Px Pulse

It’s considered one of the most important and most difficult scientific enterprises in the history of modern medicine—the hunt for an HIV vaccine. It has led to vast knowledge of HIV and the immune system, and to breakthrough technology. But developing an effective HIV vaccine is still out of reach, while HIV incidence remains high in hard-hit places in the world. In this episode, Nina Russell of the Bill & Melinda Gates Foundation talks about where she sees promise in the science, the goals for an HIV vaccine, and why it has an essential role to play alongside the scale-up of PrEP. Go to https://avac.org/resource/an-hiv-vaccine/

Our debut episode of the Advocacy Chronicles features Yvette Raphael, the Executive Director of Advocacy for Prevention of HIV and AIDS (APHA) in South Africa, and a leader in the development of The Choice Manifesto, supported from start to finish by CASPR. As co-chair of the African Women Prevention Community Accountability Board (AWPCAB), Yvette and other board members launched the manifesto in Kampala, in September 2023, calling for choice in HIV prevention options for women — such as oral and injectable cabotegravir for PrEP, the dapivirine vaginal ring and the Dual Prevention Pill — and a commitment to expanding access to them. A call heard by UNAIDS Executive Director Winnie Byanyima, who was on hand at the launch to endorse the manifesto. Yvette, who is also a 2014 AVAC Advocacy Fellow and celebrated as one of South Africa’s leading human rights activists, lays out why The Choice Manifesto matters and how advocates are leveraging it.

In this episode of PxPulse, we talk about why and how the decisions that shape global health must be made by those facing the greatest risks. As the world evaluates the pandemic response and debates on decolonizing global health gain momentum, equity in global health has never been more urgent. This conversation features global health leader and critic, Dr. Madhukar Pai. And two members of the transnational coalition COMPASS Africa, Francis Luwole and Barbra Ncube, offer an up-close look at the coalition’s pioneering new model for power-sharing. Get more details and resources at https://avac.org/resource/decolonizing-global-health/

People who are pregnant or lactating (PLP) have historically been excluded from research because of concerns for the developing fetus. But this has led to a dearth of data on new interventions against health threats for this population. In the case of HIV, pregnancy raises the risk of acquiring HIV by up to three times, but providers often do not have the data to know whether a new intervention is safe or how it will work for pregnant patients. As a result, PLP and their physicians are left to make difficult decisions around the use of proven HIV prevention products as they await more data specific to pregnancy and lactation. But change is in the air. Champions for the inclusion of PLP in research are paving the way for a paradigm shift— one that will redefine this population from needing protection from research to being better protected through research. In this episode of Px Pulse, AVAC’s Manju Chatani-Gada takes us through conversations with a trial participant who became pregnant, researchers, policy-makers, and donors to understand why this population gets excluded, the impact it has, and what to do about it.

2023 is a big year for PEPFAR. PEPFAR’s considered one of the greatest US foreign policy and global development achievements of the century; the program has saved upwards of 25 million lives since it launched in 2003. But PEPFAR is marking its 20th anniversary while fighting for its future. Its authorization expires Sept. 30th. Until a couple of months ago, most expected smooth sailing for a five-year reauthorization of the program, which has enjoyed deep and broad bipartisan support since its founding. Evangelical Christians, staunch conservatives, DC Democrats, progressive HIV activists, and public health leaders have championed PEPFAR year in and year out. But a handful of Republicans, including past PEPFAR allies, are pulling reauthorization into American abortion politics— despite US laws on the books that prohibit PEPFAR dollars from funding abortions. Supporters across the political spectrum, including many Christian conservatives, are now rallying to ensure this uniquely effective program continues. In this episode, Px Pulse talks to some of the people who put PEPFAR dollars into action, bringing life-saving medicines, prevention and healthcare to people living with HIV, orphans and other vulnerable communities. And we talk to health leaders who explain why PEPFAR’s approach represents a gold standard in advancing global health, and what’s at stake in this debate.

With several large HIV vaccine trials in the last few years finding no efficacy, the field is in transition. There are diverse ideas in vaccine research, but there's no clear concept that's ready to test in a late-phase trial or move toward product development currently. Researchers are back to testing new ideas in early-phase research. In this episode of our Px Pulse podcast, Dr. Katy Stephenson explores the implications of recent trial results, the big questions driving next-generation vaccine development, and new strategies underway in early-phase research. Katy is a doctor, a researcher, a professor of medicine at Harvard Medical School, affiliated with Beth Israel Deaconess Medical Center, and part of the Center for Virology and Vaccine Research.

In March 2023, the Ugandan Parliament moved forward broad-reaching legislation to further criminalize LGBTQIA+ people. The bill would make it a crime to even identify as lesbian, gay, bisexual, transgender or queer, with sentences up to life imprisonment. It gives authorities wide powers to crackdown on anyone who does not report on same-sex couples or who promote gay rights, including prohibitions on media coverage. And the law could impose death sentences in some cases, including for the transmission of HIV. Uganda’s President Museveni has the power to stop the bill. But so far he is issuing statements for other African countries to follow Uganda down this path. Anti-gay hate laws and actions by authorities are sweeping across the region with recent crackdowns in Ghana, Kenya, Rwanda, Tanzania and Zambia. After the news broke from Uganda, AVAC and partners came together for a call with advocates in Uganda. They are fierce and imperiled voices who are readying to fight for LGBTQIA+ people in Uganda, but at AVAC, we know they are fighting for all of us. On the call, advocates dug into the specifics of how these attacks have gained momentum and their ties to US-based religious extremists. And advocates discuss what needs to happen next.

