UNAids rings alarm bells as Covid slows battle against HIV

One and a half million people contracted HIV in 2021 – missing global targets – as inequalities exacerbated by Covid-19 and other crises stalled progress in ending the Aids pandemic, the United Nations said on Wednesday.

While the number of new HIV infections – the virus that causes Aids – decreased by 3.6 per cent last year compared with 2020, this was the smallest annual drop in new HIV infections recorded since 2016, UNAids said in its report.

Targets of fewer than 500,000 new infections by 2020 were set by the UN in 2016, but the agency said that progress had faltered during the Covid-19 pandemic and resources had shrunk, putting millions of lives at risk.

It noted that there were a few bright spots like western and central Africa, where the number of new HIV infections decreased during the pandemic and called for a coordinated, refocussed action toward the goal of ending Aids by 2030.

As global leaders on the HIV/Aids response converge at Montreal from 29 July  for the International Aids conference 2022, Dr Mary Mahy, epidemiologist and the director of data for impact at UNAids, spoke to Geneva Solutions on the report.

Geneva Solutions: The In Danger report sheds light on several important points regarding slowing down of Aids response in the pandemic era. How did we get here?

Mary Mahy: We have made fragile gains in HIV response [over the years]. There has been success. But all those successes require a considerable amount of focus from governments including domestic funding. We should have recognised that the funding [we had] could be yanked away from us at any point of time. We do a lot of advocacy in countries and we try to explain what the impact will be if the funding stops.

I think we didn't expect Covid-19 to take over the situation and the finances rapidly. What is interesting is that a similar thing happened with the war in Ukraine as well. We are seeing funding from European countries drying out. Countries in Africa are in angst about the potential food insecurity so that their domestic funding is also being held closely as it should be. I think, as a result, there is a second shockwave that we didn't prepare enough financially to recognise that our fragile gains are not being maintained.

Despite infections rising in most regions,  there seem to be bright spots too, like in Nigeria and the Caribbean. Could you elaborate on these?

When it comes to HIV, we know that treatment will keep people alive and also reduce the onward transmission, i.e., new infections. What we saw in Nigeria in the last two years has been remarkable. They had a lot of people living with HIV that weren't on treatment. Through concerted efforts by five of their 36 states, they have gotten a lot of people to enrol for treatment. They also ensured that people who were already being treated stayed that way. As a result, we estimate that new infections have declined very quickly in Nigeria in the last two years. This is a great success story.

How did Nigeria manage to achieve this and be an outlier when the response to HIV has been on a slump across the rest of the world due to the pandemic?

We've poked and prodded these numbers coming out of Nigeria, making sure that they are correct. They are supported a lot by the United States Centre for Disease prevention and Control (CDC). So when someone enters into a treatment regime, they (the CDC) have made sure to capture enough information about that individual, using technology like biometrics, to avoid duplicating them someplace else. Thus, they have got these systems in place that will really make sure that they are measuring these people correctly.

They also have a lot of community efforts that have reached people. In a community, if people know someone who has dropped out of treatment, they are sending people to go out and check on them as to why they haven't come back to the clinic and back on the treatment. A lot of community-led effort is underway to make sure that people get the treatment they require. It means that certain people living with HIV (for example, sex workers) who have a small network in their city going out to try and find people to get them tested or adding them to the treatment regimen.

Overall, it was a horrible situation [due to Covid-19]. We saw reduced testing for HIV, we saw reduced condom use and reduced finances. But we also saw countries realising that they needed to switch the way of handing out drugs to make sure that people who started out on drugs didn't have to keep coming back to clinics. They did multi-month dispensing of drugs needed for six months. This ability to be innovative with how we are managing our treatment services and identifying people is what drove Nigeria’s success.

Investments in addressing Aids are on a downward trend, especially from bilateral donors. How, in your opinion, can funding be bolstered?

We should convince our ministers of finance around the world of what would be the cost if they don't focus [on the HIV response], like our executive director Winnie Byanyima says. If they don't fund HIV or keep those small resources that are going to HIV, they are going to pay a lot more over the next nine to 10 years on keeping people in treatment.

The fact is that if the current funding is not maintained towards HIV, the costs in the future are going to be higher. The challenge comes when governments think on a short-term basis, like if they are going to be elected next year or if they are retiring [from politics]. We really need to be thinking five or ten years in advance.

The world seems to be moving towards a more closed approach when it comes to access to medicines. Do you think this will have ramifications on the Aids response?

What we are hearing is that the Medicines Patent Pool (MPP) is working on making medicines more quickly available to countries that need them. As MPP's success grows, we can use this as an example outside of HIV and say "look at this, you need to be much more fair with your drugs. Look at what this company is doing versus what you are doing" and try to shame them. You can see that quite often pharmaceutical companies do look at their rating in terms of being fair. We can only play on their conscience regarding this.

Do you think that the fact that HIV has been around for much longer than Covid-19 has led to systems [like the MPP] being in place?

I think that has been a changing factor. Having people like Winnie Byanyima be consistently vocal about how Covid-19 vaccinations have gone wrong and trying to draw lessons from it for the HIV programme helps. There are some good champions out there who have been consistently talking about this and leading the response in the right way.

Aids and inequalities is a vicious circle. How do you think the battle against Aids will unfold in a world where inequalities are only increasing?

I am quite optimistic that we will continue to shine light on the inequalities that will allow us to close them as we go. We saw how quickly people bought into the global Aids strategy 2021-26 [a set of priorities launched by UNAids to reduce inequalities that drive Aids -ed.] and so I think there is a good pooling together of people towards this.

The finances are indeed going down and how we maintain the funding available is a challenge. We need to be innovative wherever possible which will change the story for HIV response. As costs of innovative solutions come down and become more affordable, we will have a good boost to the HIV response.

How do you think we can get the Aids response back on track, especially now there is another global health emergency with the spread of monkeypox?

We have so much that we learnt from HIV that can be applied for monkeypox. We also need to make sure community-led organisations are involved in the response.

Community involvement and making sure that access and quality reaches all parts of that community will help us win against HIV. Community-led action will lead us to reducing inequalities, which will then allow us to succeed in this HIV response.

Prevention of HIV has been challenging because it requires engaging with key populations. It is important to ensure that services are provided to communities of people that are at increased risk of HIV – sex workers, men who have sex with men, people who inject drugs, transgender persons and prisoners. So if we can get the necessary services to them, we can get it (HIV response) back on track.