HIV Prevention News Around The Globe

Africa leads the world in reducing HIV infections

Africa's prevention measures in the fight against new HIV infections are paying off, according to a new report by UN Aids.

Sub-Saharan Africa has achieved the steepest reduction in HIV cases compared to 2010, it says.“Four countries (Kenya, Malawi, Nepal and Zimbabwe) have reduced their numbers of annual new HIV infections by 75 per cent and are well on track to reach the target of reducing new HIV infections by 90 per cent by 2030,” the authors state.

"For the first time, the number of new HIV infections outside sub-Saharan Africa surpassed the number of new HIV infections in sub-Saharan Africa." The report, titled 'The Urgency of Now: Aids at a Crossroads', was unveiled on July 22 at the 25th International Aids Conference in Munich.

New HIV infections have fallen by 39 per cent since 2010 globally, and by 59 per cent in eastern and southern Africa. However, the report shows that new HIV infections are on the rise in some regions, including in the Middle East and North Africa. Other regions seeing a surge in infections include Eastern Europe, Central Asia and Latin America.

Almost half of the people who acquired HIV in 2023 — 450,000 people of the global 1.3 million new cases — live in the eastern and southern African region. However, the report acknowledges that the two regions have achieved the steepest decline in new infections since 2010, a 56 per cent decline.

Globally, the steepest declines in numbers of new HIV infections have been among children aged 0–14 years, a trend that is reflective in Africa where “far fewer children aged 0–14 years are acquiring HIV”.

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Beginning of End of HIV Epidemic?

Researchers may have found a powerful new preventative against the AIDS virus, which has killed more than 40 million people since the epidemic began in 1981.

In late June, a trial of lenacapavir, an existing anti-HIV drug used to reduce infection, produced an astonishing result: None of the more than 2,100 young female participants in the test contracted the deadly virus. The results beat those of drugs currently being used for this purpose: Truvada, on which 16 of more than 1,000 women became infected, and Descovy, on which 39 of 2,100 plus contracted HIV, between 1 and 2 percent of those treated.

Lenacapavir, produced by drugmaker Gilead Sciences, works by preventing the virus from reproducing. Researchers wanted to know whether giving it to sexually active individuals who have not been infected — a strategy known as PrEP, or pre-exposure prophylaxis — might create a hostile environment in the body and prevent the virus from taking hold.

AIDS deaths peaked in 2004, but the condition still killed 630,000 in 2022, when there were 1.3 million new infections. In 2016, the United Nation’s member states committed to ending AIDS as a public health threat by 2030. Researchers have been unsuccessful so far in developing a vaccine.

The Gazette spoke with Roger Shapiro, professor of immunology and infectious diseases at the Harvard T.H. Chan School of Public Health, who has worked to fight AIDS in Botswana for two decades, including early trials exploring PrEP as a way to prevent mother-to-child transmission during breastfeeding. Shapiro said some caveats remain about lenacapavir, but the results are very promising.

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Possible Future HIV Cure

After a person has been infected with HIV, they remain infected for the rest of their lives. In the 1970s and 1980s, HIV was a death sentence, but now we have medications that can control it. There is no cure or vaccine, and patients must remain on medications for their entire lives. Now, the development of gene editing may offer a way of removing or inactivating HIV in the body. HIV infection usually spreads via unprotected sex. After infection, the virus spreads throughout the body, infecting the immune system cells that are mobilized to fight the infection. When HIV infects cells, it inserts its genome into the DNA of those cells. The HIV virus lives inside these cells and any future cells when the original ones divide. People with HIV who are treating it with medication cannot spread the virus.

A few weeks after infection with HIV, symptoms resemble the flu which can last days to weeks. During this acute phase, people have high amounts of virus in their blood and are contagious. Next, HIV moves into a phase called clinical latency, where the patient feels better but the virus continues to reproduce and infect immune cells. This phase can last a decade or more. Some HIV-infected immune cells go into a resting state. HIV can hide inside these cells for years, and the virus can reactivate at any time to make more viruses.

Without treatment, HIV infection progresses to a third stage, causing AIDS. This destroys the immune system, making patients susceptible to other infections. The average survival time is three years. Medications keep the virus from replicating and prevent the progression to AIDS, but they do not eliminate the virus hiding in the cells.

