Lost access to HIV/AIDS medicines is no less than a matter of life and death for those affected – but the COVID-19 pandemic has imperilled access to such drugs and, in turn, the lives of those living with HIV/AIDS.
This week marks the 23rd bi-annual International AIDS Conference. The event “provides a platform for discussing and challenging the many barriers to care and stigma faced by persons living with HIV in many countries and population groups in given countries,” states Paul A. Volberding, M.D., chief medical editor of Infectious Disease News and a professor of medicine and director of the AIDS Research Institute at the University of California in San Francisco, U.S. in comments made to Healio. “I expect that topic to be strongly evidenced at AIDS 2020 as well.”
Yet the circumstances in which the International AIDS Conference is being held this year are markedly different from years past. The HIV/AIDS pandemic is one of two the world is grappling with – the other, of course, being that of COVID-19, the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or simply coronavirus. In this climate, experts have warned of disruption to the treatment of HIV.
As reported by EuroNews, International AIDS Society (IAS) president Dr Anton Pozniak has cautioned that “medical and financial resources have been diverted towards the fight against COVID-19, making it harder to manage the ongoing HIV epidemic.” In addition, he says, “research has really been put on a freeze.”
The World Health Organization (WHO) has warned of disruption to access to HIV/AIDS medicines. “73 countries have warned that they are at risk of stock-outs of antiretroviral (ARV) medicines as a result of the COVID-19 pandemic, according to a new WHO survey,” the agency said earlier this week. Of these countries, 24 have “reported having either a critically low stock of ARVs or disruptions in the supply of these life-saving medicines.”
This threatens the progress made against HIV/AIDS in recent years. As the WHO statement notes, “in 2019, an estimated 8.3 million people were benefiting from ARVs in the 24 countries now experiencing supply shortages. This represents about one third (33 percent) of all people taking HIV treatment globally. While there is no cure for HIV, ARVs can control the virus and prevent onward sexual transmission to other people.”
WHO Director-General Dr Tedros Adhanom Ghebreyesus has described the news about HIV/AIDS medicines as “deeply concerning. Countries and their development partners must do all they can to ensure that people who need HIV treatment continue to access it. We cannot let the COVID-19 pandemic undo the hard-won gains in the global response to this disease.”
India is among the countries that has made significant progress against HIV/AIDS – progress which COVID-19 portends to undo. Between 2010 and 2017, infections fell from 120,000 to 80,000. Within the same timeframe, HIV/AIDS related deaths declined to 69,000 from 160,000. As of 2017, the country was home to 2.1 million people living with HIV/AIDS.
The Union Ministry of Health and Family Welfare has unveiled substantive, lofty targets in the fight against HIV/AIDS in India in recent years. “We can now safely say that we can end the HIV/AIDS epidemic by 2030,” then-Union Health Minister Jagat Prakash Nadda said on World AIDS Day in 2016. The Union Health Ministry last year stated its intention to bring cases down by 20,000 on a yearly basis in 2019 and 2020 through a series of ambitious measures. Yet the disruption to health systems as a result of COVID-19 threatens such ambitions, both in India and at the global level.
This moment of interruption is inopportune to say the least. As the WHO statement notes, “progress towards global [HIV/AIDS] targets is stalling. Over the last two years, the annual number of new HIV infections has plateaued at 1.7 million and there was only a modest reduction in HIV-related death, from 730,000 in 2018 to 690,000 in 2019. Despite steady advances in scaling up treatment coverage – with more than 25 million people in need of ARVs receiving them in 2019 – key 2020 global targets will be missed.” The COVID-19 crisis will only exacerbate this state of affairs, with the WHO observing that “HIV prevention and testing services are not reaching the groups that need them most. Improved targeting of proven prevention and testing services will be critical to reinvigorate the global response to HIV.”
Concerns over the disruption to the HIV/AIDS response has been articulated at length during the pandemic. The Lancet published a commentary earlier this year which warned that “people living with HIV who should have initiated antiretroviral therapy…in hospital might be deterred or delayed because hospitals are busy treating patients with COVID-19. Furthermore, because many public health authorities globally are focused on COVID-19 control, allocation of resources for HIV care could be diminished, and circumstances surrounding the HIV care continuum could worsen.”
Impaired access to HIV/AIDS medicines such as ART is an issue the WHO has sought to address with the issuance of “guidance for countries on how to safely maintain access to essential health services during the pandemic, including for all people living with or affected by HIV. The guidance encourages countries to limit disruptions in access to HIV treatment through “multi-month dispensing,” a policy whereby medicines are prescribed for longer periods of time – up to six months. To date, 129 countries have adopted this policy. Countries are also mitigating the impact of the disruptions by working to maintain flights and supply chains, engaging communities in the delivery of HIV medicines, and working with manufacturers to overcome logistics challenges.” The guidance can be accessed here.
COVID-19 may dominate the news cycle and the global health discourse, but it is not the sole health challenge with which the world is faced. As I previously wrote for Health Issues India
“There may seem to be a heightened urgency for dealing with COVID, but it cannot be forgotten that a diverse population carries with it a diverse burden of disease – as is the case in India. Public health emergencies require preparedness and planning, with contingencies to be in place for those affected by chronic and critical diseases. This is true of HIV. What is imperative also is the need to tackle the long-standing issues of prejudice and stigmatisation levelled at the HIV-positive community. In a time of crisis, such stigma poses to exacerbate the difficulties many are already facing to access the vital medicines they require.”
It is imperative not to neglect addressing the HIV/AIDS pandemic whilst addressing the COVID-19 pandemic. For India, beset before the COVID-19 pandemic by a plethora of issues pertaining to its public health system, this will undoubtedly be a challenge. It is home to the third-largest epidemics of both COVID-19 and HIV/AIDS at the time of writing. It will not be easy to address both crises in tandem – but it is imperative.