Aids-related deaths on the rise as pandemic sets back progress

Health officials check lists of people who are to be tested for Covid-19 as well as HIV and Tuberculosis, in downtown Johannesburg, April 2020. Credit: AP Photo / Jerome Delay

Gains made towards ending the Aids epidemic by 2030 could be jeopardised by the Covid-19 pandemic, UNAIDS has warned.

The global response to Aids was already off track before the start of the pandemic, but the spread of the virus has caused additional setbacks, according to a new report from UNAIDS.

In many countries, HIV services have been disrupted and supply chains for medicine and commodities have been stretched. Over the past year, fewer people have been diagnosed with HIV due to reduced access to diagnostic centres and fewer people living with HIV have started treatment.

“Covid-19 has worsened the inequalities that have been driving the HIV pandemic,” said Winnie Byanyima, executive director of UNAIDS, speaking at the report’s launch yesterday. “We see now the close link that exists between our health and the health of the global economy...The gains that have been made over the past years are threatened.”

Reduced access to HIV services. As governments scrambled to slow the spread of the virus and ease the pressure on overwhelmed health systems, few people have had access to HIV services. There have been worrying drops in treatment in countries such as Sierra Leone and South Africa - which has the world’s largest population of people living with HIV - and large decreases in HIV testing across the world. Early modelling by UNAIDS projected that a six-month disruption of antiretroviral therapy could cause more than 500,000 additional Aids-related deaths in sub-Saharan Africa.

The scale of HIV treatment was 50 per cent lower in the first half of 2020 than the first half of 2019. Modelling of the pandemic’s long-term impact on the HIV response suggests there could be between 123,000 to 293,000 additional new HIV infections and 69,000 to 148,000 additional AIDS-related deaths worldwide between 2020 and 2022.

The world is off track. In the past decade, new HIV infections have been reduced globally by 23 per cent, but while the most affected regions have made progress the epidemic is on the rise elsewhere. Infections decreased by 38 per cent in eastern and southern Africa, but rose by 72 per cent in eastern Europe and central Asia, 22 per cent in the Middle East and north Africa and by 21 per cent in Latin America.

The report showed significant progress in sub-Saharan Africa, with many countries including Botswana and Eswatini (formerly known as Swaziland) achieving or exceeded targets set for 2020 - in Eswatini, 95 per cent of people living with HIV know their status and most are accessing treatment. However, many more countries are falling behind.

The 2020 target was to reduce Aids-related deaths and new HIV infections respectively to 500,000 or less, but from 2015 to 2020, there were 3.5 million more HIV infections, and 820,000 more Aids-related deaths than there would have been had targets been met . In 2019 alone, the report revealed there were 690,000 Aids-related deaths and 1.7 million people became infected.

There are now 38 million people living with HIV, and more than 12 million waiting for life-saving treatment.

Fighting the pandemic and the epidemic. “The collective failure to invest sufficiently in comprehensive, rights-based, people-centred HIV responses has come at a terrible price,” said Byanyima in a statement. “Implementing just the most politically palatable programs will not turn the tide against Covid-19 or end AIDS. To get the global response back on track will require putting people first and tackling the inequalities on which epidemics thrive. ”

The report outlines a new series of targets for 2025 focusing on high coverage of HIV and sexual health and reproductive services, as well as the removal of policies and laws that promote stigma and discrimination.

UNAIDS is calling on governments to learn from the impact of Covid-19 and make greater investments in strengthening health systems and social safety nets, accelerating action to make universal health coverage a reality.

“No country can defeat these pandemics on its own,” said Byanyima. “A challenge of this magnitude can only be defeated by forging global solidarity, accepting a shared responsibility and mobilising a response that leaves no one behind. We can do this by sharing the load and working together.