Presented by AFS Youth Assembly
The fight against HIV evolves, with potentially game-changing advances on the horizon.
Also in today’s edition: Are big INGOs raking in high overheads while their local partners get zilch? One study says so. Plus, the latest famine figures from Gaza.
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Patients? Zero
100%
—A 100% success rate. You don’t get any better than that in a medical trial — and that’s why Gilead’s new injectable drug to curb HIV infections has inspired such hope in the global health community.
Data from Gilead’s latest trial of lenacapavir showed that the twice-yearly injectable is 100% effective in preventing HIV in women and adolescent girls.
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There were zero cases of HIV infection among the 2,134 women who were given the drug. It was also “generally well-tolerated and no significant or new safety concerns were identified,” according to a news release.
My colleague Jenny Lei Ravelo writes that it could be a “game changer.”
Current HIV prevention drugs known as preexposure prophylaxis, or PrEP, are highly effective when taken as prescribed. But a lot of people don’t take them for a variety of reasons — stigma, discrimination, and difficulty adhering to the pill regimen. Taking only two injections a year could obviously help people stick to a more discrete routine.
Another important element of the drug is that it specifically works among women and girls, who accounted for 46% of all new HIV infections globally in 2022. That’s 4,000 adolescent girls and young women ages 15 to 24 years old infected with HIV every week.
Gilead is still waiting on further data. In the meantime, advocates are calling on the pharmaceutical giant to clearly lay out plans for access to the drug. That’s especially key because it can take years for drugs to become available in low- and middle-income countries, Janet Ginnard of Unitaid says.
“I think the ideal would be that everyone has it in all geographies, regardless of where they live,” she says. “Someone who could benefit from this product living in a low-income country shouldn't be in a queue, and only getting that years later.”
Read: HIV trial shows injectable prevents 100% infection in women and girls
Being better PrEPared
Effective HIV prevention drugs — namely PrEP — already exist in low- and middle-income countries in generic pill form, but stubborn social barriers remain, especially among young people.
As my colleague Sara Jerving writes, many are afraid of repercussions from their parents, their sexual partners, and even judgmental health professionals.
Moreover, many youth don’t use condoms and many have multiple sexual partners, according to a group of young people Sara talked to at the Desmond Tutu Health Foundation in Cape Town during her recent trip to South Africa, which is home to the highest number of people living with HIV of any country in the world.
But funders such as the Gates Foundation are trying to tear down these barriers.
Gates approached the Desmond Tutu Health Foundation with a $12.8 million project that offers a comprehensive suite of reproductive health services, including PrEP, to at least 25,000 young people.
Among the features: young people employed as “peer navigators”; mobile clinics, which are near schools, offering sex education; tailored service delivery; and young people getting offered different available forms of PrEP.
“Young women have quite different needs to young gay men, who may have quite different needs to people who are pregnant,” said Linda-Gail Bekker, CEO of the Desmond Tutu Health Foundation.
For example, the program includes courier delivery of pills or the vaginal ring in an unmarked box and an HIV self-test kit. Others get PrEP in a group setting, such as Saturday meetings where they can discuss their experiences.
“We know that oral PrEP has its challenges,” said Shirley Chen of the global health division at the Gates Foundation. “We need more options for people.”
Read: HIV prevention drug uptake is slow. Can offering choices change that?
Bucking the system
Following the money trail in specific projects can reveal the dispiriting realities of localization. One study by the Share Trust did just that — and found some startling results.
An international NGO levied a sky-high overhead rate of 34% while its project’s local partners received nothing, according to the study, which argued the arrangement exposes the “unfair playing field” faced by many local aid players.
“This issue goes to the heart of the localization agenda,” says Courtenay Cabot Venton, founder and chief executive of the organization that works to boost the “small fraction” of aid funding passed to local groups.
The study follows the Share Trust’s 2022 “Passing the Buck” report, which strongly criticized the money wasted because of donors’ lack of progress on localization.
It found local intermediaries could deliver aid in a way 32% more cost-effective — potentially generating annual savings of $4.3 billion if they were devolved one-quarter of the $54 billion of aid flowing through the United Nations and INGOs.
Read: INGO claims 'unjustifiable' overhead, while local partners get nothing (Pro)
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Impossible conditions
Perhaps they’re not overly surprising to observers of the war in Gaza, but the latest famine figures from the enclave are still stark.
In its newest analysis, the Integrated Food Security Phase Classification found that a high risk of famine persists throughout the Gaza Strip, with about 96% of the population — 2.15 million people — facing high levels of acute food insecurity.
That includes 495,000 people battling catastrophic levels of acute food insecurity, known as IPC phase 5, in which households experience an extreme lack of food, starvation, and exhaustion of coping capacities.
The latest data also shows that to be able to purchase food, more than half of the households had to exchange their clothes for money and one-third resorted to picking up trash to sell. More than half also reported that oftentimes they do not have any food to eat in the house, and over 20% go entire days and nights without eating.
“Despite some improvements throughout March and April, hostilities in the northern governorates and the Rafah offensive resulted in very limited humanitarian access to and within the Gaza Strip,” the report said.
“People are enduring subhuman conditions resorting to desperate measures like boiling weeds, eating animal feed, and exchanging clothes for money to stave off hunger and keep their children alive,” said Kate Phillips-Barrasso, Mercy Corps’ vice president of global policy and advocacy, in response to the report.
"The humanitarian situation is deteriorating rapidly, and the specter of famine continues to hang over Gaza,” she added. “Despite some aid getting in, the glaring contradictions remain — commercial trucks are allowed passage, yet humanitarian aid is limited, scrutinized at the border, and, when permitted to cross, typically only reaches some city centers without proper security. Compounding the suffering is oppressive summer heat, no access to clean water, and increasing exposure to garbage and sewage. This lethal equation will undoubtedly lead to acute suffering and mortality.”
Related: Why famine is 'inevitable' in Gaza — and what's next
In other news
EU prosecutors have launched a probe into former European Investment Bank chief Werner Hoyer over what his lawyer confirms is a corruption case. [Politico]
A maternity hospital attack in Sudan's El Fasher city, which killed a pharmacy worker, sparked outrage and renewed calls from the WHO chief to provide safe access to health care amid ongoing conflict. [UN News]
UNESCO asks swift action from Australia to protect the Great Barrier Reef, which includes setting bolder climate targets for the country. [France 24]
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About the author
Anna Gawel
Anna Gawel is the Managing Editor of Devex. She previously worked as the managing editor of The Washington Diplomat, the flagship publication of D.C.’s diplomatic community. She’s had hundreds of articles published on world affairs, U.S. foreign policy, politics, security, trade, travel and the arts on topics ranging from the impact of State Department budget cuts to Caribbean efforts to fight climate change. She was also a broadcast producer and digital editor at WTOP News and host of the Global 360 podcast. She holds a journalism degree from the University of Maryland in College Park.
