Every aspect of life has been affected by COVID-19, and this year’s International AIDS Conference was no exception. While it was the 23rd conference since the inception of the International AIDS Society (IAS), it was the first to be virtual. As its in-person predecessors, the conference was jam-packed with content: there were more than 600 virtual sessions and events: 12 live “prime” sessions; 27 workshops; 70 satellite sessions; 62 abstract sessions; multiple pre-conferences; and hundreds of “on-demand” posters. There was so much that it was not possible to reasonably consume even a small percentage of what was offered, but the digital nature of the conference will allow for a permanent repository of sessions and posters.
Conference overview
Each day, Karl Schmid hosted “The Daily,” featuring interviews with high-profile guests, as well as community members from all over the world. I recommend Ambassador Deborah Birx’s interview, in which she discusses her role as White House coronavirus response coordinator and her experience overseeing the implementation of PEPFAR influences the COVID-19 response. Another engaging interview was with Dr. Anthony Fauci, who also spoke of lessons from HIV, including the importance of community engagement and contributions.
One of the best presentations of the week was the plenary session presented by Greg Millett, vice president and director of public policy at amfAR. During his talk, Millett uses data (and impressive data visualization skills) to explain the disparities that link HIV and COVID-19, what can be done to mitigate these inequities, and how the HIV community can turn progress into success. A must-watch!
Finally, I would be remiss if I didn’t acknowledge HIV2020, designed as the protest conference, and planned to run concurrently to IAS. When it was announced in 2018 that San Francisco would host AIDS2020, activists demanded the event be moved off U.S. soil because the U.S. isn’t safe for many people affected by HIV (e.g., sex workers and people who use drugs) to travel to. Because of COVID-19, HIV2020, which was planned for Mexico City, was also moved to a virtual format. The sessions are planned for release between July and October (making for more manageable consumption). See the full program.
JSI’s presence
JSI was represented by more than 60 staff from six countries. We contributed two oral presentations; one satellite session; 15 on-demand posters (and three at the one-day COVID-19 conference); three Facebook live sessions; and countless tweets about our contributions toward epidemic control in Africa and the U.S.
I focused a lot of my time on human-centered design (HCD) and how we are using it to implement and evaluate HIV prevention, care, and treatment interventions. I was proud to be the second author on the oral presentation, “That’s how we roll! Using human-centered design to allow the community voice to design an educational campaign, social media and direct-to-consumer communication for PrEP rollout in Zambia, and really impressed by my colleague Mwansa Njelesani, who presented JSI’s HCD work in Zambia. JSI started with an HCD study and ended with a refreshed brand and nationwide campaign. It was expanded beyond pre-exposure prophylaxis (PrEP) into all HIV modes of prevention, acknowledging the vacuum in HIV prevention communication in Zambia. The benefit of HCD was to understand the knowledge, beliefs, and attitudes of end-users of toward various HIV prevention products, directly from end-users, who reported finding the old materials stale, and that the red ribbon and fear-based prevention messages didn’t mesh with how young people saw HIV prevention and treatment in their lives. As a result of this learning, JSI helped the MOH develop the fresh and colorful national HIV prevention brand and campaign Zambia Ending AIDS.
Mwansa and I also designed a satellite session, Begin with the end in mind: Using human-centered design to improve outcomes across the HIV continuum of care, which explored the process and outcomes of using HCD across multiple HIV prevention interventions, including PrEP and HIV self-testing. On the panel, Cal Bruns, chief innovationist at Matchboxology, and Michelle Kreger, senior portfolio manager at IDEO.org, discussed their experiences in product and process development at the intersection of design and health. Mwansa presented our work using HCD to rollout PrEP under the USAID DISCOVER-Health Project in Zambia. With Emily Harris from USAID’s Office of HIV and AIDS moderating, the session ended with a call to encourage the use and application of HCD in global public health. The design thinking and creation processes highlighted led to solutions to big challenges (like rolling out PrEP in Zambia and HIV self-testing in Kenya) and seemingly small ones (like a padded pill bottle that prevents rattling and thus user exposure). Michelle Kreger said it best: “Great design work in health requires going against your discomfort… you must create conditions to listen.”
Innovations in PrEP Delivery
I focused the rest of my AIDS2020 time on sessions related to PrEP and innovations in delivery mechanisms to meet end-user needs. One highlight was the study findings from the HIV Prevention Trials Network (HPTN083) PrEP administered as an injection every eight weeks was more effective in preventing HIV than oral PrEP in gay and bisexual men and transgender women. Injectable PrEP offers superior efficacy to oral PrEP in clinical trials — announced prior to the conference when the study was terminated early when it became clear that there were fewer infections in people who took injectable PrEP than those who took it orally. During HPTN083, the drug cabotegravir was tested on more than 4,500 cisgender men who have sex with men and transgender women who have sex with men in 43 countries. The study showed that participants who received injectable cabotegravir every eight weeks were 66% less likely to acquire HIV than those taking daily oral PrEP. The implications, for both PrEP and antiretroviral treatment, will give users more choice in treatment and be especially helpful for people who find daily pill-taking burdensome.
On the topic of better tailoring services to an individual’s needs, AVAC and PATH presented “Bringing PrEP closer to home: Why is now the time for differentiated PrEP?” which looked at leveraging differentiated service delivery models to make antiretroviral treatment for PrEP more “person-centered,” an especially important strategy to limit in-person interactions during COVID-19 and periods of staying at home.
COVID-19 may change people’s personal assessments of risk due to less sex during lockdowns and stay-at-home orders. Some individuals may have cycled off PrEP during this time, while others, regardless of the situation, prefer intermittent PrEP use. As risk changes during various phases of life, or if sex can be planned, the advent of event-based or “on-demand PrEP” is another tailored option to users. At AIDS2020, this was discussed during the session, On-demand PrEP is highly effective, but some may find it confusing (it involves taking two Truvada tablets 2–24 hours before engaging in sex; taking a single tablet 24 hours after the first two; and another tablet 24 hours after that). The presentation showed that when given the choice, on-demand PrEP was the preference of 24% of clients, among whom the rate of new infections was low, based on the original study, IPERGAY done in France.
AIDS2020 was a packed week of presentations, panels, and posters. What it lacked, obviously, was the networking, shouts from activists, intimacy, and palpable energy and excitement that comes from discussing research and ideas in person. At the same time, the success of HIV2020 and AIDS2020 proves that we can hold conferences of this size virtually. Perhaps IAS will merge the best of both worlds to allow in-person and online participation, reducing the conference’s carbon footprint and removing cost- and travel-related barriers to attendance.
Written by: Sean Maher, Senior HIV Advisor
