By 2020, UNAIDS predicted massive declines in HIV incidence. Incidence isn't dropping worldwide. Widespread treatment is essential, but it isn't enough. UNAIDS' primary prevention targets won't be met by a long shot.

now what?

annual report 2019

Table of Contents

Download the Full Report: Now What? AVAC Report 2019
Download: AVAC Report 2019 One-pager
The Honest Answer: A letter from the Executive Director
Now What? AVAC's top three priorities for 2020—and beyond
1. NOW: Enact bold, activist, visible leadership on HIV from the grassroots to Geneva
2. NOW: Use today's evidence to guide tomorrow's prevention targets
3. NOW: Double down on multilayered prevention approaches
Not the End—Just the Beginning: AVAC's commitments for 2020 and beyond
Infographics: Download all the visuals from AVAC Report 2019 here

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The Honest Answer

A Letter from the Executive Director

"Now what?"

It's been a challenging year as new data have confirmed, with greater clarity, the distance left to go in addressing global and local HIV epidemics.

Midway through 2019, a range of trials brought new data on the potential and limitations of biomedical strategies in the global HIV response. The data weren't surprising, but they made some serious obstacles clearer than they have been before. Community-wide testing followed by ART for people living with HIV has health benefits for the individual and reduces incidence by around 30 percent. That's both invaluable and insufficient to end epidemic levels of new diagnoses. 2019 also brought fresh data from the ECHO trial, data on HIV risk in young women, and their unmet need for integrated sexual and reproductive health and HIV. This clarity comes as the world nears the 2020 deadline UNAIDS has set for reducing new infections to fewer than 500,000 per year worldwide.

2020 is also the deadline for critical milestones in the contraceptive field. FP2020—the global partnership focused on tracking and expanding contraceptive coverage and choice—had hoped to see 120 million additional users of modern contraception (compared to 2012), and all projections say that target won't be met either.

Now what?

The answer that you'll find in this report is: sustain the investment, do the more difficult things that have been put off, measure those things, modify the approaches, repeat. It's easy to say, hard to do and there are unknowns at every step. But there is hope: much of what needs to be done involves approaches that are, in many respects, familiar. We need not reinvent the wheel, just reorient the direction of the field.

Continue reading the letter from our Executive Director.

Now What?

AVAC's top three priorities for 2020—and beyond


Now with a raised fist

Enact bold, activist, visible leadership on HIV from the grassroots to Geneva.

From the head of UNAIDS, to African houses of parliament, to civil society coalitions: take uncompromising stances, demand accountability, speak out for intersectional issues of race, gender, class and climate. This work needs to be funded, full-throttle and fearless. In Section One, we lay out what we hope these leaders will take on.

Read Section 1


Now with a target visual

Use today's evidence to guide tomorrow's prevention targets.

The world is going to miss the 2020 incidence-reduction target not because it tried everything and failed, but because many things didn't get funded or evaluated and fixed when needed. Prevention impact can be achieved and measured. Let's not waste any more time. In Section Two, we identify the interlinked suite of approaches and terms that should be used to set and measure the next generation of prevention targets.

Read Section 2


Now with a person visual

Double down on multilayered prevention approaches.

Let's try a new term to address old siloed problems. Multilayered prevention involves multipurpose strategies (think contraception and HIV prevention) embedded in multisectoral strategies (think policy reform, community norms changing, economic empowerment and more). Only layered approaches like these will drive incidence down. In Section Three, we lay out work for UNAIDS, FP2020 and a new set of targets—including goals for the research pipeline—that are shared by HIV and sexual and reproductive health and rights fields.

Read Section 3

Not the End—Just the Beginning

AVAC's commitments for 2020 and beyond

As longtime AVAC Report readers know, we develop a "3-D agenda" every year that summarizes our take on the critical advocacy priorities for the field of HIV prevention. Every year, with our partners, we take on these challenges. But, the way that we've presented that agenda in the past hasn't always been clear about what we, as AVAC, are taking on ourselves.

So this year, as we near global deadlines and wrestle with the question of "Now what?", we want to change that—and share our answers with you.

AVAC has a bold agenda for 2020 and beyond.

  • We will work with our partners to influence the post-2020 agenda to ensure that funding for prevention increases and money is directed to the geographies and populations with the most need, and to the most effective interventions.
  • We will continue to build and sustain a global cadre of smart, evidence-based, impact-driven advocates who stand at the front lines of this fight.
  • We will continue to raise our voices for women's HIV prevention and help craft the global prevention agenda for women.
  • We will ensure civil society perspectives are informing and influencing decision-making on current and next-generation trials and trial designs.
  • We will guide and pressure developers, funders and policy makers to ensure comprehensive plans for all relevant populations for products entering and coming out of the product pipeline in 2020.
  • And we will identify, raise up and advocate for ways to increase uptake and continuation rates for prevention methods through a people-centered lens.

Continue reading AVAC's commitments for 2020 and beyond.