WHO: HIV services rebounding after pandemic shock

Speaking at a press briefing on the eve of World AIDS Day on 1 December, WHO experts noted that, while progress on HIV/AIDS had slowed in the past year due in part to the shock of Covid-19, HIV services have “rebounded” in the last few months.

“The number of countries reporting disruptions in HIV services has declined by almost 75 per cent since June,” said WHO director general Dr Tedros Adhanom Ghebreyesus. “This is good news.”

Early disruptions followed by rebound. According to the World AIDS Report 2020 released by UNAIDS last week,  HIV services in many countries were disrupted and supply chains for medicine stretched in the first months of the pandemic. The scale of HIV treatment was 50 per cent lower in the first half of 2020 than in the same period in 2019, as numbers of people receiving antiretroviral therapy and accessing testing services dropped.

However, healthcare workers and governments rallied to get essential services back up and running after a series of initial lockdowns. Only nine countries are still reporting disruptions, and 12 reporting critically low-stock of antiretroviral medicines, Dr Tedros noted.  Although reduced access to HIV services in countries such as Mexico, which has seen a recent surge in Covid-19 infections, remains a severe concern, there has still been a marked improvement since the start of the pandemic.

“Early on we saw some dipping in the numbers of people getting tested, getting put onto treatment, and that can have effects over the long-term of increased deaths and new infections,” said Dr Meg Doherty, director of global HIV, hepatitis, STI programmes at WHO during the press conference.

“But what we’ve seen since June until November is a sort of rebound where, as the cases are lower, systems have been able to regroup and put more people back onto therapy, shore up their ARV stocks, and make sure they have adequate supplies.”

Significantly, Dr Doherty said, healthcare workers are also making HIV services work for pandemic control by providing multiple tests at their facilities. “They are not only taking care of Covid testing, but combining Covid and HIV testing,” she added.

Innovation in services. Adapting existing services has been key to this recovery. Innovations have included the introduction of longer prescriptions for antiretrovirals for three to six months, allowing people living with HIV - who have an increased risk of severe death and disease from Covid-19 - to visit health facilities less frequently. Countries have also rolled out self-testing for HIV and remote counselling services, with Dr Doherty citing South Africa as a pioneer in this area.

“Countries have introduced a number of effective adaptations and innovations during Covid 19,” said Dr Tedros. “WHO is urging countries to maintain these innovations as part of the new normal, and to help expand testing and treatment to people who need it.”

New drugs rolled out . There have also been a number of innovations surrounding HIV/AIDS that have emerged over the past few months. In South Africa, where infection risk is extremely high among adolescent girls and young women in particular, health officials are hoping new long-acting drugs to help prevent HIV infection will be a turning point in the fight against the diseases.

New and more affordable HIV treatments for the 1.7 million children living with HIV as well as adults are being rolled out this week, involving cheaper versions of the WHO-approved antiviral dolutegravir-based (DTG) treatments. The new strawberry-flavoured paediatric HIV drug, which slashes costs by 75 per cent, will initially be made available in six African countries in the first half of 2021. A cheaper, adult formulation of DTG will be made available in middle-income countries like Azerbaijan, Belarus, Kazakhstan and Malaysia, that had been left out of the loop of earlier agreements.

Still a long way to go. The UNAIDS report showed that the world has made progress on tackling HIV/AIDS over the past decade, with HIV infections declining by 23 per cent and AIDS-related diseases having fallen by 39 per cent. A record 26 million people are on antiretroviral treatment.

However, there is still a long way to go, and Covid-19 has undoubtedly slowed progress, with the world missing the global target of 30 million people on ARVs by 2020.

Addressing stigma can close gaps. Social and legal stigmatisation, particularly of sex workers and LGBTI groups who may be at risk, remains a big barrier to accessing HIV/AIDS services in many countries.

“Sometimes [we] think we can solve the problem of HIV/AIDS through a biomedical approach. We can't,” said UNAIDS executive director Winne Biyanyima at the launch of their report last week. “There is no treatment, no pre-exposure prophylaxis, ARVs or whatever, that will reach the hands of a gay man in my country, Uganda, where the criminal law is being enforced in a harsh way.”

Speaking at a briefing this week, Deborah Birx, the US special representative for global health diplomacy, said more investment in “peer-led” services can help overcome such barriers.

“In many places around the globe, peer-led service delivery is much more successful outside of the public sector for many reasons,” Birx said. “Stigma discrimination - It's how people are dressed and how people are seen and spoken to and spoken with.”

Call for solidarity. An estimated 12.6 million people living with HIV are not receiving treatment - a gap which is “jeopardising our goal of ending AIDS as a public health threat by 2030”, said Dr Tedros on Monday.

“But if the pandemic has taught us anything, it's that in the face of an urgent health threat the world can come together in new ways to defeat it,“ he added. “For many people, the pandemic is a source of fear, but it can also be a source of hope that we can defeat COVID-19, and we can defeat HIV.”