AIDS IS NOT OVER: Address inequalities, accelerate inclusion and innovation

#ICASA2023
Daily E-Bulletin Issue 5: (9 December 2023)

Curtain comes
down on ICASA
2023
By Kuda Pembere
and Michael Gwarisa

T
he 22nd edition of the Inter-
national Conference on AIDS
and STIs in Africa (ICASA)
ended on Saturday with calls to step
up support for communities of people
living with HIV for the elimination
of the pandemic by 2030 being made.

Speaking on behalf of Zimbabwe’s

Vice President Dr Constantine Chi-
wenga, Foreign Affairs and Interna-
tional Trade Minister Fredrick Shava
said it was important to put commu-
nities at the fore in HIV responses.

“I am particularly encouraged by the

emphasis placed on strengthening
community engagement and involve-
ment. Community-led responses
have proven to be effective in raising
awareness, reducing stigma and dis-
crimination, and improving access to
prevention and treatment services.

“Let us therefore support and amplify Foreign affairs Minister Hon Shava closes ICASA 2023
the voices of those most affected
by HIV and AIDS, STIs and Ebola
at community level, so that their
experiences can shape our policies
and interventions,” the Vice President
said.

VP Chiwenga also said multisectorial

and all-inclusive approach is critical
in the HIV response.

“The conference has reminded us

of the importance of implementing
comprehensive and evidence-based
prevention strategies that prioritize
vulnerable populations, including
young people, sex workers and peo-
ple who use drugs.

“By adopting a multi-sectorial,

all-inclusive approach, we can create have learned at the 22nd edition of “And this time around, we have no- This year, we give a total of 1,771
an enabling environment that fosters “The conference reminded us that ICASA to edify the response to HIV, ticed that at the community village, scholarships. It is also important to
healthy behaviors and empowers AIDS is not over and we must re- Ebola, and other epidemics,” he said. we have 6,856 participants. 275 notice that in terms of abstracts, we
individuals to take control of their main vigilant to ensure we effectively participants. The total participants received 2,600 abstracts. And 2,540
sexual and reproductive health,” he truncate and achieve the Sustainable Society of AIDS in Africa (SAA) for this ICASA Zimbabwe 22nd was reviewed. 1,747 was rejected.
said. Development Goals by 2030 without president Dr David Parirenyatwa said edition is 8,118 participants. As we “And to run this ICASA 23, we run
leaving anyone behind. Spectacular they will open the bid for countries to are talking about participation, it it with 78 oral abstracts. We also
Health and Child Care Minister as it may have been, we have to rec- host the next ICASA conference for is very important that we should run it with 115 postcards. Let me
Dr Douglas Mombeshora said the ognize that the conference is coming 2025 by March next year. He also talk about the scholarship. It is conclude, Honorable, to say that in
conference had 78 oral abstract to its end and we must say goodbye. said they will publish an international important to understand that the terms of program, for the five days,
presentations, 19 non-abstract driven journal for this year’s conference. government of Zimbabwe gives we organized 182 sessions We have
sessions, 13 special sessions, 8 work- “We need to make friends and 500 scholarships to the local people 546 speakers coming from around
shops, 32 pre-conferences, 77 satel- connections, but still we must say ICASA director Luc Bodea said scholarships in person. the world,” he said.
lite sessions, 27 community village goodbye. It is my fervent hope that there were 8 118 attendance at the
sessions, and 813 abstract posters as the friendships and connections we conference. “And we give 1,571 scholarships.
well as nearly 480 speakers.
1
 #ICASA2023 HealthTimes
SAVE approach bears fruits in fighting stigma
By Munyaradzi Doma

P
art of the stigma that has been
obtained in the fight against
HIV over the years has been
largely due to stigma coated, hence
a better way of talking about the
disease was devised.

In an interview at ICASA, Reverend

Canon Professor Gideon Byamugi-
sha from Uganda, founder of Africa
Network of Religious Leaders Living
with or Personally Affected by HIV
who is now the Patron of the Interna-
tional Network of Religious Leaders
Living with or Affected by HIV said
after noticing the stigma within some
messaging, they had to come up with
the SAVE approach.

"We saw stigma that was coming

from the message that was being giv-
en as a prevention message; abstain;
if you can't, be faithful; if you can't,
use condoms.

"And then people are surprised to see

a religious leader who is positive and
say oh he can't abstain, he can't be
faithful, so we said no no no, this is
stigmatizing to abstinent people, to
faithful people and people who have
HIV from none sexual means, like
mother to child or infected blood so Reverend Canon Professor Gideon Byamugisha
we designed a new way of talking you empower those who are vulnera- about it, eliminate it because where and then develop answers and go
about Aids. ble or are already positive," he said. "People on treatment have increased, stigma is, people hesitate to test to faith communities for dialogue
people who are taking ARVs well to and when they test they hesitate to to say there is stigma coming from
"It's no longer new, it is being used He further added that the SAVE ap- the point they have undetectable viral disclose and when they disclose, people thinking you die early, so
in 25 countries, it's called the SAVE proach had really helped in terms of load are also increasing." they disclose too late. "So gov- how do we go about it, there is stig-
approach. reducing stigma as some results were ernments, communities and faith ma coming from people thinking
coming from ICASA. INERELA is present in 25 countries communities lose out on two fronts, you will spread HIV from eating
"How do you SAVE your community and has about 40 000 members. the infections spread which could with someone who is positive, so
from HIV, you multiply safe behav- "The stigma is reducing, we have have been prevented if someone how do we go about it," added Rev
iours and practices, A; you multiply reports from this conference, people "We support the faith communities, had done this in time and we lose Can Prof Byamugisha.
access and adherence to treatment saying Oh testing is 99 (percent), faith congregations to face up stigma, people early, so our work is to look
and good food, V; you increase others 98, others 96. interrogate it and do something at where the stigma is coming from
voluntary counselling and testing, E;

