In the heart of vibrant Nairobi, a dynamic gathering of 30 young individuals came together in August 2023. These were the champions of tomorrow, belonging to the Adolescent Girls and Young Women (AGYW) cohort. Their mission: to mark World Youth Skills Day with a bang, celebrating the boundless potential of young minds and their pivotal role in shaping our global health future.

This gathering had a clear purpose, and its objectives set the stage for exciting engagement outcomes.

• The participants were on a quest to make the world resonate with the advocacy efforts of the DAPI Ring, both on a national and global scale.
• Foster Inclusivity:- They sought to create an inclusive dialogue, a movement that would resonate far and wide, powered by WithMeInMe.
• Introducing the Choice Manifesto:- An introduction to the Choice Manifesto was on the agenda, igniting the spark of change.

Advocacy on the DAPI Ring: In the spotlight was the imperative of accurate information, dispelling myths, and the fight for free and accessible HIV prevention tools. Also highlighted was the progress of the CATALYST studies in Kenya and the progress of the activation sites to date.

Skills and Empowerment: The power of advocacy skills and communication took center stage. Social media emerged as a mighty weapon for spreading awareness. Evidence-based advocacy was highlighted as a critical tool in modern day advocacy. The participants went ahead and brainstormed around various ways digital media advocacy can amplify the call for inclusion of the DAPI Ring on the HIV Prevention basket of choice.

LGBTQI Inclusivity: The discussions ripped through stigmas, championing equality. Discussions illuminated a critical imperative: dismantling stigmas and dispelling misconceptions surrounding LGBTQI communities. The spotlight was on promoting acceptance and nurturing inclusivity within HIV prevention programs. In this narrative of change, education and awareness emerged as potent catalysts for fostering equality. This collective insight resounded loudly, underscoring the WithMeInMe campaign as a vital platform for meaningful dialogue. It hammered home the urgency of inclusivity and the indispensable role of education in propelling effective change within the realm of HIV prevention efforts.

Global Fund Writing Process:Ruth Jerop, AYAREP Executive Director and a community representative on the Kenya Coordinating Mechanism (KCM), graced us with an update on the Global Fund writing process. She stressed the critical need for the Dapivirine (DAPI) ring, citing past challenges faced by interventions like PEPFAR in effectively combating HIV. Jerop emphasized that the DAPI ring’s potential to empower individuals to take control of their bodies and sexual health has not been fully realized. Urgency looms, and addressing the roadblocks is crucial. She called for a thorough examination and rectification of these hindrances, ensuring that the Global Fund’s financial resources lead to a comprehensive, culturally sensitive implementation strategy.  As she concluded her address, Ruth appealed to the young audience to grasp the challenges faced by different demographics to enable the advocacy to be evidence-led. 

In the end, this electrifying gathering was a rallying cry for action. The Youth advocates pledged their dedication to HIV prevention, inclusivity, and the continued advocacy of the DAPI Ring. The Choice Manifesto launch scheduled for September 2023 lays a promising secure and effective discussions around the HIV Prevention Choice agenda regionally.

AfNHi Secretariat

Stakeholders have warned that COVID 19 disruptions are likely to set back efforts made in curbing HIV infections back to ten years or more. According to UNAIDS’ new report released in July 2020, while securing antiretroviral therapy has been steadily improving, the progress is inequitable. In its report, Seizing the moment, the World Bank warns that if we don’t act, even the gains made will be lost. To reach the Millions still left behind, nations must double down and work with more urgency.

Unequal progress

Prevention of new HIV infections in Africa is far behind the rest of the world. Nearly two million people were newly infected with the virus, more than three times the global target. Seizing the moment report shows unequal progress, leaving behind vulnerable people and populations. For example, infected key populations such as gay men and their partners, men who have sex with men, sex workers, drug users and people in prison, accounted for 62 per cent of these new HIV infections. Women and girls from marginalised communities face barriers to accessing reproductive health services, especially contraception and HIV services. Those living with HIV/AIDS face stigma. A total of 59 per cent of all new HIV infections in Sub-Saharan Africa in 2019 were among women and girls, with 4500 girls and young women between 15 and 24 years old becoming infected every week. Thus, a growing number of young women are getting HIV infection, despite only making up 10 per cent of the population in sub-Saharan Africa.

