Dear Advocates,
Ten years ago this week, on July 16, 2012, the US FDA approved oral TDF/FTC for PrEP. On that joyful day, there was widespread hope that a daily pill, proven to be up to 95% effective at preventing HIV, would quickly lead to a diminishing pandemic.
Ten years later, just
2.4 million people worldwide have initiated oral PrEP, a far cry from what’s needed with 1.5 million people still acquiring HIV each year. What happened?
At the hearing where the US FDA considered oral PrEP in 2012,
AVAC gave testimony urging the global community to “act now on the scientific evidence and translate it into practice and impact.”
Unfortunately, the foresight that no prevention product, no matter how good, can achieve widespread use without focused, funded and supported policies and programs to ensure that it’s accessible, affordable and responsive to user needs has not been heeded. Advocates who track the history are calling out the inequities. See veteran advocates’ Jim Pickett’s article,
It’s No Time to Rest on Our Laurels and Matthew Rose’s article,
10 Years later, Where Are My Options.
We missed the mark with oral PrEP, but today, as we stand poised to rollout injectable PrEP and the PrEP ring, we have another chance.
In
Stop Squandering Our Chances to End AIDS published today in STAT's First Opinion, Linda-Gail Bekker and
Mitchell Warren argue that the world has another chance right now to roll-out lifesaving scientific HIV prevention, and build better models for delivering services for HIV, and for other diseases as well, building on the lessons from oral PrEP. They share key lessons on how (and how not) to rollout new options:
First: products don’t end pandemics. Scientific discovery must be supported with robust and concurrently conducted research about the needs and preferences of the people prevention should help.
Second, talking about sex and relationships is essential to product uptake and effective use. Most health marketing efforts, however, lack the budget, imagination or insight to engage potential users.
Third is the need to make health systems much more responsive to their customers. Bad service, inconvenient hours and stigmatizing attitudes don’t build consumer interest in prevention. Neither do health marketing efforts that use clinical terminology and focus exclusively on HIV risk. Research shows that uplifting, aspirational conversations about healthy sexuality and relationships are much more effective.
Fourth, equity and community engagement are essential at every stage of product development, introduction and access. People know whether the products they’re offered have been developed with the support, engagement and input of their communities. They are also keenly aware of whether essential health products are being distributed according to need, or stockpiled by wealthy countries. Equity and engagement should not be seen as goals, or even as priorities. They are essential cornerstones of prevention. Without them, the whole structure falls.
Finally, it is time to fundamentally reframe HIV prevention to emphasize consumer choice. Science has given us pills, long-acting injections and a vaginal ring for prevention. Implants, vaccines, antibodies, multipurpose prevention technologies and other potential options are in development. A comprehensive approach to HIV prevention that embraces and supports choice is essential to increasing prevention uptake and ensuring that products are used for maximal impact.
The challenging rollout of oral PrEP has taught us all so much about the hard work behind making prevention access real. We at AVAC look forward to working together to apply the lessons of the past decade to the promise of the future, and to help make prevention options feasible and impactful choices.
Best,
AVAC
P.S. see here some related resources for advocates:
STAT First Opinion: Stop Squandering our Chances to End AIDS
Report:
Getting Rollout Right: Lessons from Oral PrEP (PrEPWatch.org)
Global PrEP Tracker
Report:
Translating Scientific Advance into Public Health Impact: A Plan for Accelerating Access and Introduction of Injectable CAB for PrEP (AVAC)