TASQ program
scales up HIV
epidemic control
in Zimbabwe’s
communities
By Michael Gwarisa

I
cadres which are also seconded by
n a bid to promote access to HIV OPHID and JFK and from our end as
services at the community level, ZNNP+.
the Target to Accelerate and
Sustain Quality Care for Epidemic “So for OPHID, they are what we
Control program has mobilised part- call community outreach agents, so
ners to work directly in communities they are involved in tracking and
and link clients to care. following up mainly with clients and
the industry, making sure that they
TASQ is a USAID-funded program receive services including provision
with OPHID as the lead organisa- of HIV self-test kits. Then from
tion and is being implemented in 15 our end, our goal is to also bring in
districts in four provinces. The four the community voices so that the
provinces are Harare, Masvingo, program hears what the community
Matabeleland South and Bulawayo. expects from the service providers,
Speaking to HealthTimes on the the implementing partners, from the
side-lines of the ICASA, Clarence health service providers, including
Mademutsa, Head of Programmes JFK.
and Training at ZNNP+ said the
TASQ was one of the best programs “So our role is to gather those voices
around. and share with the clinical partners
that there are issues we may be miss-
“So those are the 15 districts. So the ing our target here because we do not
work that we do, like the title of the have this A, B, C, D concern. So a
program suggests, we have targeted typical example of cervical cancer,
responses and we seek to accelerate there are a lot of misconceptions. We
the current interventions to ensure notice misconceptions that are built
that there's epidemic control. So in the community. So we share these during outreaches, they ensure it enhance and improve the delivery
this program seeks to accelerate my with the clinical partners, but we also happens. “We have 15 districts and we hope of services within a program before
interventions to ensure that we get work with the community to say, no, that all 63 districts have this kind of the external assessors come in and
to 2030 or even achieve those results this is misinformation. The correct “So for us, we are happy because it's arrangement, where the community say, okay, is this a gap and that
before 2030,” said Mademutsa. information about cervical cancer is a good model where communities voices are sufficiently captured and gap?”
A, B, C, D. are being engaged. And this is what covered. We do understand there's
OPHID and JFKPNEC work in the we've been pushing for oftentimes, this thing called CLM program.
15 districts and they offer clinical ZNNP+’s role is to communicate the clinical responses don't take any But it's different. It's different in
services through their secondary with the community and also get compensation. The social and soft that CLM comes now to be like an
healthcare workers within the their voices and often if they need issues that affect the reserves of the external auditor. But what we're say-
facilities and also community to communicate messages around provision of services. ing is through this program, we can

2
 #ICASA2023 Diary HealthTimes
ICASA : To e nd AIDS as a public healt h t hr eat , ramp up t he HI V r es pons e , including pae diat -
r ic t r eat me nt , and acce le rate pr eve nt ion f or adoles ce nt gir ls and k ey populations
By Own Correspondant
HARARE/GENEVA, 9 December
2023—Africa can end AIDS as a
public threat, but to do so African
governments and international
partners need to ramp up their HIV
responses. Actions needed include
accelerating treatment for children
living with HIV and prevention for
adolescent girls and key populations.
This was the message from UNAIDS
as the 22nd International Conference
on AIDS and Sexually Transmitted
Infections in Africa (ICASA) drew to
a close. UNAIDS is also calling on
governments to support communi-
ties’ vital leadership role in the HIV
response.

At ICASA, thousands of delegates,

including AIDS activists, grassroots
communities working to end AIDS,
governments and private sector
partners, key populations, doctors,
scientists, donors and other interna-
tional and African stakeholders came
together to advance progress in the
HIV response. Representatives from
communities urged authorities to step
up investments and policy reforms to
end AIDS. ing people who are currently not threat by 2030 if communities on the fight against the epidemic at risk. operate with insufficient budgets
accessing treatment and ensuring that frontlines get the full support they and little political or no political
“Emerging from this conference we all people who need access to HIV need from governments and donors, Accelerate innovation, science support, limiting their full poten-
are clear. To end AIDS, governments services, including key populations, including political and financial and increase political and financial tial to do their work, including
and partners need to step up HIV have it.” backing. support to end AIDS providing life-saving services. Gov-
prevention efforts to reach chil- ernments need to increase political
dren, young women, girls and key Let Communities Lead During the conference, communi- Delegates attending the conference and financial support, especially for
populations. And they need to ensure ties called for recognition of the called for accelerated innovation to community-led responses and civil
that every person living with HIV In its World AIDS Day report Let important work that they do. They quickly turn the tide against AIDS. society organizations working to
has access to treatment, both current Communities Lead, UNAIDS called for the removal of obstructive They called for the speedy rollout of end AIDS. Authorities need also to
antiretroviral treatments and new demonstrated that where communi- laws which have criminalized key long-acting treatment – including in- guarantee safe operating environ-
longer-lasting injectable medicines, ties are at the forefront of the AIDS populations, including LGBTQI jectable cabotegravir which prevents ments for community-led organi-
to live long and healthy lives,” response, countries were making sig- people, people who inject drugs, transmission of the virus. zations by removing harmful laws
said Winnie Byanyima, Executive nificant progress in the fight against and sex workers. Criminalizing key which criminalize key populations.
Director of UNAIDS. “Collectively the disease. The report shows that populations prevents them from Non-governmental organizations
we are calling for health justice and AIDS can be ended as a public health accessing HIV services, putting the working to end AIDS often have to
equality for all people, including
people living with and affected by UNAIDS Executive Director, Ms Winnie Byanyima talks to exhibitors at the ICASA
HIV. Pharmaceutical companies need
to put people first over profits by
making sure that treatment is afforda-
ble and easily accessible.”

