LEN in the Spotlight at AIDS 2024

Dear Advocate,  

Zero infections! 

Midpoint at #AIDS2024 in Munich, one of the most significant advances in HIV prevention in the history of the response, the efficacy of lenacapavir as PrEP, was presented at the Co-Chair's Choice session. The findings, zero infections and 100% efficacy among the trial participants in the PURPOSE 1 trial, brought a standing ovation.  

Presented by Linda-Gail Bekker of the Desmond Tutu Health Foundation, and published in the New England Journal of Medicine, PURPOSE I enrolled 5,300+ cisgender adolescent girls and young women (ages 16-26) in South Africa and Uganda. PURPOSE 1 also evaluated daily oral emtricitabine/tenofovir alafenamide (F/TAF) for PrEP, which was shown to be safe. Overall adherence in the F/TAF arm of the trial was low and the intervention did not show overall efficacy. But, among those trial participants with medium to high adherence (2-4 doses per week), data showed a significantly lower chance of HIV infection compared to participants with low adherence.  

For more on PURPOSE 1 and the rest of the PURPOSE program evaluating lenacapavir across diverse populations, see AVAC’s primer for advocates, The Lens on LEN.

So now the work must accelerate.  

New UNAIDS data released at the meeting calculated that 44% of all new HIV acquisitions were among women and girls in 2023 globally, and young women in Africa accounted for 62% of new HIV acquisitions, making the case that there are millions of women in urgent need of HIV prevention and who must be given the opportunity to benefit from every proven method of HIV prevention. 

Data for key populations is just as stark. The latest data from UNAIDS points to marginalization, discrimination and criminalization as drivers pushing the median prevalence of HIV in 2023 to be much higher than the global average among sex workers, gay men and other men who sex with men, and transgender people (3%, 7.7% and 9.2% higher respectively than the global adult prevalence of .8%).  

All these populations represent individuals with unique and evolving needs. No single prevention product will ever be a miracle drug. People need real choices in programs tailored to reach them. Implementers, policymakers, donors, advocates and communities must collaborate for the speedy, reliable delivery of every option. Check out AVAC’s statement calling for early planning to accelerate LEN’s regulatory review and for ambitious introduction plans, and the joint civil society call to action with specific priorities about what needs to happen next. 

In a satellite session with advocates Wednesday, Winnie Byanyima of UNAIDS recommitted to the Choice Manifesto, a powerful declaration calling for continued political and financial support for more choice in HIV prevention. As Angeli Achrekar also of UNAIDS said at a subsequent session, “Both data and services need to be precisely tailored to the people who need prevention most, and we have to make solutions more affordable. We need a new HIV prevention revolution.”  

We couldn’t agree more. 

Best,

AVAC