Reflections from the AIDS 2018 Conference

Attending AIDS 2018 was a great opportunity to discuss new findings, innovations, and learnings with leading HIV experts. The conversations that I had during my presentation on Redefining partnership: The importance of coordination in HIV implementation programs, were eye-opening to the audience, who appreciated the need to prioritize on project coordination. In my experience working on the DREAMS-Innovation Challenge (IC)* project, I have seen firsthand the importance of leveraging diversified forms of partnerships to strengthen the effectiveness in service delivery, relevance, and sustainability of the project.

Under the theme of ‘Breaking Barriers Building Bridges,’ this year’s conference sought to bring attention to the need for rights and evidence-based approaches to more effectively reach key populations. Over 16,000 researchers, activists, and policymakers representing more than 160 countries participated in the numerous poster and panel sessions. Here are some key highlights:

• Prince Harry, the Duke of Sussex, emphasized the importance of breaking the stigma of HIV programming. To effectively advocate for policy change, it is critical to involve and provide young people with a platform to share their experiences on how HIV and AIDS affect their lives.
• Sir Elton John launched MenStar Coalition, a $1.2 billion partnership with PEPFAR, which seeks to engage men, particularly in sub-Saharan Africa, in new and innovative ways to break the cycle of male transmission of HIV.
• TackleAfrica, one of the three DREAMS-IC partners that is driving linkages of males to HIV/voluntary male medical circumcision (VMMC) services through football, presented at the MenStar Coalition booth. They had a skit on VMMC and a short discussion on the significance of having the procedure done.
• With targeted community-based and media campaigns, Kenya has made strides in its VMMC program. It reached 868,038 men between 2014–2017. However, National AIDS Control Council director, Nduku Kilonzo, said, “We have not celebrated this enough or leveraged the lessons—such as the importance of harnessing community leadership which has been key to all VMMC programs.”

Pre-exposure Prophylaxis (PrEP) was front and center at the conference. Two DREAMS-IC partners, the University of Washington and the Bar Hostess Empowerment and Support Program, made presentations on this. While vast experience exists in implementing PrEP programs for key populations around the globe, JSI’s DREAMS-IC project is a leader in pioneering PrEP programming in sub-Saharan African countries. Here are several takeaways from these two sessions:

1. PrEP has the potential to be integrated into family planning clinics, sexual health clinics, and youth centers.
2. Experts in the field need to better understand retention in care and adherence measures in order to tailor unique interventions to various communities.
3. Evidence showed there are missed opportunities for offering PrEP for HIV negative persons at health facilities, as many of the clients, especially girls and women were noted to have visited the health facilities seeking services for bacterial STIs, prior to HIV diagnoses.
4. Perceived risk is an important driver of PrEP initiation and continuation. However, it is not the only driver. Health facility-level factors and contexts within which individuals live need to be considered if they are to initiate and continue PrEP when needed.
5. Simply initiating individuals on PrEP is not enough. Issues of adherence must be considered.
6. We need to remember that PrEP is not the only prevention option and strive to identify what works for each individual.

As DREAMS-IC comes to an end in a few months, there are many lessons learned that we can apply to institutes for more robust systems for service delivery, not just in PrEP, but across the HIV care continuum. Stay tuned for a follow-up blog on this.

*DREAMS-Innovation Challenge is a 2-year PEPFAR-funded project that aims to reduce the incidence of HIV infections in adolescent girls and young women living in 10 sub-Saharan African countries. JSI develops organizational capacity where needed, manages funds, and provides overall program support for DREAMS–IC.