Accelerate paediatric treatment

and prevention for young women
and adolescent girls to end AIDS

While progress has been made in

ensuring that many people around
the world have access to antiretrovi-
ral treatment, ensuring that they lead
long and healthy lives – too many
people are still not accessing treat-
ment. HIV prevention services are
also lacking particularly for young
women and adolescent girls.

While three million children have

been protected from HIV since 2000
by ensuring adherence to antiret-
roviral treatment for mothers, still
there were 110 000 new infections
among children (aged 0-14 years)
in Africa in 2022. Botswana has
shown the way forward by achiev-
ing a milestone in the pathway
towards eliminating vertical HIV
transmission. However, the world is
still failing children. In Africa only
55% of children living with HIV
are accessing antiretroviral therapy,
compared with 83% of adults living
with HIV in Africa.

Gender inequalities continue to drive

new infections in Africa. Among
young people (aged 15-24) 77% of
the new infections in that age group
(15-24) are among young women
and 23% among young men.

“AIDS is an injustice of inequalities.

If you look at people who are not
receiving treatment and people who
are dying of the disease, you will see
how inequalities are obstructing their
access to prevention and lifesaving
treatment to be able to live longer
and healthy lives,” said Ms Win-
nie Byanyima. “We can end AIDS
by redoubling our efforts to fight
the pandemic, including by reach-

3
 #ICASA2023 HealthTimes
Zim research on ART differentiated service
delivery model research wins ICASA award
By Kuda Pembere

D
r Cloreta Gwanzura, a
government medical doctor
working with the National
HIV Program, Care and Treatment
was conferred an award for the best
oral presentation for the ICASA track
E which focused on innovations and
research settings.

In an interview, Dr Gwanzura
said her research was focusing on
monitoring and evaluation systems
for differentiated service delivery for
ART in Zimbabwe which are models
Zimbabwe use to give people living
with HIV their medication.

These models have been effective in Dr Cloreta Gwanzura

improving HIV treatment coverage
in the country.

“So when we started, didn't have

a system of monitoring how we
were doing. So we then came up
with a system that would also allow
adaptation of national systems to be
able to do that at a national level. So,
that is the gist of my presentation,”
she said.
a happy surprise because it's an ac- motivation to present more papers at ber of other HIV focused conferenc- So, it was like the first time that I
Presenting her first international knowledgement of what we've done. international fora. es. We are now also, well I am now to ICASA and boom, award,” Dr
research, Dr Gwanzura said it came It was a lot of work trying to make “So that is really exciting and it's an also more motivated to participate in Gwanzura said.
as a surprise to win the award. sure that we have data that can be honor and we're happy that our work the same way. We also read your first
used for decision-making. So having could be acknowledged on a big plat- international paper. Luc Bodea, ICASA Director said,
“Receiving this award, it came as that acknowledged is an honor, not form like this one, like ICASA. So “I have presented in other forums “We reviewed 2 530 abstracts this
a surprise because you know when just for me, but also for the team. You we're excited, we're hoping to come but they were mainly regional and year. And also want to inform you
you're just submitting your working saw the big team, everyone is excited up with more papers. Now we're also everyone was expected to present but that 1 647 have been rejected.
hour, let's see if uh other people con- because we're working together as a very motivated. for this one, it was like the first one We should really thank all the
sider this important enough, but you team,” Dr Gwanzura said. that we had to come up to think up reviewers. Presented here, were 78
also want to share so that you learn. “We're also very motivated. AIAS, a topic to look at the data ourselves abstracts.”
“So it was a surprise, but it was also She said this award comes as a there is AIDS 2024, there are a num- and say, maybe let's put this together.

Protect your youths online,

African Governments told
By Kuda Pembere policies that will be able to guide

A
how people interact in these spaces
frican governments have
been urged to come up with
laws and regulations that
in a manner that is respectful to
everyone. Thank you so much," he
said.
The
guarantee the security of youth while
using the internet and social media Ms Maria Malomalo, the senior
international research manager at
HealthTimes
management
platforms.
Restless Development Zimbabwe
Speaking at the ICASA Conference, said it was important to engage

and
Mr Alan Maleche from the Kenya youths in research instead of just
Legal and Ethical Issues Network on researching about them.
HIV, said one of the concerns raised

staff
by African youth was that of data "So, our thinking is that you know,
privacy and security from health care oftentimes we think young people
workers alongside online platforms. are not able to conduct and that

"Is there anyone else who has access

they cannot be engaged in research
processes, but they are very key
in terms of collecting the insights
would like to thank
all our sponsors, advertisers
to that data? And if they are, what
should happen? Because many of which matter most to them, and
them have not disclosed their HIV often peers speak to peers, and it's
one thing that most institutions
and readers for
status to their friends or other people,
and so they are concerned about the don't think about. So we need to
safety and security of their data," he engage young people whenever we

their overwhelming support during

said. are conducting our research so that
whatever insights come from that
While there have been reports on can influence programming and can
the European Union (EU) coming
up with laws for tech giants, Mr
also influence advocacy processes,"
she said. the 22nd edition of the International
Maleche noted the importance of Af-
rican governments to regulate these
companies.
Conference on AIDS and STIs in Africa
"And so that's where we are con-
cerned around the private sector. in
(ICASA).
the private spaces that are running
these apps, that are running these
technologies, what steps that they put
into place to ensure that the young
people are protected from any forms
of violation or any issues that are
likely to affect them.

