Covid response has shown world can end Aids as public health threat, say experts

The response to the Covid-19 pandemic has demonstrated that the world has the resources, technology and political capital needed to effectively tackle Aids as a public health threat, experts and campaigners have said.

Amid fears that the Covid crisis has undermined a decade’s worth of HIV prevention, the World Health Organisation, UNAIDS and various charities have urged governments not to lose sight of the ongoing Aids pandemic – which last year claimed nearly 700,000 lives.

Global HIV infections have plateaued at 1.7 million annually, though a new report from UNAIDS has warned that an additional 293,000 infections could be recorded by the end of 2022 as a result of Covid-related disruptions.

Prior to the emergence of coronavirus, the globe was already behind in its 90-90-90 targets for 2020. This objective aimed to diagnose 90 per cent of all people living with HIV across the globe, to treat 90 per cent of positive diagnoses, and to achieve viral suppression among 90 per cent of those receiving treatment by the end of the year.

According to the WHO, 81 per cent of people living with HIV know their status, 67 per cent of these are receiving antiretrovirals (ARVs), and only 59 per cent of this group have achieved viral suppression, which allows the immune system to keep working and prevent illness.

Since the outbreak of Covid-19, the situation has deteriorated in countries with some of the highest HIV burdens in the world, including the likes of Kenya, Malawi, Nigeria and Ukraine.

Over the past eight months, HIV prevention services have been forced to close down, testing output has plummeted and stocks of crucial ARVs have run low. According to the WHO, ARV supplies were disrupted in 36 countries – 24 of which reported critically low levels.

Although the WHO said these services were “getting back on track”, the organisation has called for countries and governments to “renew our fight to end Aids”.

“We have to step up the work we're doing,” Meg Doherty, director of the WHO’s HIV/Aids department, told The Independent. “We're going to have to figure out how to rebound after Covid and put into action some of the best practices that have been identified during this year.”

Ms Doherty said the global HIV targets were being raised to 95-95-95, to be achieved by 2025. “That means we'll have to catch up and do even more,” she said.

Referring to the “amazing amount of science and global urgency” that has defined the global response to Covid-19, Ms Doherty said that “HIV needs this similar whole-world approach if we really want to move forward and end Aids as a public health threat.”

Mike Podmore, director of Stopaids, said the past 10 months had fostered a spirit of cooperation between leading global health actors, governments and the pharmaceutical industry that should be similarly adopted for HIV.

“The mobilisation of the global health architecture and the different institutions coming together, the pooling of funding at a global level – all of these very quick response demonstrate what we're capable of globally if we choose to coordinate and work together and support each other in solidarity,” he told The Independent.

Mr Podmore acknowledged that the ability to move so swiftly against Covid-19 has been “built on the shoulders and structures” of past responses to Aids, tuberculosis, malaria and Ebola.

Ms Doherty pointed to the example of low- and middle-income countries across Africa and Asia where authorities were able to maximise testing platforms and laboratory networks that had already been set up for HIV.

“In South Africa, they were able to harness 10,000 health care workers who had worked on HIV. They were able to go out into communities and test for Covid and do contact tracing,” she said, adding that these sort of intensive approaches will need to be replicated with regards to Aids.

Deborah Gold, chief executive of the  National Aids Trust, told The Independent that the means for ending HIV transmission within populations exist – unlike with Covid-19. 

“We have the tools – from testing, to HIV prevention drug PrEP, to the fact that prompt and effective HIV treatment means you can't pass HIV on to your sexual partner,” she said.

Ms Gold said: “HIV doesn’t need to be a challenge at all”, but warned that meaningful progress “requires strong action from those across government, healthcare, business and more.”

A report released on Tuesday by Frontline Aids on countries with high rates of HIV infection shows that the implementation of quality prevention and treatment services continues to be a serious challenge.

Data collected this year shows only 42 per cent of priority districts offer prevention packages dedicated to young women and their male partners in Mozambique, despite these groups being disproportionately affected by HIV.

In Zimbabwe, service coverage reaches just 17 per cent of adolescent girls and young women, whilst in Uganda, only 31 per cent of high incidence districts had dedicated programmes for these individuals in 2019.

Coverage is also inconsistent in Ukraine, where only 11 per cent of men who have sex with men, 40 per cent of sex workers and 48 per cent of people who inject drugs are routinely reached by services.

As the world continues to fight Covid-19, with countries now preparing to launch extensive and costly vaccination programmes for their populations, campaigners have warned that HIV funding and policy cannot be neglected in the months to come.

“We have to make sure that a robust and strong response to Covid is not done at the expense of other diseases and health issues,” Mr Podmore said. “It's really important we're not pulling funding for Covid away from other diseases.”

In the UK, campaigners and charities are using World Aids Day to release a first-ever HIV Commission, which includes 20 recommendations for the government to meet its goal of ending all transmission by 2030.

“It covers everything that needs to be considered from stigma and inequalities through to innovation, resources and leadership,” Ian Green, chief executive at Terrence Higgins Trust, a charity involved in the report, told The Independent.

“One of the key focuses is on drastically increasing HIV testing with opt-out rather than opt-in testing across all areas of our healthcare systems. For example, when registering for a GP, at the local pharmacy, at cervical screening, and in A&E departments.

“We want to see this done across the board, no matter your age, gender, sexuality or ethnicity – which will be a big step-change with a similarly big impact.”

The latest figures for the UK estimate there are 105,200 people living with HIV in the UK. Of these, 5,900 are not thought to be aware of their status.

“We’ve come a huge way in the fight against HIV and stand on the shoulders of those who fought so hard for more research, more funding and more empathy,” Mr Green said. “We have all the medical tools we need to prevent, test for and treat HIV – they’re just being woefully under-utilised.”

The HIV Commission was co-founded by National AIDS Trust, the Elton John AIDS Foundation and the Terrence Higgins Trust.