HIV Prevention News Around The Globe

Murang’a calls for establishment of special HIV and TB fund ahead of donors exit

The Murang’a County Assembly has adopted a report that proposed the establishment of a special fund to manage HIV and tuberculosis on Tuesday.

Tabling the report, Chairperson of the Assembly’s Committee on Health Service Boniface Ng’ang’a urged the County Executive Committee Member for Health to prioritise publicising the Murang’a County HIV/AIDS Bill 2024. According to Ng'ang'a, the report would provide a framework for the provision of a special fund for HIV and TB management in the county.

Ng’ang’a said key donors who fund HIV/AIDS programmes in the county would withdraw their donations in 2027, and the enactment of the bill would enable Murang’a to be self-reliant after the donors’ exit. “World Bank, CDC, and other NGOs that fund the HIV/AIDS programmes in the county will be withdrawing their donations in 2027," he said. "Approval of this Bill will lead to the development of HIV/AIDS Regulations to create a special fund for HIV and TB management in the County.”

To stop the spread in these areas, Kahumbu MCA Chefman Njoroge said that the County Executive Committee needed to come up with educational programmes to teach farmers the importance of using protection during sex.

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Long-acting injectable lenacapavir continues to show promising results for HIV prevention

WHO welcomes the latest findings from the PURPOSE-2 trial on long-acting injectable lenacapavir (LEN) for HIV prevention. An interim analysis, announced on 12 September 2024, demonstrated the drug’s remarkable efficacy in preventing HIV. LEN, an HIV-1 capsid inhibitor delivered by subcutaneous injection twice a year, was shown to be highly effective in preventing HIV among cisgender men, transgender men, transgender women, and gender non-binary individuals who have sex with partners assigned male at birth.

The PURPOSE 2 trial reported a 96% reduction in the risk of acquiring HIV among study participants, with 99.9% of individuals using LEN not acquiring HIV. Only two new HIV cases were recorded among 2180 participants receiving LEN twice-yearly, compared to nine new cases among the 1087 participants receiving daily oral TDF/FTC (tenofovir disoproxil fumarate/emtricitabine). Lenacapavir demonstrated a 96% reduction in HIV incidence compared to background HIV incidence (2.37 per 100 person-years) and was 89% more effective than daily oral TDF/FTC in preventing HIV acquisition. Both LEN and daily oral TDF/FTC were well tolerated, with no significant or new safety concerns identified.

Together, the results from PURPOSE 1 and PURPOSE 2 provide compelling evidence for the potential of LEN to transform HIV prevention globally, across diverse populations. It is important to note that oral PrEP is safe and effective in preventing HIV when taken as indicated. LEN’s twice-yearly dosing offers a significant advantage for people who face challenges with adhering to daily oral PrEP, including stigma and discrimination, pill fatigue, and challenges with consistent access to medication.

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Namibia marks HIV/Aids wins but stigma puts LGBTQ+ people at risk

HIV/Aids remains the leading cause of death in Namibia, where some 230,000 people have the disease. But the southern African country of 3-million people is also seen as one of the most successful in slowing the spread of HIV, with experts crediting community-focused HIV prevention and treatment programs.

New HIV infections in Namibia fell by 54% between 2010 and 2022, according to data from UNAids, the UN's main agency working on the epidemic. But girls and young women, sex workers, men who have sex with men and trans Namibians are among population groups still at high risk for HIV. Dausab said stigma is still a major obstacle to life-saving treatment for marginalised groups such as LGBTQ+ people. “Even though Namibia has free services and medications, if people can't get them, then it's almost like having a beautiful car without the key to drive it,” he said.

'Innovative strategies'

Among the milestones Namibia has reached in the fight against HIV/Aids is nearly eliminating mother-to-child transmission, the first country in Africa to achieve this. The country is also close to meeting UNAids’ so-called 95-95-95 targets, in which 95% of people living with the virus should know their status, with 95% of those diagnosed receiving antiretroviral treatment. Among them, 95% should show viral suppression. A long-running campaign to encourage circumcision — which has included enlisting Namibian Kwaito musician The Dogg to popularise the “Smart Cut” — has helped expand a voluntary medical male circumcision programme that is covered by the public healthcare system.

“Innovative strategies tailored to local contexts have been vital for our progress,” said Rachel Love Gawases, executive director at Namibia's Equal Rights for All Movement, a sex-worker rights organisation.