" So that's safeguarding us, which

is why we are holding governments
accountable, UN agencies and de-
velopment partners to play a leading
role to provide guidance, documents
to guide governments or for govern-
ment centres to develop laws and

4
 #ICASA2023 HealthTimes
New WHO guidance on HIV viral suppression and scientific updates

T
he World Health Organization
(WHO) is releasing new sci-
entific and normative guidance
on HIV at the 12th International IAS
(the International AIDS Society)
Conference on HIV Science.

New WHO guidance and an accom-

panying Lancet systematic review
released today describe the role of
HIV viral suppression and undetecta-
ble levels of virus in both improving
individual health and halting onward
HIV transmission. The guidance de-
scribes key HIV viral load thresholds
and the approaches to measure levels
of virus against these thresholds; for
example, people living with HIV
who achieve an undetectable level of
virus by consistent use of antiretro-
viral therapy, do not transmit HIV to
their sexual partner(s) and are at low
risk of transmitting HIV vertically
to their children. The evidence also
indicates that there is negligible, or
almost zero, risk of transmitting HIV
when a person has a HIV viral load
measurement of less than or equal to
1000 copies per mL, also commonly
referred to as having a suppressed
viral load.

Antiretroviral therapy continues to

transform the lives of people living
with HIV. People living with HIV
who are diagnosed and treated early,
and take their medication as pre-
scribed, can expect to have the same
health and life expectancy as their
HIV-negative counterparts.

“For more than 20 years, countries all

over the world have relied on WHO’s
evidence-based guidelines to prevent,
test for and treat HIV infection,” said
Dr Tedros Adhanom Ghebreyesus,
WHO Director-General. “The new
guidelines we are publishing today
will help countries to use powerful
tools have the potential to transform
the lives of millions of people living
with or at risk of HIV.”

At the end of 2022, 29.8 million of

the 39 million people living with
HIV were taking antiretroviral
treatment (which means 76% of all
people living with HIV) with almost
three-quarters of them (71%) living
with suppressed HIV. This means
that for those virally suppressed their
health is well protected and they
are not at risk of transmitting HIV
to other people. While this is a very
positive progress for adults living Delta and Omicron variant waves, mpox and COVID-19 to save lives; gies on HIV, viral hepatitis and
with HIV, viral load suppression in mpox detection, prevention, and care
with an overall in-hospital mortality community-led responses that work sexually transmitted infections for
children living with HIV is only 46% with existing and innovative HIV
rate of 20%-24%. For people without for HIV will also be beneficial for 2022-2030 actively advocate for
- a reality that needs urgent attention. and sexually transmitted infection
HIV, the risk of death fell during the addressing future pandemics." synergies within the framework
prevention and control programmes.
Omicron variant wave by 53%—55% Optimizing HIV testing services of universal health coverage and
Here is an overview of other key compared to pre-Delta and Delta through expanded testing options and primary health care.
scientific and normative updates To understand how to better prepare
variant waves; but for people living simplified service delivery
being released by WHO at IAS 2023 for and respond to future increases in
with HIV, the percentage decline “Ending AIDS is impossible
conference: mpox transmission, WHO led a rapid
in mortality during the Omicron With new recommendations on HIV without optimizing opportunities
electronic survey in May 2023 to
wave period compared to the other testing, WHO is calling on countries across and within health systems,
HIV and mpox assess community experiences of the
waves was modest (16%-19%). This to expand use of HIV self-testing and including with communities and in
2022-2023 mpox outbreak in Europe
difference resulted in a 142 times promote testing through sexual and the context of primary health care”,
An analysis of global surveillance and the Americas.
increased risk of death among people social networks to increase testing said Dr Jérôme Salomon, WHO As-
data reported to WHO during the living with HIV when compared coverage and strengthen uptake sistant Director-General, Universal
multi-country outbreak of mpox, More than 24 000 people participated
with people without HIV during the of HIV prevention and treatment Health Coverage, Communicable
identified that among more than in the survey which focused on men
Omicron wave period. services in high-burden settings and and Noncommunicable Diseases.
82 000 mpox cases, around 32 000 who have sex with men, and trans
in regions with the greatest gaps in
cases had information on HIV status. and gender-diverse people, with 16
Risk factors for in-hospital death testing coverage. This latest research and guidance
Among those, 52% were living with 875 eligible individuals completing
that were common across all variant are being presented at a time when
HIV, most being men who have the survey. Almost 51% changed
waves of the pandemic were low The recommendation comes at a progress towards ending the global
sex with men (MSM); and more their sexual behaviour (such as
CD4 count (less than 200 cells per pivotal time, where self-care and AIDS epidemic has lagged, after
than 80% reported sex as the most reducing the number of sexual part-
m3), and severe or critical COV- self-testing are increasingly being the COVID-19 pandemic; but the
probable route of getting infected ners), and 35% had maintained these
ID-19 illness at hospital admission. recognized as ways to increase response is rapidly catching up,
with mpox. changes one year later. Findings from
access, efficiency, effectiveness and with some countries now charting
this survey provide valuable insights
“Uncontrolled HIV remains a risk acceptability of health care across a path to end AIDS, including
Among 16 000 people diagnosed into the experiences and needs of
factor for poor outcomes and death many different disease areas, includ- Australia, Botswana, Eswatini,
with mpox and living with HIV, affected communities and emphasize
in the mpox outbreak and COVID-19 ing HIV. Rwanda, United Republic of Tan-
around one quarter (25%) had the importance of increasing access
pandemic”, said Dr Meg Doherty, zania, and Zimbabwe and 16 other
advanced HIV disease or immuno- to mpox vaccination and diagnostics
Director of WHO’s Global HIV, Primary health care and HIV countries that are close to reaching
suppression – leading to an increased globally.
Hepatitis and Sexually Transmit- the 95-95-95 global targets, which
risk of hospitalization and death. ted Infections Programmes. "We A new policy framework on primary aim for 95% of people living with
People living with HIV who were HIV and COVID-19
must ensure the integration of HIV health care (PHC) and HIV will help HIV knowing their status, 95% of
taking HIV treatment and with good considerations in pandemic prepared- decision-makers optimize work and those diagnosed receiving ART and
immunity had similar hospitalization An updated analysis from WHO
ness and response. Protecting people collaboration underway to advance 95% of those on treatment having
and death outcomes as those who global clinical platform for COV-
living with HIV from future pandem- primary health care and disease-spe- suppressed viral loads.
were HIV negative. ID-19 up through May 2023 revealed
ics is vital and reinforces the need cific responses, including HIV. In
a persistent high risk of death in
to ensure access to HIV testing and the second year of implementation,
In the light of these findings, WHO people living with HIV hospitalized
treatment and preventive vaccines for the Global Health Sector Strate-
recommends countries integrate for COVID-19 across pre-Delta,
5
 HealthTimes HIV Research & Innovation
Unlocking a real cure for HIV: Viral shock and kill therapy
doherty.edu

