“…keep up the two struggles on HIV and COVID-19. Do not drop one for the other”. Winnie Byanyima, Executive Director, UNAIDS.

HIV became a major global concern in the 1980s and remains a serious public health threat today. The burden of the epidemic varies considerably between countries and regions: sub-Saharan Africa, home to 12% of the world’s population, accounts for 72% of the global HIV burden- 25.6 million of the 36.9 million People Living with HIV (PLHIV) worldwide (UNAIDS, 2019) live in that region;[i] Eastern Europe and Central Asia have the fastest-growing regional epidemic in the world[ii] while the Philippines, which has the fastest-growing epidemic in the western Pacific, recorded an HIV incidence increase of 174 percent between 2010 and 2017(WHO).[iii]

Although the world’s current focus is on stopping the spread of Covid-19, with about 1.7 million new HIV infections in 2019 (UNAIDS)[iv] , we cannot and must not forget the AIDS epidemic which the world has been fighting for about 40 years. Both viruses must be fought at the same time.

Sadly, HIV seems to have faded into the background with reports from all corners of the world detailing sharp declines in public health responses because personnel and resources are being diverted to combat Corona virus and the lockdown imposed by many governments to halt its transmission is affecting people in different ways.

How is the Covid-19 response distressing PLHIV? Disruption in HIV service delivery and daily routine, travel restrictions, food insecurity and other instabilities are exacerbating vulnerabilities. Some are experiencing interruption in treatment and they, as well as the 13.4 million who are not accessing treatment (UNAIDS),[v] risk passing on the virus.

Undoubtedly, interruptions in ART can be fatal. If PLHIV contract COVID-19 while off treatment, they could become seriously ill. This scenario could be even more scary in sub-Saharan Africa where over 9 million are not accessing ARVs (UNAIDS)[vi] and health systems are under-resourced. Disruption in treatment can also result in drug resistance and even death.

It should be stated that a recent study conducted in South Africa found “approximately twice the risk of Covid-19 death in people with HIV irrespective of viral suppression or ART use. The study also mentions an “increased risk of Covid-19 death associated with other risk factors, such as older age [ten times more likely] or diabetes”[vii] [between four and 13 times more likely]. There should be concern for PLHIV who have co-morbidities.

 

COVID-19 lockdown

Sadly, from Africa to Asia, the stories emerging are alarming: hunger compromising adherence to medication, fear of disclosure to security operatives enforcing lockdown because of stigma, absence of social engagement with peers which further aggravates isolation and loneliness and, above all, the fear of getting infected by COVID.

In South Africa, the country that has the world’s highest HIV rates, some PLHIV are trapped in areas where they cannot get their medication and, at some point, Gauteng province reported that nearly 11,000 people had failed to collect their HIV medicine[viii].

 

In Uganda, the country with one of the highest rates in east Africa, people who struggle to eat avoid medicine as ARVs make them nauseous and dizzy when taken without food. And, the story is no different in India where district treatment centres could be 30 to 40 km from villages making access to treatment during the nationwide lockdown practically impossible[ix].

Spike in deaths predicted

A WHO and UNAIDS modelling group has predicted over 500,000 extra deaths from AIDS-related illnesses, including tuberculosis, in sub-Saharan Africa from 2020–2021 if the disruption in health services and ART continue for up to six months. Last year about 470,000 people died of AIDS-related illness in that region. Additionally, a disruption of this length of time would also result in a sharp increase in the number of mothers transmitting HIV to their children during pregnancy, childbirth, or breastfeeding – this will undo years of hard-won gains.

 

Call to action

Lockdown restrictions are being eased and a lot needs to be done urgently to repair the damage caused by the interruptions experienced at various levels. We cannot and must not sit idly by and watch Corona virus reverse the hard-earned gains in the prevention of vertical transmission, the use of treatment as prevention, early detection of HIV through testing, immediate linkage to care etc. In sub-Saharan Africa, only 64% or 16.4million of the estimated 25.7 million PLHIV were on treatment in 2018. The lives of these 25.7 million people living with HIV matter and this is an opportunity to help. In particular, the lives of those not accessing treatment matter as they need to be linked to treatment and care.

 If you are interested in joining hands with us to halt preventable deaths, needless HIV transmission, drug resistance and contribute to the reduction of hunger among PLHIV please get in touch with us at info@positivelysharing.

 

[i] Nweze, J., Eke, E., Nweze, I. (2017) HIV/AIDS in sub-Saharan Africa: Current status, challenges and prospects. https://www.researchgate.net/publication/316598262_HIVAIDS_in_sub-Saharan_Africa_Current_status_challenges_and_prospects

[ii] AVERT, https://www.avert.org/hiv-and-aids-eastern-europe-central-asia-overview

[iii] https://www.rappler.com/nation/93839-who-ph-response-hiv.

[iv] https://www.unaids.org/en/resources/fact-sheet

[v] https://www.unaids.org/en/resources/fact-sheet

[vi] https://www.unaids.org/en/resources/fact-sheet

[vii] HIV and TB increase death risk from COVID-19, study finds—but not by much; https://www.sciencemag.org/news/2020/06/hiv-and-tb-increase-death-risk-covid-19-study-finds-not-much

[viii] https://www.theglobeandmail.com/world/article-the-covid-19-pandemic-could-be-devastating-for-battles-against/

[ix] India’s focus on coronavirus leaves TB and HIV patients adrift; https://scroll.in/article/958400/invisible-crisis-tb-and-hiv-patients-left-adrift-in-indias-focus-on-coronavirus