more likely to acquire HIV and less likely to have suppressed virus if living with HIV.”
Health Policy Watch (Switzerland) reports, “Twelve African nations have joined with the United Nations and other international organizations in forming a new alliance that will work to prevent new infant HIV infections and to ensure no child living with HIV is denied treatment by the end of the decade. Proponents of the new Global Alliance for Ending AIDS in Children by 2030 announced its creation [at the AIDS2022]… Just 52% of all children living with HIV are receiving treatment that can save their lives, far behind the 76% of all adults that are receiving antiretrovirals. That’s according to data released in the UNAIDS Global AIDS Update 2022. Because of that the alliance says over the next eight years it will focus on closing the treatment gap and breastfeeding adolescent girls and women living with HIV and optimizing continuity of treatment, and on preventing and detecting new HIV infections among pregnant and breastfeeding adolescent girls and women.”
A special issue of JIAS (Switzerland) on stigma was released. Getting to the heart of stigma across the HIV continuum of care.
In a Thompson Reuters (UK) opinion piece GNP+’s Sbongile Nkosi writes, “Countries are moving to roll out new HIV prevention tools, such as PrEP, a daily pill that cuts transmission, and a newer, antiretroviral-based vaginal ring shown to reduce women’s risk of contracting HIV by more than half. We know more than ever that effective, easy-to-use treatment is also one of our best prevention strategies….Governments must acknowledge that punitive laws against key populations perpetuate stigma and undermine health equity.”
AIDSMAP (UK) reports, “A client-centred approach that simplifies the provision of PrEP (regular medication to prevent HIV infection) to meet the needs of population groups has increased uptake and contributed to the 2.4 million people starting PrEP since the beginning of 2021, the 24th International AIDS Conference (AIDS 2022) in Montreal heard on Friday. This achievement has been accelerated during the COVID-19 period, which required innovative approaches to maintain PrEP services. What’s known as ‘differentiated service delivery’ for PrEP has seen many countries tailoring the when (frequency of visits), who (service provider), where (location), and what (package of services), based on client preferences.”
AIDSMAP (UK) reports, “In a global sample of 60 countries with high HIV prevalence, only 8% fully included trans people in all aspects of their HIV national strategic plans. Some of these countries made no mention of trans people at all, according to research presented to the 24th International AIDS Conference (AIDS 2022) last week. Trans women are 66 times more likely to be living with HIV than the general adult population, whereas trans men are nearly seven times more likely to be living with HIV. Thus, there is a clear need for the explicit inclusion of trans people in national HIV strategic plans…. The authors recommend that governments should meaningfully engage with trans communities when formulating strategic plans.
International funders, such as the Global Fund and PEPFAR, can provide technical assistance and funding to trans community organisations, but can also require trans inclusion in any research that they are funding. Advocates need to decide what they want to be included in their country’s strategic plan (for example, trans specific budgetary targets for HIV prevention, or the use of peer navigators to conduct HIV testing activities) and how best to engage with government officials to ensure specific representation and inclusion. Engaging early is key to this process.”
AIDSMAP (UK) reports, “New data on oral PrEP use during pregnancy suggest it is not harmful to children’s longer-term development, according to a preliminary analysis presented at the 24th International AIDS Conference (AIDS 2022) on Monday. The study looked at the growth and neurodevelopmental outcomes of infants between the ages of two and three whose mothers had used PrEP (tenofovir disoproxil fumarate/emtricitabine) during pregnancy and found no differences between them and infants whose mothers had not used PrEP. Previous studies of PrEP during pregnancy have only measured infant outcomes up to 12 months after birth.”
News from beyond the conference
A special issue of African Journal of AIDS Research looks at the intersection between HIV and COVID. UNAIDS Matt Kavanaugh writes in an editorial: “We have a wealth of approaches that the evidence confirms succeed — in short we know how to stop pandemics. Whether we do, lies in a combination of political will and how we deploy resources. Investing enough in the HIV response now, so that we work to defeat the AIDS pandemic quickly is much less expensive than underinvesting now in an effort to defeat it slowly. Alongside many preventable deaths and new infections, moving against AIDS today also rational economic self-interest. The papers in this issue can help inspire the courage we need to get there.”
A Viewpoint in Annals of Global Health (US) argues, “While there is general agreement among those involved in global health partnerships that the current system needs to be made more equitable, suggestions for how to address the issue of decolonization vary greatly, and moving from rhetoric to reform is complicated…The degree to which decolonization of global health will be successful depends on how the global health community in both the HICs and LMICs move forward to discuss these issues. Specifically, as part of a paradigm shift, attention needs to be paid to creating a more equal and equitable representation of researchers in LMICs in decision-making, leadership roles, authorship, and funding allocations. “
Medscape (US) reports, “A quiet academic debate over a physician’s right to refuse specific healthcare services on the basis of moral or ethical objections or religious beliefs is spilling over into the HIV arena in some states, pitting some patients requesting preventive medication (preexposure prophylaxis or PrEP) against legislators and lawyers…. ‘When it comes to prescribing PrEP and any medical objection to somehow being complicit in someone’s sexual life and sexual identity — that’s coming from a strictly religious basis,’ explained Jason Eberl, PhD, a healthcare ethics professor at the Gnaegi Center for Health Care Ethics at Catholic-based Saint Louis University….”
Erasing 76 Crimes (US) reports, “Homophobic Ugandan officials have ordered a shutdown of Sexual Minorities Uganda (SMUG), which has been the nation’s most prominent support group for LGBTQ+ people since 2004…. SMUG is an umbrella organization that reinforces and coordinates the work of smaller LGBTQ+ rights and health-action groups. Frank Mugisha, SMUG’s executive director, said that Ugandan authorities who oversee non-governmental organizations told him to suspend activities, saying that the group lacked necessary documentation.” Dozens of international organizations have signed a statement condemning the decision and calling “on the Ugandan government to reverse this decision, and to bring an end to the longstanding persecution of Uganda’s vibrant LGBTQI+ community.”
A study in the journal HIV Medicine reports on “Missed opportunities for HIV pre-exposure prophylaxis among people with recent HIV infection: The French ANRS 95041 OMaPrEP study.” The authors say, “We found two gaps in the retrospective PrEP cascade: insufficient provision of PrEP information by healthcare providers (mainly general practitioners) and low PrEP acceptability by informed, eligible patients. More diverse healthcare providers need to be involved in PrEP prescription, and at-risk people need to be sensitized to the risk of HIV infection.”
Kay Marshall
