September 22, 2021 – From testing to treatment, the COVID-19 pandemic has hampered global HIV efforts.
“We have been slowed down by COVID, but we have seen remarkable resilience, a lot of innovation and creativity,” said Siobhan Crowley MD, head of HIV at the Global Fund.
“If you consider that 21.9 million people are currently receiving (HIV drugs) through the Global Fund, I think that should be appreciated. Ten years ago, that would not have been the case; all these people would have disappeared. in ethers. “
Through close partnerships with the United States Agency for International Development, the United States Emergency Plan for AIDS Relief, and other Western countries and organizations, the Global Fund has invested 22.7 billion dollars in HIV and AIDS prevention and treatment programs, and $ 3.8 billion in tuberculosis / HIV. programs, according to the organization’s 2021 annual report.
But the report also highlights the significant effect of the COVID-19 pandemic on the progress of Global Fund beneficiary countries towards targets for HIV testing / diagnosis, treatment and viral suppression by 2030.
The setbacks have been difficult and have affected almost every service, from prevention to treatment. According to the report, between 2019 and 2020:
- Voluntary male circumcision has decreased by 27%.
- The number of people reached by HIV prevention programs has fallen by 11%.
- 4.5% fewer mothers received drugs to prevent transmission of HIV to their babies.
- HIV testing services, including initiation, decreased by 22%.
The numbers only tell part of the story, Crowley says.
“We have an emergency mechanism in place to make funds available to countries to do everything except vaccines to support COVID,” Crowley explained. (As of August 2021, these funds had been sent to 107 countries and 16 multi-country programs.)
Countries were told they could use emergency funds in three ways: for specific COVID purposes (e.g. diagnostics, oxygen, personal protective equipment; to support existing HIV programs, tuberculosis and malaria, or to get them back on track; and for so-called ‘health system fixes’, such as investing in data systems to track COVID, HIV and other diseases fundamentals, as well as the community workforce.
Countries were also urged to adapt HIV testing procedures, for example by moving organized testing out of facilities and into neighborhoods to meet people where they are. Rapid diagnostic testing and triage care using technologies such as WhatsApp have been the result, as have home testing opportunities which Crowley says remains a critical part of the overall strategy.
“Self-testing is important for two reasons, not only because you are trying to find people who are HIV positive, but also when people know they are negative they know what they can or should do to stay negative,” she declared. . “It’s a pretty powerful motivator.”
The imperfect storm in the world and in the United States
“One of the things that is striking about the report is the decline in the number of people reached by testing and prevention services,” Chris Beyrer, MD, professor of public health and human rights at the Johns Hopkins Bloomberg School of Public Health in Baltimore, said. Beyrer was not involved in the preparation of the report.
“You know, a 10% drop in 1 year to reach people in need is substantial,” he said. “Let’s say this continues; many people predict that we will not have reasonable coverage for low-income countries with COVID until 2023. This adds to a substantial drop in the number of people reached with these services. “
Beyrer is also concerned about the convergence of HIV and TB in already overburdened and fragile health systems. “Globally, the leading cause of death for people living with HIV is tuberculosis, and of course, it is highly transmissible. So in many high burden countries children are exposed, usually by household members early on, and so the number of people with latent TB infection is simply huge. “
But now is not the time for US suppliers to rest on their laurels. Beyrer says the 22% drop in HIV testing reported by the Global Fund is similar to what’s happening in the United States with elective procedures like HIV testing and even preventative procedures like medical male circumcision.
“It is very clear here in the Global Fund data that the majority of new infections worldwide are in key populations [that] include gay and bisexual men, men who have sex with men, transgender women who have sex with men, people who inject drugs, sex workers of all genders. These are people who have already faced barriers to accessing health care and who have been made worse by COVID. “
Beyrer says that, according to the Centers for Disease CControl and Prevention, in 2019 in the United States, 68% of new HIV infections occurred in gay and bisexual men, and the effect COVID will have is still unknown.
“This is also where we see the worst of COVID, low vaccine coverage and high rates of hospitalization and death,” he says. “It’s a dark and gloomy time for many,” Crowley said. “And there were some amazing moments of resilience and adaptation as well.” “The odd thing is that the HIV platform is a natural platform; I mean, if we can keep 21.9 million people on treatment, we can probably provide them with a COVID test and a vaccine. ”