PrEP Access in Africa: US Cuts & New Funding Models
PrEP Innovation and access: Charting the Future of HIV Prevention
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London, UK – The ongoing evolution of HIV prevention strategies was a central theme at a recent discussion, highlighting the need for ambitious planning and innovative approaches to ensure equitable access to new tools like long-acting PrEP. Dr. Yogan Pillay, Director of HIV & TB Delivery for the gates foundation, emphasized that support from organizations like the Global Fund and the Gates Foundation shoudl be viewed as “catalytic” rather than foundational, underscoring the importance of sustainable, locally-driven programs.
The Promise of Monthly Oral PrEP and Beyond
Dr.Pillay pointed to the progress of MK-8527, a once-monthly oral PrEP pill anticipated to be available by 2028, as a significant advancement. He stressed the immediate need to develop access programs for this new formulation and to strategize its integration alongside existing injectable and daily oral PrEP options.
“Bundling PrEP programmes into, for example, family planning services is entirely feasible,” Dr.Pillay stated, advocating for a model of “wholesale health innovation.” He suggested that artificial intelligence (AI) could play a crucial role in modeling and optimizing these integrated service delivery approaches.
Addressing the “Elephant in the Room”: Reaching Key Populations
A critical question raised by Charles Brown, an AVAC Fellow and PrEP advocate from uganda, addressed the significant challenge of delivering PrEP to criminalized and stigmatized populations, including gay and bisexual men and transgender women in countries with restrictive legislation. UgandaS notorious anti-LGBT+ laws, as documented by Human Rights Watch, create substantial barriers to accessing essential health services.
Lloyd Mulenga, acknowledging the difficulties faced when national health budgets do not specifically account for the unique needs of key populations, noted that “accessing the usual service points might be very difficult.” Though, he proposed that local authorities could facilitate the use of community service organizations’ venues to create safe spaces. This could involve offering support for LGBT+ individuals within existing youth services, allowing funding for key populations to be channeled through more general budget lines.
“But,” Mulenga added, “we do need to make sure that safe spaces are more available.”
A Call for Ambitious Prevention
Concluding the session, Mitchell Warren, reflecting on the 40-year history of HIV response, stated, “We’ve spent the first 40 years in HIV on treatment. But prevention is not just what you do after you get everyone treated. In the next 40 years can we be as ambitious for prevention?” This sentiment underscored the imperative to shift focus and resources towards proactive HIV prevention strategies.
Following the AVAC session,aidsmap spoke with Remko van Leeuven,strategic advisor for Aidsfonds,a Dutch funding organization. Van Leeuven described the session as “highly constructive,” expressing encouragement at the concrete commitments made by key stakeholders. He particularly valued the candid insights shared by Lloyd Mulenga from the Zambian Ministry of Health, whose openness about the political realities of implementing effective approaches offered crucial lessons for future strategies.
“it’s genuinely encouraging to see multiple African governments now incorporating both HIV cure research and lenacapavir roll-out as a central pillar of their national AIDS strategies, signalling a significant shift in how the continent is approaching long-term HIV response planning,” van Leeuven concluded. This growing commitment from African governments to integrate cutting-edge research and treatment options into national strategies signals a promising trajectory for the future of HIV response across the continent.