AIDS 2024: A time for collective action

Published on 23 August 2024 | Sarah Hand

At the opening ceremony of AIDS 2024, Executive Director of UNAIDS Winnie Byanyima set a tone of determination and collective action saying, “The path that ends AIDS is well sign-posted, it is proven and it has been promised. Success or failure will be determined by which path leaders take today. Let us continue walking the path of solidarity, together and with urgency.” As UNAIDS’ new global report launched at the conference made clear, inaction at this point, or funders walking away too early, will result in exponentially higher human and financial costs in the long run. Now is not the time to leave.

Across the conference, from lively discussions in the Global Village and hundreds of poster presentations to the high-level plenaries and panel discussions, a number of new themes emerged, alongside others that were more familiar.

“The path that ends AIDS is well sign-posted, it is proven and it has been promised. Success or failure will be determined by which path leaders take today. Let us continue walking the path of solidarity, together and with urgency.”

A leap forward with lenacapavir

The big game-changing announcement came under new technologies and PrEP, with Gilead Science’s new twice-yearly injectable lenacapavir for HIV prevention. A “miracle prevention tool” is how UNAIDS Executive Director Winnie Byanyima described it. Full results from the Purpose 1 trial confirmed that lenacapavir gave 100% protection against HIV acquisition in cisgender women. Further trials will now be taking place with other population groups.

As we saw 2 years ago when CAB-LA came onto the market as a long acting injectable for PrEP, the work to ensure that these lifesaving medical advances now reach everyone and there is truly access for all remains fraught with challenges from pricing, licensing, manufacturing and distribution. Long acting injectables offer a more discreet and often preferred option to taking daily PrEP that also overcomes challenges in accessing daily medication. Leaders and passionate activists are calling for Gilead Sciences to follow a similar process as ViiV Healthcare has done with CAB-LA and ensure that generic licensing is granted quickly to producers in low and middle income countries so they can bring the cost of the drug down for their citizens.

Simultaneous to the efforts to overcome licensing, pricing and access must be efforts to build knowledge, self-efficacy and demand. “Millions of people stand to benefit, and they have a right to know how this breakthrough drug applies to them,” says Avert CEO Sarah Hand. “Building health literacy must not wait. It is an integral part in moving to real-world implementation.”

Under other encouraging efforts to integrate HIV care into the broader health system, Avert was pleased to support Frontline AIDS and Unlimited health in the delivery of a high-level session titled – “The Time is Now – FGS Integration into HIV and SRHR services”. FGS (Female genital schistosomiasis) is a highly prevalent neglected tropical disease that could be better responded to if integrated into existing HIV and SRHR services in endemic areas. This is a must for patient centred holistic health that makes sound clinical, programmatic and financial sense.

“Building health literacy must not wait. It is an integral part in moving to real-world implementation.”

Supporting community health workers

Through four poster presentations and a partners meeting, we were pleased to share the evidence from the rollout of Boost, our co-created digital job-aide targeted at community health and peer educator volunteers. The posters, presented by OPHID, shared a range of findings including how Boost has supported improved trust of CHWs in the community, how Boost has supported the increased knowledge and confidence of their CHWs, and how Boost has supported the timely and relevant referrals of clients to services through the use of a screening tool added to the app. The Boost partners’ meeting focused on efforts to scale Boost across Zimbabwe and now into Kenya.

We were pleased to have had the opportunity to share the findings from our work on Young Africa Live by B-Wise in South Africa. Young Africa Live was an innovative digital response to the challenges of reaching young people in South Africa with sex positive, judgement free health content in a bid to increase their health literacy, agency and reduce the stigma associated with HIV. Avert shared that a key success of the work was through a private, non-judgmental chatbot, young people felt confident to talk about sex, intimacy, mental health and other issues with their peers and partners.

Sadly it is not new to hear that despite the incredible efforts of many, such as the Beyond Stigma programme, HIV associated stigma and discrimination remains a major barrier to progress and freedom of expression for millions of people. Across several presentations, we heard how stigma and fear of discrimination continues to impact people’s confidence, self-efficacy, learning and economic potential, self-esteem, self-worth and readiness to come forward for healthcare. We heard how self-stigma and fear of discrimination remains a key reason for treatment and care drop out for younger people in particular, disadvantaging their longer-term health and wellbeing. In the conference Tackle shared the results of their programme in Uganda, where they use football to reduce self-stigma (which affects almost 85% of people living with HIV), increase ART adherence and improve health outcomes for young people living with HIV.

The challenges of localisation

A newer theme at the conference that is gathering pace was around the localisation agenda. We were pleased to support FCAA’s session titled – “Decolonizing HIV Philanthropy – Unlocking equitable resources for community led organisations” that drew in over 100 participants to engage in a lively workshop. This is a challenging area that raises a number of complex issues for funders and community-led implementing organisations alike to think through. Getting the balance right on the localisation agenda and ensuring that the benefits of global solidarity are not lost, especially when it comes to advocating for the most vulnerable and marginalised in countries with punitive laws will be critical. What came out loudly in the workshop was that some investments are failing to have the desired impact due to complex systems and processes that often disqualify locally-led organisations and value-based judgements such as trust that affect the flow of funds to those most in need. Avert welcomed the opportunity to talk about the steps we are taking this year to transition our work to locally-led organisations as part of a bold strategy putting the localisation agenda at the centre of decision making.

As we move on from the conference, we do so with a clear understanding that the UNAIDS 2030 goals must remain a priority and not get forgotten within the growing complexity of global health and human rights. Everyone has a right to health information and building HIV and sexual health literacy must continue to be recognised as a fundamental foundation underpinning progress in the HIV response going forward. Avert is confident that through our current transition strategy we are taking responsibility where we can and being proactive in an increasingly complex environment.

Photo credit: Avert.