Since the onset of this pandemic, health systems all over the world have become overwhelmed in response to the virus. Patients and health care providers have canceled or postponed many outpatient visits and converted others to telemedicine due to shortages of healthcare resources or the risk of infection. The lockdowns, mainly across parts of Africa, Asia, and Latin America, have raised insurmountable barriers to patients who must travel to obtain diagnoses or drugs. All this adds to the growing narrative about care delays during the COVID-19 pandemic.
Results from a WHO survey show that health services have been partially or completely disrupted in many countries. Imperial College London estimates that HIV, TB, and malaria-related deaths in high burden settings over five years may be increased by up to 10%, 20%, and 36%, respectively, compared to if there were no COVID-19 epidemic. According to another survey by the Global Fund, prevention, testing, and support for people living with HIV are still the most impacted. Nearly 20% of countries are still experiencing a high or very high level of disruption in HIV service delivery.
Globally, it’s estimated that more than 36 million people are living with HIV with acute challenges faced by Sub-Saharan Africa and many low- and middle-income countries. Medical advances over the last 30 years have helped transform HIV from a fatal disease into a chronic, manageable condition for many people. According to UNAIDS, there has been a 23% decline in new HIV infections since 2010. WHO reports that in 2019, 68% of adults and 53% of children living with HIV globally were receiving lifelong antiretroviral therapy (ART). A great majority (85%) of pregnant and breastfeeding women living with HIV also received ART, which not only protects their health but also ensures the prevention of HIV transmission to their newborns.
However, progress on the prevention of HIV transmission remains far too slow, with the estimated total number of new infections in 2019 more than three times higher than UNAIDS’s 2020 target.
UNAID’S 2020 targets, also known as 90-90-90 targets, aim to bring HIV testing and treatment to the vast majority of people living with HIV by 2020, and to reduce the amount of HIV in their bodies to undetectable levels that will keep them healthy and prevent further spread of the virus.
At the end of 2019, 14 countries had achieved the 73% target, while Eswatini and Switzerland have made the remarkable achievement of surpassing the 2030 targets of 95–95–95, meaning that a minimum of 86% of people living with HIV have suppressed viral loads. Advancement in treatment effectiveness, as well as increases in the number of people who know their status and are on treatment, are reflected in the fact that rates of viral load suppression among all people living with HIV rose by 44% between 2015 and 2019. Additionally, increased access to antiretroviral therapy has averted an estimated 12.1 million AIDS-related deaths since 2010. Yet, despite all these efforts, still, far too many people are dying due to HIV.
One of the major gaps in the HIV response could be the deeply unequal success. Data from 46 countries in sub-Saharan Africa show a positive relationship between HIV prevalence and income disparity. Women and girls of all ages accounted for 59% of new HIV infections in sub-Saharan Africa. Unequal gender norms, limited sense of agency, and reduced access to education and economic resources could be key reasons why women face a higher HIV risk.
The impact of the COVID-19 is severe among people who are socioeconomically disadvantaged and marginalized and among people with underlying medical conditions. Because of this, people with HIV remain especially vulnerable to the pandemic. Recent modelling has estimated that a six-month total disruption of antiretroviral therapy could lead to more than 5,00,000 additional deaths from AIDS-related illnesses (including tuberculosis) in sub- Saharan Africa in 2020–2021.
Discrimination and stigma associated with HIV also act as barriers in availing HIV prevention services and closing the book on the AIDS epidemic. There is a cyclical relationship between stigma and HIV. People who experience stigma and discrimination are marginalized and made more vulnerable to HIV, while those living with HIV are more vulnerable to experiencing stigma and discrimination.
Data from 35% of countries show that over 50% of people report having discriminatory attitudes towards people living with HIV. Findings from 50 countries indicate that roughly one in every eight people living with HIV is denied health services because of stigma and discrimination.
Various factors are responsible for stigmatizing AIDS patients. Like- HIV is associated with behaviors that some people disapprove of (such as homosexuality, drug use, sex work, or infidelity); HIV is mainly transmitted through sex, which is a taboo subject in some cultures; many believe that HIV infection is the result of personal irresponsibility or moral fault that deserves to be punished.
Stigma promotes discrimination, which negatively impacts the lives of AIDS patients. The discriminatory attitude towards people living with AIDS makes their situation even worse. These people get marginalized, not only from society but from the services they need to protect themselves from HIV. For example, in 2016, 60% of countries in the European Economic Area reported that health care professionals’ negative and discriminatory attitudes towards men who have sex with men and people who inject drugs hampered the provision of adequate HIV prevention services for these groups. One study found that patients who reported high stigma levels were over four times more likely to report poor care access. This leads to a higher number of AIDS-related deaths.
Collaborations and partnerships among countries is key to ending the AIDS epidemic. In addition, urgent and concerted efforts are similarly needed to scale up core prevention strategies, invest in data and evidence-driven building systems and focus on eliminating stigma, discrimination, and social exclusion.
Ankita Valecha – Executive-Communications, Sambodhi
Anubrata Basu – Senior Manager – Research & Communications, Sambodhi