E
ver since the Human Immu-
nodeficiency Virus (HIV)
was first identified in the
early 1980s, researchers have been
searching in vain for a cure. While
antiretroviral therapy (ART) has
helped millions live healthy lives
with the infection, HIV and AIDS
burden health care systems and
people continue to suffer from social
stigma. Is a cure on the horizon?

Back in 2011, curing people of Hu-

man Immunodeficiency Virus seemed
a long shot. HIV is a retrovirus - it
integrates its own DNA into the DNA
of human cells and sometimes goes
dormant, hiding out from the immune
system and the medicines researchers
have developed to kill it.

Youry Kim was still an undergrad-

uate studying biomedical science at
Monash University at the time, when
a series of lectures by Sharon Lewin,
director of the Peter Doherty Institute
for Infection and Immunity in Mel-
bourne, Australia, piqued her interest
in the sly tactics that HIV uses to
thwart the human immune system.

When Lewin offered Kim the oppor-

tunity to do an honors project in her
lab studying latent HIV, Kim jumped
at the chance. The project led to a
PhD under Lewin’s tutelage.

Today Kim is a post-doc in Lewin’s

lab, focused on finding drugs that
can eliminate latent HIV from human
cells so people living with HIV are
not reliant on antiretroviral therapy
(ART) for the rest of their lives.

