The United Nations says global HIV/AIDS targets for 2020 will not be met, and that some progress could be lost, in part because of the coronavirus pandemic, which has seriously impacted the HIV/AIDS response.
“Our report shows that COVID is threatening to throw us even more off course,” Winnie Byanyima, executive director of UNAIDS said Monday at the report’s launch in Geneva. “COVID is a disease that is claiming resources — the labs, the scientists, the health workers — away from HIV work. We want governments to use creative ways to keep the fight going on both. One disease cannot be used to fight another.”
COVID-19 is the disease caused by the new coronavirus.
UNAIDS says despite expanding HIV treatment coverage — some 25 million of the 38 million people living with HIV now have access to antiretroviral therapy — progress is stalling. Over the last two years, new infections have plateaued at 1.7 million a year, and deaths have only dropped slightly — from 730,000 in 2018 to 690,000 last year.
The U.N. attributes this to HIV prevention and testing services not reaching the most vulnerable groups, including sex workers, intravenous drug users, prisoners and gay men.
COVID-19 poses an additional threat to the HIV/AIDS response because it can prevent people from accessing treatment. The U.N. estimates that if HIV patients are cut off from treatment for six months, it could lead to a half-million more deaths in sub-Saharan Africa over the next year, setting the region back to 2008 AIDS mortality levels. Even a 20% disruption could cause an additional 110,000 deaths.
HIV/AIDS patients who contract COVID-19 are also at heightened risk of death, as the virus preys on weakened immune systems.
The World Health Organization warned Monday that 73 countries are at risk of running out of antiretroviral (ARVs) drugs because of the COVID-19 pandemic. The WHO says 24 countries have reported having either a critically low stock of ARVs or disruptions in the supply chain.
Gains and losses
UNAIDS reports progress in eastern and southern Africa, where new HIV infections have dropped by 38% since 2010. But women and girls in sub-Saharan Africa continue to bear the brunt of the disease, accounting for nearly 60% of all new HIV infections in the region in 2019.
Each week, some 4,500 teen girls and young women becoming infected. They are disproportionately affected, making up only 10% of the population, but nearly a quarter of new infections.
Condom use has also dropped off in parts of central and western Africa, while it has risen in eastern and southern parts of the continent.
Eastern Europe and Central Asia is one of only three regions where new infections are growing. Nearly half of all infections are among intravenous drug users. Only 63% of people who know their HIV status are on treatment. UNAIDS says there is an urgent need to scale up HIV prevention services, particularly in Russia.
The Middle East and North Africa have also seen new infections rise by 22%, while they are up 21% in Latin America.
“New infections are coming down in sub-Saharan Africa, but going up in Eastern Europe and Central Asia, going up in the Middle East and North Africa, and going up in Latin America. That’s disturbing,” Byanyima, the UNAIDS chief said.
Progress is also impacted by draconian laws and social stigma. At least 82 countries criminalize some form of HIV transmission, exposure or nondisclosure. Sex work is criminalized in at least 103 countries, and at least 108 countries criminalize the consumption or possession of drugs for personal use.
One of UNAIDS’s main targets was to achieve “90-90-90” by this year. That means 90% of all people living with HIV would know their status; 90% of those diagnosed would be on antiretroviral treatment; and 90% of all people on treatment would have suppressed the virus in their system.
Only 14 countries have reached the target, including Eswatini, which has one of the highest HIV rates in the world. The others are Australia, Botswana, Cambodia, Ireland, Namibia, the Netherlands, Rwanda, Spain, Switzerland, Thailand, Uganda, Zambia and Zimbabwe.
“It can be done,” Byanyima said. “We see rich and poor countries achieving the targets.”
Globally, there have been gains in testing and treatment for HIV. By the end of 2019, more than 80% of people living with HIV worldwide knew their status, and more than two-thirds were receiving treatment. Therapies have also advanced, meaning nearly 60% of all people with HIV had suppressed viral loads in 2019.
UNAIDS says that increased access to medications has prevented some 12.1 million AIDS-related deaths in the past decade. While some 690,000 people died from AIDS-related illnesses last year, that is a nearly 40% reduction since 2010.