AIDS 2012 Where are we, and where are we going?

1. AIDS 2012 Where are we, and where are we going? Mitchell Warren Executive Director, AVAC August 15, 2012

3. “Few could have imagined that we’d be talking about the real possibility of an AIDS-free generation.  But that’s what we’re talking about.”

4. What Works in HIV prevention, 6/10 Effect size (CI) Study Prime-boost Vaccine (Thai RV144, 2009) 31% (1, 51) Medical male circumcision (Orange Farm, 2005; Rakai, Kisumu, 2007) 57% (42, 68) 0% 10 20 30 40 50 60 70 80 90 100% Efficacy

5. What Works in HIV prevention, 7/12 Effect size (CI) Study Prime-boost Vaccine (Thai RV144, 2009) 31% (1, 51) 1% tenofovir gel (CAPRISA 004, 2010) 39% (6, 60) TDF/FTC oral PrEP (iPrEx, 2010) 44% (15, 63) Medical male circumcision (Orange Farm, 2005; Rakai, Kisumu, 2007) 57% (42, 68) TDF/FTC oral PrEP (TDF2, CDC, 2011) 63% (22, 83) TDF oral PrEP (Partners PrEP, 2011) 62% (34, 78) 73% (49, 85) TDF/FTC oral PrEP (Partners PrEP, 2011) 96% (82, 99) Immediate ART for HIV+ partner (HPTN 052, 2011) 0% 10 20 30 40 50 60 70 80 90 100% Efficacy Note: Does not include flat results from FEM-PrEP and VOICE arms

7. TDF/FTC: Gilead approves oral PrEP with TDF/FTC July 2012

8. Three-Part Agenda for Ending AIDS • Deliverproven tools for immediate impact • Modelsuccessful programs • Mobilizedemand for new tools • Reprogramresources for impact • Fundevidence-based scale-up • Testing • Treatment • Male Circumcision GOAL: A sustained decline in HIV infections (now at 2.7 million/year) • Demonstrateproven tools for immediate impact • Planfor rollout in different settings • Prioritizeuse of tools for greatest impact • Pilotto guide real-world implementation COMBINE • PrEP • Microbicides • Developlong-term solutions to end the epidemic • Sustainresearch funding to capitalizeon new scientific insights • Other ARV-based px • Vaccines • Functional Cure End Years to Impact Zero to 5 5 to 10 10 to

9. Combining effective prevention Hallett, T., et al., Imperial College London (2011)

10. Mind the Language Antiretroviral therapy—the combination of medications leading to viral suppression in people living with HIV. ART ARV Antiretrovirals—treaments drugs individually or co-formulated. Potentially strategies, such as a periodic shot of ARVs or a viginal ring (inserted monthly), which could potentially provide continuous protection against HIV. Long-acting methods Substances that can block HIV in the vagina or rectum—refers to a range of products including topical PrEP, non-ARV-based compounds and/or “multi-purpose” technologies. Microbicides Multi-purpose technologies The emerging term for combination HIV prevention, STI prevention and/or contraceptive products. PrEP Pre-exposure prophylaxis using ARVs. Topical PrEP ARV-based microbicides. Systemtic use of ART to reduce sexual transmission risk in HIV-positive people. Also known as TasP, T4P, TisP and TLC+ (testing, linkage to care plus treatment). Treatment as prevention Source: AVAC Report 2011: The End?

11. Real-world challenges: treatment cascade

12. Real-world challenges: treatment cascade

13. Real-world challenges: treatment cascade

14. Real-world challenges: treatment cascade

15. Invest Now to Save Lives and Funds Baseline Baseline Cost (billions US$) AIDS deaths averted between 2011 and 2020 New infections averted between 2011 and 2020 7.4 million 12.2 million AIDS Deaths New HIV infections InvestmentFramework Investment Framework

17. Top 10 for 2012 and beyond • No magic bullet; need smart combinations • It’s behavior, stupid! • Adherence, adherence, adherence • Embrace the niche • Strategize the sequence • Testing, testing, testing • Watch our language • Money, money, money • Scientific data do not change the world—programs and policies backed by civil society, donors, implementers and governments do • Five questions

18. Five Questions • Who needs what? • Who wants what? • Who gets what? • Who pays? • Who decides?