ART revolutionized HIV and AIDS

treatment when it first became availa-
ble in the mid-1990s, but HIV is still
a major issue globally. The therapy's
powerful ability to suppress viral
replication, and thereby enable the
immune system to recover, gave hope
that at the very least, the infection
could be managed long-term. But
ART is not a cure. hopes that researchers will be able to from the procedure and the expense, of specific proteins that may tip the
develop a functional cure for people Brown’s case showed that a cure was cells towards survival, outliving their Using a multiplex dPCR assay that
In middle-and low-income countries, living with HIV - one that elimi- possible. normal lifecycle that would include Kim and her colleagues adapted to
up to 30% of people living with HIV nates or slashes levels of latent HIV programmed cell death, or apoptosis the QIAcuity system, she can now
have limited access to ART, says enough so that the immune systems Then came another unexpected boon - some cancer cells produce the same detect and quantify the fraction of
Lewin, so the number of the newly of people living with HIV will be to the field: Targeted cancer treat- proteins and circumvent apoptosis intact HIV DNA in her samples.
infected continues to grow. And able to control the virus without life- ment. About a decade ago, a class of too. Drugs that inhibit these proteins “Measuring the amount of intact
despite the success of Antiretroviral long antiretroviral medication. new cancer drugs became available are already available to treat cancer. virus helps us see how well our
Therapy in both treating and pre- that blocked cancer’s ability to The “shock and kill” approach to treatments are working,” she adds.
venting HIV, the infection remains a A cure would not only save health “hide” from the immune system. curing HIV
public health burden. care systems billions spent on life- The advance got HIV researchers Researchers working on the shock
long ART for the roughly 40 million thinking about whether they might In what’s called the “shock and kill” and kill approach continue to look
How HIV hides from the immune people currently living with HIV, use the same approach to target latent approach to curing HIV, Kim is now for drug combinations that might
system but it would also eliminate the social HIV. Although cancer is a distinct focusing her efforts in combining a have the desired effect.
stigma that many of them suffer, says disease, researchers discovered that drug to trigger latent HIV to repli-
Once the virus infects human Lewin. both cancer and HIV share certain cate, a so-called “latency-reversing” To reduce toxicity, some research-
immune cells, it uses a number behaviors in common, “which is why agent, with a pro-apoptotic drug to ers are also looking at delivering
of strategies to evade the immune It would also offer a safer alternative a lot of these cancer drugs have been first “shock” latent HIV out of hiding shock and kill drugs with more
system. For one, HIV replicates and since studies have shown that people repurposed for HIV,” says Kim. and then “kill” the infected cells. precision - packaging them into
mutates at lightning speed, making taking ART long-term have a higher nanoparticles that hone specifically
it tough for the immune system to risk of many ailments that include Mutations in cancerous cells, for To test the approach, Kim treats to infected cells, for example.
adapt quickly enough to fight it. In cardiovascular, liver and kidney example, are thought to alter the blood samples from people living
addition to infecting active immune disease. structure of chromatin - material that with HIV with the drug combination Scientists are also pursuing other
cells, the virus also infects resting forms chromosomes - in cancer cells, and compares them to untreated ways to cure HIV. Among them are
immune cells, where it goes dormant “This is what is driving people making it easier for them to prolifer- blood samples from the same person. the “block and lock” approach that
and hides. around the world trying to find a ate. The ability of HIV to integrate aims to permanently silence latent
cure,” Lewin says. into host cell DNA, researchers The challenge had been determining virus with drugs that block the tran-
These HIV reservoirs mainly consist think, is also influenced by how whether the drugs are eliminating in- scription step in the cell's lifecycle.
of a type of immune cell called Using cancer treatments for HIV chromatin is organized. In the cancer tact virus. Not all latent HIV is “rep- Over time, this would cripple HIV’s
resting CD4+ T cells, which behave field, there are many drugs that work lication-competent,” Kim explains. ability to replicate. Still others are
like sleeper cells - they don’t actively For years, the viral craftiness of HIV by loosening chromatin to make it studying gene therapy approaches
produce new virus nor do they trigger had dampened hopes that a cure was more accessible to cellular machinery Because the virus mutates so quickly, that could knock out genes that ena-
an immune response. even possible. But then, in 2007, to initiate transcription, says Kim, 90% of HIV DNA is defective and ble the virus to infect cells.
came news that a bone marrow trans- thereby tamping down the cell’s abil- therefore can’t replicate, it is unable
This makes it harder for the immune plant cured a person with HIV. The ity to replicate. Researchers theorized to infect CD4 cells. With the drug In the meantime, Kim is hoping
system and medications to detect and patient, Timothy Ray Brown, was that these same cancer drugs might combination, “you really want to that the positive results she is see-
eliminate them and is also the reason HIV positive and suffering from leu- also force cells infected with latent be targeting replication competent ing in the lab will lead to clinical
why in as little as 2 to 3 weeks after kemia. The donor marrow came from HIV to initiate transcription of viral intact provirus.” This is made even trials to test the efficacy of her drug
a person stops ART, HIV levels a person who was naturally resistant DNA, making them “visible” to the more difficult by its scarcity. “It’s combination in people living with
rebound: Dormant virus becomes to HIV infection. Brown became immune system. only a tiny fraction,” she adds. “Only HIV. But of course, she adds: “Any
active again and the cycle of replica- the first person known to be cured of around one in one thousand CD4 approach that leads to a cure for
tion, reinfection and destruction of HIV - there were no detectable levels However, while the approach could cells is infected with latent HIV in HIV is wanted.”
new CD4 cells continues. of virus in his blood. trigger latent HIV to replicate, it people taking ART and only a tiny
didn’t prove powerful enough to rid fraction of that pool contains intact
Advances in our understanding of While a bone marrow transplant for the body of infected cells. Research- HIV DNA,” she says.
HIV’s behavior and the availability people living with HIV was never ers then took a cue from another sim-
of new technology and medicines considered a desirable or even prac- ilarity between cancer and HIV. Cells Still looking for the right combi-
from the cancer field have rekindled tical cure because of the health risks infected with HIV have high levels nation

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 HealthTimes #ICASA2023
Mpilo HI V Ce nt r e of Excelle nce doc tor w ins ICASA Awar d
By Kuda Pembere

M
pilo Hospital AIDS
Healthcare Foundation
(AHF) HIV Centre of
Excellence medical doctor Dr Nka-
zimulo Tshumo’s research on causes
and clinical determinants of deaths
among people living with HIV at her
hospital earned her a Track B award
for the best abstract.

Her research, an analysis of Causes

and Clinical Determinants of Mortal-
ity among People Living with HIV
at Mpilo Centre of Excellence in Bul-
awayo, in Zimbabwe won the Track
B focusing on Clinical Science,
Treatment and Care.

She said the majority of deaths at her

facility were people on ART with an-
other portion being on the medication
“So, we did an analysis on mortality
among people living with HIV for
the period of January to December
2022.

“And we noted that from our analy-

sis, maybe just to mention, we had
129 deaths during that year, and a
majority of the death among people
already on antiretroviral therapy, we
had a portion which was contributed
by people who not yet on antiretrovi- Dr Nkazimulo Tshuma
ral therapy,” Dr Tshuma said.

