Between June 12th and June 18th, hundreds of experts from academia, research, government, and within the community came took part in the 2015 HIV Prevention Trials Network Annual Meeting in Arlington, VA. On June 16th, Jonathan and I were able to attend the HPTN Plenary session which consisted of a series of speakers discussing topics and projects in HIV prevention research. The first portion of the plenary consisted of three presenters who discussed HIV prevention in what was termed “priority populations” - populations that bear a disproportionate burden of HIV. The first speaker, Dr. Frances Cowan, spoke about female sex workers (FSWs) and HIV.. She mainly discussed the use of the two-part WHO guidelines when developing interventions for FSWs: (1) providing essential health services provided to the FSWs such as condoms, harm reduction equipment, and periodic screening for STIs, and (2) providing an enabling environment for FSWs including supportive legislation and policy, aims towards reducing violence among FSWs, and reducing the stigma and discrimination of FSWs. She used these guidelines when conducting her research in examining the use of ART as prevention for FSWs in Zimbabwe.

The second presenter, Dr. Steve Shoptaw, discussed the population of non-injection drug users and HIV prevalence. He summarized the biological influences of non-injection drug use on HIV such as evidence has shown that cocaine use promotes HIV entry and its replication. He also discussed the behavioral influences of non-injection drug use, such as MSM who use substances before having sex, making them less likely to use protection. Since Non-IDUs only avenue for HIV transmission is through sex, his research methods for this population are either biologically or behaviorally directed which ultimately work to promote a reduction in risky sexual behaviors.

The third and final presenter, Dr. Kenneth Mayer, spoke about the transgender population. He discussed the need to standardize the identity labels for people that identify as transgender in order to differentiate their issues from one another. He also noted the importance of taking into account the “multilevel axes of risk and vulnerability” to HIV in the transgender population including identity issues, stigma, mental health, drug use, sexual behaviors, poverty, and homelessness. His research on transgender populations has looked at the implementation of standards of care to reduce HIV prevalence including culturally appropriate staff training, access to gender reassignment surgery, hormones, behavioral health services, and social services to address transphobic violence and poverty. 

In the second half of the plenary, Wafaa El-Sadr, Bernard Branson and Linda-Gail Bekker wrapped up the day by explaining two ongoing HPTN studies (HPTN 065 & HPTN 067): one that is in the process of evaluating the feasibility of an enhanced test, link to care, plus treat approach using financial incentives and the other highlighted a phase II trial evaluating the use of PrEP in high risk, HIV negative African women who have sex with men. Both studies outlined their current progress, as well as their challenges and barrier. To close out the day, Dr. Raphael J. Landovitz discussed the use of PrEP - a very promising new HIV prevention method - in clinical trials and the issues holding it back.

Overall, the meeting was fascinating. It was enlightening to be able to see current research focuses in HIV prevention and the people behind the projects. HPTN's inclusion of a discussion on high risk populations was most compelling, as they are often left out of a lot of discussions in health and medicine.  In the meeting. I thought: how often do we get a chance to talk about such high risk populations like sex workers, transgenders, and non-injection drug users in HIV prevention? These are populations that basically define the term "social determinants of health" because as Dr. Mayer expressed, they represent "multilevel axes of risk and vulnerability" to HIV.  It was interesting seeing that HIV prevention research takes on different modalities of prevention to accomodate the different populations; whether it be through physical barrier methods such as condom use and other contraceptive techniques, or harm reduction methods like syringe exchange, or treatment as prevention such as Post-Exposure Prophylaxis (PEP) and Pre-Exposure Prophylaxis (PrEP), or health behavior education. Through the discussion on current projects, this plenary revealed the spectrum of innovative approaches that are currently used in HIV Prevention research, and the successes and challenges that were encountered and overcome.