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Study: Twice-yearly PrEP works for gay men, trans women

Lenacapavir, a twice-yearly injectable antiretroviral, reduced the risk of HIV infection by 96% in a large study of gay and bisexual men and gender diverse people, according to a Gilead Sciences announcement.

Along with recent data from a parallel study of cisgender women, these results position lenacapavir for federal Food and Drug Administration approval for HIV prevention, possibly next year. Advocates are already pressuring Gilead to ensure that lenacapavir PrEP is made available at an affordable cost to those who need it most.

Jorge Roman, senior director of clinical services at the San Francisco AIDS Foundation, is eager to start offering twice-yearly PrEP as an additional prevention option. "We hope that the path to FDA approval for lenacapavir goes quickly and smoothly," Roman told the B.A.R. "We still need more tools and resources to end HIV transmission in this country and globally. Long-acting injectable versions of PrEP could do a lot to help us end the HIV epidemic. A key here is that new PrEP options must be affordable and accessible."

As the B.A.R. reported this week, the San Francisco Department of Public Health's latest HIV epidemiology annual report shows an encouraging decline in new cases, but twice-yearly PrEP could further move the needle. While the daily PrEP pills Truvada and Descovy (both from Gilead) are around 99% effective when taken consistently, additional options are still needed. Some people have trouble remembering to take a pill every day and some are hesitant to have pill bottles that could be lost or stolen or reveal they are at risk for HIV. Currently, ViiV Healthcare's Apretude (injectable cabotegravir), which is administered every other month, is the longest-acting PrEP option.

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Breakthrough vaccine strategy guides the immune system to generate HIV neutralizing antibodies

A team led by the Duke Human Vaccine Institute (DHVI) has developed a vaccine approach that works like a GPS, guiding the immune system through the specific steps to make broadly neutralizing antibodies against HIV.

Publishing in the journal Cell Host & Microbe, the study describes an approach that provides step-by-step directions for the immune system to generate the elusive, yet necessary antibodies for a successful HIV vaccine. HIV is the fastest-evolving virus known. So it's been a long-standing goal in HIV research to create a vaccine that can generate broadly neutralizing antibodies that can recognize diverse HIV strains."

Kevin Wiehe, Ph.D., lead author, associate professor in the Department of Medicine at Duke University School of Medicine and director of research at DHVI. Wiehe and colleagues started with an engineered version of a broadly neutralizing antibody in its original state, before any mutations occurred. Knowing that the antibody will need to mutate to keep up with the ever-changing HIV virus, the researchers then added sequential mutations one-by-one to determine which mutations were essential for the antibody to broadly neutralize HIV.

Doing this allowed them to figure out what the exact points were along the route to arrive at broadly neutralizing antibodies. They then developed a vaccine which gave the immune system the turn-by-turn directions to follow that mutational route. Using mice specially bred to encode for the original version of the antibody, the researchers demonstrated that the guidance system approach triggered the immune system to start churning out the sought-after antibodies.

"This paper shows that our mutation-guided vaccine strategy can work," said Wiehe, adding that the technique could also be used in vaccines for other diseases.

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WHO calls for action to support adolescent mental and sexual health

Increased investment is urgently needed to address evolving health risks and meet the mental and sexual and reproductive health needs for the nearly 1.3 billion adolescents (aged 10-19 years) globally, according to a new scientific publication released by the World Health Organization (WHO). Adolescence is a unique and critical stage of human development, involving major physical, emotional, and social transitions, and is a pivotal window for laying long-term foundations for good health.

The publication was launched at an event on the margins of the United Nations' Summit of the Future. It highlights a number of troubling trends in adolescent health observed over the last decade, pointing to the urgent need for action. At least 1 in 7 adolescents globally now suffer from a mental disorder, for instance, with particularly high rates of depression and anxiety. Anaemia among adolescent girls remains prevalent, at levels similar to those in 2010, while close to 1 in 10 adolescents are obese. Sexually transmitted infections (STIs) including syphilis, chlamydia, trichomoniasis, and genital herpes that commonly occur among youth are rising, and if left untreated, can have lifelong implications for health.

The study emphasizes other broader fundamental challenges to the future of adolescents including climate change, conflict, and inequality. The authors also highlight that gains are possible with the right investment and support. For example, adolescent HIV infections have declined, due to coordinated and persistent efforts in this area. Adolescent pregnancy and harmful practices such as female genital mutilation and early marriage have reduced. In addition, many positive trends in health outcomes are linked to more time in school, especially for girls; since 2000, the number of secondary-school-age children out of school decreased by nearly 30%.

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