While people with HIV are highly

susceptible to TB, in terms of deaths
they ranked the top followed by cryp- She said in terms of mortality there separately, we notice that cervical conditions. And when we looked “And also, if you really look at
tococcal meningitis. were more females compared to men cancer was top on followed by breast at the cardiac related conditions, it our results you see that more than
as they succumbed to cervical cancer. cancer. was mainly to do with complications 50% of people are still dying of ad-
“So in terms of causes of death, we of hypertension. So top on the list vanced HIV disease. So this speaks
noted that TB and also pneumonia, “And among the cancers, the females “Then the other cancers contributed a cancers, renal failure, strokes and to that AIDS is not over. So it was
which most likely would be TB, were top list with cervical cancer is similar proportion, that is, hepato- cardiac related with temperatures, the theme of the conference.
under investigation with the top a cause of death. The adrenal failure carcinomas, gastric, oesophageal, complications of hypertension,” she
cause of mortality. This was followed we didn't really disaggregate to see squamous cell carcinomas, but top on said. “So it causes and terminates, okay
by a cryptococcal melangitis. If you whether it was treatment related or it the list was cervical cancer followed so the title of the research was
notice that we had quite a number was related to HIV or other causes. by breast cancer. Aside from documentation and causes and terminates of mortality
of mortality which was NCDs, replication of similar research at a among people living with HIV
non-communicative disease related, “So in terms of mortality related to “Then going back to NCDS, what larger scale, she recommended that at Mpilo Centre of Excellence in
and they seem to be emerging and NCDs, we actually had cancers being then follows cancers was renal failure said incorporating NCDs screening Bulawayo over the period January
contributing significantly towards top on the list with 11 clients who and cerebrovascular accident strokes. was important to reduce the burden to December 2022,” Dr Tshuma
mortality,” she said. had cancer as a cause of death. And So those were top on the in terms of advanced HIV. added.
when we then look at the cancers of mortality and also cardiac related

Bending the curve: What a decade-long roll-out of the an-

ti-HIV pill can teach the world
By Mitchell Warren and Despite people being slower to start around 70% of new HIV infections KEEPING TRACK: Avac follows
Wawira Nyaga taking these prevention pills than occur among key populations and If HIV prevention is thought of in global PrEP use through quarterly
public health authorities had hoped, their partners, someone’s chance for terms of sexual health and main- user surveys and data from drug

B
y September, over five million two new, longer-acting choices contracting HIV can change depend- taining healthy relationships, health manufacturers and government
people worldwide had started — a monthly vaginal ring and a ing on with whom and how they are workers can help their clients agencies. This graphic shows what
using PrEP (short for pre-ex- two-monthly injection — have come having sex, for example whether understand how using the medicines PrEP use looks like around the
posure prophylaxis). This means onto the scene in the past two years. a partner knows their HIV status can contribute to these goals — even globe. See more at PrEPWatch.
taking medicine before sex to prevent and whether they use protection or when the chance of getting HIV
These advances can help the world not. To get the most out of PrEP, isn’t their main worry. Experts say In Kenya, for example, the Jilinde
getting infected with HIV. rethink HIV prevention. But can they programmes and policies need to pitching PrEP as a way to reduce project looked at how people’s be-
translate into choices that actually reframe the idea of risk so that it fits anxiety, take control over their sexual haviour drives their choices about
At just over a million users, South work for people, and so help slow better with the lifestyle and experi- health, increase sexual satisfaction, using a product and divided the tar-
Africa makes up about a fifth of the down new HIV infections? ences of those the medicines aim to pleasure and intimacy, and stay safe get market into specific subgroups
total. help, instead of narrowly focusing on and healthy can help people see a to shape messages and strategies to
We believe the answer to both ques- population groups. better future. the needs of teen girls and young
These sound like big numbers — tions is yes — if we put in practice 2. Drive up demand women, female sex workers and
and they indeed point to progress in the lessons learnt from rolling out Research shows that HIV prevention men who have sex with men.
the fight against HIV, considering oral PrEP to make it easy for people is not a priority for many people who Thinking that people will use new (Jilinde is a Kiswahili word that
that the World Health Organisation to get these new products when, have been thought of as in the high- products and interventions sim- means “protect yourself”.)
(WHO) added these drugs to the where, from whom and how they risk group in the past, nor do they ply because they were developed
medicine cabinet only eight years need them. think about their chance of getting doesn’t hold. If the demand for these The project used both mass media
ago — but the uptake still falls well HIV in the way healthcare providers products doesn’t exist, they won’t — for widespread awareness —
short of the UNAids global target of Here are four lessons to guide HIV do. Instead, managing a relation- get used. and interpersonal communications
10-million PrEP users by 2025. prevention programmes going ship and looking after their sexual — for focused outreach. Social
We are proud to bring you trustwor- forward. health are more important. Talking to When oral PrEP was first introduced, media, community engagement and
thy analysis on health policy issues. 1. Rethink risk potential PrEP users only about how ideas about what people wanted or drawing on existing networks were
Want more? Sign up to our newslet- READ MORE: Over a million SAs the drugs can stop them from getting why they’d want the pills weren’t central to their approach. Impor-
ter. have used the HIV prevention pill HIV may therefore not entice people considered much, and so initial up- tantly, apart from only handing out
to learn more about PrEP, start using take was low. Programmes eventu- the pills, the project also helped
And Monday’s release of the results Many early oral PrEP programmes it or use the medication in the most ally realised that to get more people people to understand that they had
of the Human Sciences Research targeted groups that were thought effective way. on board, there’d need to be broad, to take the medicine every day to
Council’s latest HIV household sur- to have a “high risk”, such as sex sustained and user-centred efforts to get the best results.
vey makes achieving this goal even workers and men who have sex with For example, a programme in South create demand for the products.
more urgent: condom use in South men. These groups are called “key Africa helps young women think To get people on board, messages
Africa is declining. Less than half of populations” as they have a bigger about PrEP as part of a “journey” Because people from key populations pitched PrEP as a general health
the almost 72 000 people interviewed chance of contracting HIV and, of self-empowerment, during which are often shunned by society, they intervention rather than targeting
used a condom the last time they had because of social and legal stigma, they consider what they want their may struggle to get preventive med- specific groups, and so created a
sex — which means getting people often struggle to access treatment or future to look like and identify the icines or treatment for HIV. Drives more inclusive environment for
to use HIV prevention medication is prevention services. support — including to protect their tailored specifically to the needs of PrEP uptake, free of stigma. The
crucially needed. sexual health — they’ll need to real- these groups can help to curb the programme also helped journalists
While data from UNAids show that ise those goals. spread of HIV. and media outlets.