Exclusion, stigma and discrimination

Social inequity and exclusion, stigma and discrimination have proven to be significant obstacles in curbing the new HIV infections. At least 82 countries criminalise HIV transmission, exposure, or non-disclosure, 103 criminalise sex work, and 108 criminalise the use, possession, or consumption of HIV related drugs.

Progress in targets

There is, however, a significant reduction in HIV transmission levels where comprehensive HIV services are provided. In addition, combining proactive medical practices with social and economic support for young women in Eswatini, Lesotho, and South Africa has narrowed inequality gaps and driven down the incidence of new HIV infections. Fourteen countries have achieved the 90–90–90 HIV treatment targets (90% of people living with HIV know their HIV status, of whom 90% are on antiretroviral treatment and of whom 90% are virally suppressed), including Eswatini, which has one of the highest HIV prevalence rates in the world, at 27% in 2019, and which has now surpassed the targets to achieve 95–95–95. The expansion of antiretroviral therapy has saved countless lives.

However, in 2019, 690 000 people died of AIDS-related illnesses in 2019, and 12.6 million of the 38 million people living with HIV did not receive life-saving treatment. Although progress has been made, it is masking the lack of progress and challenges that continue to persist, threatening the progress made during the past decade, with tragic consequences for people’s lives, economies, and health security. Again, Sub-Saharan Africa is most affected.

A case for biomedical research

Reducing new HIV infections need to be a deliberate act in Africa. It is imperative that the locally tailored, evidence- based, and community-owned programs be tailored to sustainably reduce new HIV infections.

In the just-concluded 5^th  Biomedical HIV Prevention Forum (BHPF) hosted virtually in South Africa which focused on Financing of HIV Prevention Research in Africa, findings revealed that most countries did not have funding for biomedical research, and where research happened, it was mostly donor-driven.

To achieve Africa free of New HIV infections (AfNHi)’s vision of ending new HIV infections in Africa, the BHPF aims at mobilising scientific knowledge and building bridges between science and policy. In addition to mapping potential for collaborative national and regional activities within the AfNHi network, the forum looks to strengthen connections between policy and research through information exchange with HIV prevention advocates.

Reporting on the state of funding biomedical research in Africa, Dr Caleb Mulongo, in his research findings based on four countries; Kenya, Rwanda, Eswatini and Malawi noted that none of the four countries met the recommended allocation of two per cent of a country’s domestic budget to biomedical research.

While the Abuja Declaration targets that 15 per cent of the national budget be allocated to the health docket, none of the four studied countries (Kenya, Rwanda Eswatini and Malawi) met the target. The highest was Malawi with 11.5 per cent, with Kenya reporting the lowest allocation at less than seven per cent. Rwanda allocated about eight per cent while Eswatini allocated about nine per cent of their national budget to health.

When it comes to research allocation, Malawi set aside 1.06 per cent, which was the highest allocation from the studied countries. Eswatini had the least allocation, at 0.3 per cent.  Kenya allocated 0.79 per cent while Rwanda 0.27 per cent. It is evident low allocation in the health sector which is not adequate to support quality and universal coverage of health means there is very little if any funding to allocate to biomedical research.

More than underfunding

The mini-BHPF conferences held in Rwanda, Zimbabwe and Cote d’Ivoire, presented during the main BHPF forum had similar findings, that their respective countries had not prioritized biomedical research for preventing new HIV infections. More challenges beyond funding were nevertheless noted. There was a lack of expertise in writing proposals, those in charge do not know how to bind for funds to support their activities and where research was conducted, it was noted that because it was donor-driven, it did not particularly prioritise local issues, but rather ran with the donors’ agenda.

Own the process

A challenge has been thrown to African governments to invest more in biomedical research for HIV prevention funding, as well as invest in making sure systems are in place for translating findings into actions. A case of Malawi was noted, whose National Research Council of Malawi (NRCM) is domiciled in the Office of the President. This positioning is thought to be responsible for the higher allocations in the Health docket, hence elevating research as a national priority.

Other stakeholders including advocates for change, Civil Society and communities, Researchers and Front-line providers were called upon to keep the momentum for biomedical research HIV prevention funding, by pushing for better allocations of funds, elevating the discussion to the national level where policymakers sit and as well as information sharing across the countries.