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Charting the Path to an HIV-Free Generation

The National Institute of Allergy and Infectious Diseases (NIAID) supports four research networks as part of its HIV clinical research enterprise. Every seven years, the Institute engages research partners, community representatives, and other public health stakeholders in a multidisciplinary evaluation of network progress toward short- and long-term scientific goals. This process takes account of knowledge gained since the networks were last funded and identifies essential course corrections based on the latest scientific and public health evidence. Subsequent NIAID HIV research investments build on the conclusions of these discussions.

Pregnancy, childbirth and the postnatal period are a key focus of NIAID HIV research and call for measures to support the health of people who could become pregnant as well as their infants. Biological changes and social dynamics such as gender inequality, intimate partner violence, and discrimination can increase the likelihood of HIV acquisition during all natal stages.

Of note, breastfeeding/chestfeeding is emerging as the predominant mode of vertical HIV transmission. NIAID is committed to optimizing HIV treatment and prevention options for people who might become pregnant, people who are pregnant and lactating, newborns, and young children who are still nursing or are living with HIV. Our goals are to offer safe, effective, acceptable, and accessible tools that provide evidence-based HIV prevention choices throughout the period of reproductive potential; prevent vertical HIV transmission to infants; and enable infants born with HIV to experience long periods of HIV remission or complete HIV clearance. We think these goals can be reached with discovery and development studies to advance biomedical interventions, and implementation science to rapidly introduce state-of-the-art interventions where they are needed most urgently.

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Spoiled for choice? What's blocking uptake of HIV prevention tools

In addition to widening the selection of HIV prevention tools, experts are calling for lower prices, faster regulatory approval, and engagement with communities to ensure there will be demand.

With the recent advent of new HIV prevention tools, including the start of last month’s International AIDS Conference- a promising injectable that appears to offer six months of protection, providers are moving closer to being able to offer a variety of HIV prevention services.

It is increasingly clear, though, that simply expanding choice will not be enough to hit global targets of having 10 million people on some form of preexposure prophylaxis, or PrEP, by 2025. An estimated 3.5 million people accessed PrEP in 2023. In addition to widening the selection, experts are calling for lower prices, faster regulatory approval of the tools, and, perhaps most critically, engagement with communities to make sure there will actually be demand for the methods when they become available.

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CDC Finalizes DoxyPEP Guidelines

The Centers for Disease Control and Prevention (CDC) has issued clinical guidelines for using doxycycline as post-exposure prophylaxis after sex to prevent sexually transmitted infections (STIs). DoxyPEP involves taking a single dose of the antibiotic within 72 hours after anal, vaginal or oral sex.

The new guidelines are supported by findings from the DoxyPEP trial, which enrolled more than 500 gay and bisexual men and transgender women at public health clinics in San Francisco and Seattle. Taking doxycycline after sex significantly reduced the risk of gonorrhea, chlamydia and syphilis. But this approach failed to lower STI incidence in a similar study of cisgender women in Africa, likely due to poor adherence. Concerns about doxyPEP include antibiotic resistance and its effect on the gut microbiome.

The CDC recommends that health care providers should discuss doxyPEP with gay, bisexual and other men who have sex with men and transgender women who have had a bacterial STI within the past year. For other groups, providers are urged to use their clinical judgment and shared decision-making with patients.

“Doxy PEP represents the first new STI prevention tool in decades, at a time when innovation in the nation’s fight against STIs is desperately needed,” says Jonathan Mermin, MD, MPH, director of the CDC’s National Center for HIV, Viral Hepatitis, STD and TB Prevention.

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Advocates Spotlight

WACI Health's youth leadership and advocacy program recently onboarded a new cohort of mentees. This program aims at creating a cadre of high quality and impact youth advocates. Our current cohort has young people from different African countries who meet online twice a week for mentorship. The program involves regularly bringing in mentors and experts to speak on and share their experiences. Meet Progress Agboola who is an HIV prevention advocate based in Nigeria.

Progress Agboola is a medical doctor and global health advocate with over six years of experience in HIV prevention and sexual and reproductive health and rights (SRHR) advocacy. As a Program Officer at Sage and Enamel Foundation (SANDEF), he has implemented impactful community-based projects, significantly reducing the burden of HIV and other infectious diseases in Nigeria. His commitment to HIV prevention is further demonstrated through his role as a Youth Advocate at Africa Free of New HIV Infections (AfNHi) and his current position as Programs Intern at WACI Health, where he contributes to developing program initiatives for African-led advocacy in biomedical HIV prevention research.

Through his various roles and achievements, Progress continues to drive meaningful change in global health, focusing on HIV prevention and improved health outcomes in resource-limited settings.