7
 #ICASA2023 GBV HELPLINES HealthTimes

DO NOT IGNORE A CRY FOR HELP!

Help is nearby.
It is a call or SMS or WhatsApp away.
Take action if a child near you or someone you know is suffering any of these abuses;
1. Physical abuse
2. Emotional abuse
3. Sexual abuse including rape, indecent assaults, exposure to sexual material
4. Sexual or Economic abuse and exploitation
5. Child being married off against her will or allowing a child to elope and not do anything
about it
6. Threats or intimidation of any kind
7. Neglect of a child

Get in touch with any of these numbers for free assistance in Zimbabwe
Help needed Who can help? Coverage Their Contact details

Counseling/emotional 1. National GBV Hotline National 1. 575

support 2. Childline 2. Call 116 App
3. Ministry of women affairs 0732116116
4. Department of Social 3. District office near you
Development 4. District office near you and
5. Musasa Ward Child Care Workers
5. Econet 08080074
6. Shamwari Yemwanasikana Netone 08010074
Telecel 0731080072-4
6. Toll Free 08011034
7. Padare/Men’s Forum Helpline 0777851120
8. Contact 7. Helpline 0776027290
8. Netone 08010186/7
Whatsapp 0719528158/9
Reporting violence 1. National Hotline national 1. 575
2. Ministry of Education 2. 317
3. Childline 3. 116 or App 0732116116
4. Saywhat Hotline 4. 577
5. ZRP Victim Friendly Unit 5. Econet 08080554
Netone 080101149
Telecel 0735342874
6. Zimbabwe Gender 6. Toll Free 08004379
Commission
7. Shamwari Yemwanasikana 7. Toll free 08011034
Helpline 0777851120
8. Issues/Pane Nyaya 8. Media 0773910095
Place of safety/Fostering 1. Department of Social National 1. Any district office or CCW
Development in your Ward
2. Ministry of women affairs 2. Any district office near
you /WardCo
3. Musasa 3. Econet 08080074
Netone 08010074
Telecel 0731080072-4

8
 #ICASA2023 HealthTimes
Health and Safety Measures Published For Delegates Attending ICASA
2023 In Harare
The ICASA Conference will run from 4 to 9 December, 2023 at the Harare International Conference Center (HICC). The conference will be run-
ning under the theme, “AIDS IS NOT OVER: Address inequalities, accelerate inclusion and innovation.”

Attendee health and safety measures

Here’s all you need to know for attending ICASA 2023 safely, responsibly, and confidently. Note that some guidelines are mandatory.

NB: All delegates should have their COVID-19 vaccination cards and yellow cards. Cholera vaccination cards if available will also be appreciated.

Action to take in advance

Mandatory – badging

To avoid lines, we’ll email your QR code confirmation in advance. Please have this QR code with you on your smartphone or as a printout when
you arrive at the conference venue. Badge holders and lanyards will also be available at registration desks.

AT RAINBOW TOWERS HOTEL & CONFERENCE CENTER – moving around the Conference

Wearing face masks is mandatory within the Rainbow Towers Hotel & Conference Center (except for medical exemptions). Staff, Security, and
ICASA 2023 Volunteers are jointly responsible for monitoring face-covering compliance and both are authorized to escort people out of the venue
in the case of non-compliance.

Mandatory – Staff access to booths

Booths with exhibiting partners will have their own dedicated info desk.

Entering the Conference

Traffic flow in and out of the conference center will be carefully managed. As much as possible we will ensure one-way movement of people to
minimize contact. There will be appropriate signage provided and volunteers to assist and guide delegates to their various destinations.

Exhibition hall density

Wider aisles will be added wherever possible and the conference will provide more seating areas in the exhibition hall to reduce crowding and
improve traffic flow.

Mandatory – Refreshments
The conference venue will provide an extended range of individually packaged food items and will observe all applicable COVID-19, public health
and safety standards.

Cleaning standards and special measures during the Conference

Mandatory- Exhibition Hall cleaning

The convention space will be cleaned regularly including electrostatic spray treatment every night in accordance with ICC standards. Exhibitors
will also be required to clean meeting areas between each appointment or meeting.

Mandatory – Health and Safety monitoring

ICASA 2023 staff, volunteers, and security at the venue will continually monitor the COVID-19 and public health safety protocols across the con-
ference to ensure compliance.

Hand Sanitizer

Hand sanitizer dispensers will be placed throughout the conference venue as well as the exhibition hall and community village. Attendees are en-
couraged to sanitize their hands frequently and after every meeting.

Meeting/Conference rooms

Meeting rooms will be set up in compliance with the current social distancing and room capacity guidelines in Zimbabwe to ensure you can take
part safely in ICASA 2023 sessions.

Other Safety standards

The venue has implemented a vast range of health and safety measures which are not detailed on this page but can be viewed on the Rainbow
Towers Hotel and Conference Centre website.

Importantly, the entire Rainbow Towers Hotel & Conference Center, including the exhibition halls, is equipped with highly efficient ventilation
systems concurrent with International Conference standards.

Important notice: All delegates are required to avoid eating street food and purchasing from street hawkers. All delegates are to patronize restau-
rants within the conference venue.

In case of a positive COVID-19 test, the affected delegate will cater for all related costs, including quarantine.

Medical Travel Insurance

Delegates must hold valid medical travel Insurance to cover his or her duration.

9
#ICASA2023 DAY 5 In Pictures HealthTimes

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