This was my first time attending the International AIDS conference and straight out of the gate the MSMGF pre-conference set the tone for what I think will be a focus for the duration of the conference. That is calling bullshit where we see it. There a parallel epidemic of blue sky, magical thinking and one stop solutions and simple target numbers that are expected to be effective anywhere they are applied, without factoring into account complexities and needs and empowerment of specific communities and diverse cultures. A couple powerful takeaways from the opening plenaries: Of the annual 4 billion globally invested into the HIV response, MSM get only about 2.6%. Realities like the Asia Pacific region making up 60% of the global population and yet they are woefully, inadequately funded. The statement that funding in HIV prevention and treatment is not an expenditure it is an investment, and that we have to reanimate the response to young MSM. The call to “show us the money” and for meaningful action for MSM and led by MSM was loud and clear throughout the day.
Expanding PrEP Across the World With Tailored Approaches:
PrEP is still the topic du jour and rightfully so, this is the first HIV prevention intervention since the condom and the topic dominated the MSMGF breakout session schedule. This session focused on the different approaches to rolling out trials and I want to focus mainly on Jessica Horowitz from Sutter Health in the United States who presented on their CRUSH study as I found it the most exciting, nuanced and forward thinking.
I think there is real power in focusing on the people as opposed to just the figures and that is what was echoed in her presentation. For a start they have an organic and robust Community Advisory Board. These 12 individuals have a high impact on influencing everything this study does from marketing and media to hiring and not just “best practices from 10,000 feet above”. This in a nutshell encapsulated their approach to this study with participant feedback and ownership of the experience vital to the how the study runs. They look at a correlation between returning information to participants and the notion that hearing about your adherence and the efficacy of PrEP in your system and how well invested they are in their health for best outcomes and best study results. Dry blood spot testing is done every 3 months with a measure of 45 days prior and everything is quantifiable. All of this approach really fascinated me as the bottom line was about working with and empowering people to understand risk and take ownership of their own health as a partnership between clients and the provider without the blame or the preaching. This vibe is further reflected in how they work to get people linked into health insurance and how they provide care for people under 18 regardless of the figures not being included in the study for obvious reasons. The clients are truly important and more than just numbers or statistics. This was illustrated again when she explained that they have an individual whose sole job it is to keep people in care and monitor their drug adherence. All fascinating.