In just about 24 months, the world will arrive at the deadline for the UNAIDS "Fast Track" goals for ending the epidemic. The primary fast-track goal for HIV prevention is reduction in new diagnoses from roughly 2,000,000 a year, to less than 500,000. There's no chance this goal will be achieved.

That's the bad news. The good news, such as it is, is that the reasons why the world is going to miss the target are obvious and can be tackled. This year's AVAC Report is dedicated to diagnosing the problem, and proposing actionable solutions.

Table of Contents

Section 1: No Demand Creation, No Impact

Section 2: No Choice, No Prevention

Section 3: No Radical Action, No End

To download AVAC Report 2018, all graphics and an accompanying Px Pulse podcast, click here.

the problem

Today's primary prevention and treatment strategies need approaches to "demand creation".

the risk

The perfect cannot be the enemy of the good.

the path to a solution

Advocates and activists must demand demand creation and refuse to do the work alone.

The future of new and existing biomedical prevention options depends on investment in "demand creation", a term that has been around for a long time and is increasingly becoming a buzzword. The problem with buzzwords is that they can mean everything and nothing.

Demand creation encompasses many things, and always will. But there's a minimum set of pieces that should be considered, if not in place, and often isn't. We think the future depends on defining and doing demand creation right. Download this section from the Report.

the problem

Informed choice is easy to advocate for and hard to implement.

the risk

Embracing informed choice in biomedical prevention is tricky.

the path to a solution

Identify, cost and adapt best practices in informed choice programming and monitoring from family planning and HIV programs as part of planning for new biomedical tools.

Choice is a dangerous word in public health these days. It's been that way since the Trump administration implemented a vastly expanded version of the Global Gag Rule, restricing foreign NGO recipients of US funding from speaking about, referring or advocating for expanded access to abortion.

At AIDS 2018 in Amsterdam, a range of presentations showed the pernicious effects of this rule: it is causing much-needed services to a close, sowing such confusion about allowable activities that reproductive health coalitions are faltering, and costing women's health and lives, as unsafe abortions and poor outcomes from unplanned pregnancies take their toll. Download this section from the Report.

the problem

There is a primary prevention crisis.

the risk

So much has been accomplished in the fight against AIDS; so much is left to do.

the path to a solution

In the short-term, maximize impact of existing resources by tailoring prevention approaches and packages to specific communities and contexts.

An end to epidemic levels of new HIV infections — a situation that occurs when the rates of new diagnoses is lower than the rate of deaths from AIDS — is possible. Profoundly, achingly possible. It will take a major course correction in approaches to primary HIV prevention, but it can happen — and there are signs that it is already underway. Download this section from the Report.

For the full Report, all graphics and an accompanying Px Pulse podcast, click here.