Over the coming months, global leaders will make key decisions about several initiatives to prepare for the next pandemic. What they commit to and how much they will spend, and how well these plans incorporate equity as a principle across all of these initiatives, is in question. Deadlines for civil society to influence these decisions are coming up. There's a Pandemic Fund, a Pandemic Accord, several UN High-Level Meetings, and a Medical Countermeasures, or MCM, platform, which would coordinate country commitments around drugs, vaccines, diagnostics and other equipment for health emergencies. In our last podcast, we spoke with Chris Collins, President of Friends of the Global Fight Against AIDS, TB and Malaria about all these efforts. He talked about how ultimately these decisions will build a new architecture for Pandemic Prevention, Preparedness, and Response, or PPPR. Chris highlighted what the world learned from COVID 19 and from HIV. We were reminded that so many of the successes from 40 years of fighting HIV came directly from community leadership, and a focus on equity. But it’s not clear whether planning for the next pandemic is heeding these lessons. Karrar Karrar, who heads up Health Policy at Save the Children, and Samantha Rick, who leads AVAC’s PPPR policy advocacy, have been tracking these efforts closely. They explain exactly what commitments for equity are needed and who needs to hear this advocacy and when.

Health leaders and advocates around the world are in the midst of creating a new architecture to deal with pandemics. This means new structures, systems and financing for pandemic prevention, preparedness and response — PPPR, for short. A lot is being discussed, and a lot more is riding on the decisions. Chris Collins, the CEO and President at Friends of the Global Fight Against AIDS, Tuberculosis and Malaria and an AVAC co-founder, has been tracking this work. He’s warned of the risk of multiple, siloed systems for global health, and was a co-author of the recent PLOS Global Public Health article, Leveraging the HIV response to strengthen pandemic preparedness, which describes many parts of the HIV response that have been, and must continue to be, central to a bolder vision for this new architecture and for global health at large. In this episode of Px Pulse, Jeanne Baron talks to Chris about what’s at stake, which policy-makers get it already, why this year matters so much, and what advocates can do about it.

With all the talk about new HIV prevention products such as the dapivirine vaginal ring or injectable cabotegravir for PrEP, what’s little understood is how to match proven products with programs, policies and the political will that's needed to get these products to the people who need them. PEPFAR Ambassador Dr. John Nkengasong shares his plan for meeting the moment. Also in this episode, seasoned advocates take on what's working and what's missing in programs today, and the expanding role of civil society in global strategies to end AIDS by 2030.

In this episode, AVAC’s Jeanne Baron and co-host immunologist Katharine Kripke of AVENIR Health explore why developing a vaccine for HIV is different from other viruses. Two vaccine researchers, Caltech’s Pamela Bjorkman and IAVI’s Vincent Kioi, lend their expertise. Learn how HIV has evolved like no other virus that exists today to escape detection by the immune system. Learn why the right target on HIV is so hard to reach and how scientists are tackling it all.

Linda-Gail Bekker from South Africa’s Desmond Tutu Health Foundation and Lillian Mworeko from the International Community of Women Living with HIV East Africa (ICWEA) join host Jeanne Baron and AVAC’s Executive Director Mitchell Warren to discuss innovative models for scale-up and delivery. Taking the right steps now could mean HIV prevention options fulfill their life-saving, epidemic-ending potential. It will require working faster and more efficiently than ever before. We dive into what lessons the field has learned, what’s still off-track, and the steps advocates, policy-makers, drug makers and funders should each take right now to turn efficacious options into effective choices.

Endpoints are a crucial component in every clinical trial but they are not always well understood, and putting them in context is essential for effective advocacy. This next installment of the Px Pulse series, Research Fundamentals, which explores key scientific concepts, lays out what endpoints are and why they matter.

The latest episode of Px Pulse goes behind the scenes of the new HBO movie, The Legend of the Underground. The film documents the lives of AVACer Micheal Ighodaro and other LGBTQ Nigerians as they confront enormous risks to ‘live out loud’.

The latest episode of Px Pulse takes a deep dive into PEPFAR, The President’s Emergency Plan for AIDS Relief. AVAC’s former Director of Strategy and Content, Emily Bass, has just published To End a Plague: America’s fight to end AIDS in Africa which documents its pioneering successes and its challenges.

Findings from two trials on antibody-mediated prevention, the AMP Trials, have been generating discussion since the beginning of the year. The results are complex, and the implications for HIV prevention research are unfolding.

Early results from trials testing cabotegravir as a long-acting injectable PrEP show it was safe and highly effective against HIV. Listen to learn what must come next for CAB-LA to advance HIV prevention alongside oral PrEP and the Dapivirine Vaginal Ring?

After decades of research and advocacy, the ring is now one step closer to becoming available as a discreet, woman-initiated HIV prevention option.

Whether it’s condoms, a flu shot, oral PrEP or the dapivirine vaginal ring, proven products fall short of 100 percent protection against disease, and there’s a lot to know about how and why an intervention may offer imperfect but still useful protection. This episode is part of a new series on Px Pulse, Research Fundamentals

In this episode of Px Pulse, hear unique perspectives on how COVID-19 and HIV are shaping one another. Mark Feinberg, CEO of IAVI, and Helen Rees, Executive Director of the Wits Reproductive Health and HIV Institute (Wits RHI), speak to COVID-19 vaccine development. Sinead Delany-Moretlwe, Director of Research at Wits RHI, Vincent Basajja of the Uganda Virus Research Institute, Jau Nanyondo from Uganda’s Makerere University Walter Reed Project and Philister Adhiambo from the Kenya Medical Research Institute, explain how HIV prevention trials are adapting in the wake of COVID-19.