(CN) — A United Nations program aimed at eliminating HIV/AIDS released a report Monday showing that the global response to the epidemic has fallen far short of goals set for 2020, in large part due to the coronavirus pandemic.
“Like the HIV epidemic before it, the Covid-19 pandemic is exposing our world’s fragilities — including persistent economic and social inequalities and woefully inadequate investments in public health,” U.N. Secretary-General António Guterres wrote at the start of the 384-page report. “In many parts of the world, Covid-19 is colliding with the ongoing HIV epidemic.”
In 2016, the U.N. General Assembly resolved to end AIDS by 2030, setting goals to reduce HIV infections and AIDS-related deaths and improve treatment globally by 2020. But every one of those targets will be missed due to uneven progress, according to the report from the Joint United Nations Programme on HIV/AIDS, or UNAIDS.
The Covid-19 pandemic is directly to blame for some of these obstacles. International freight transport has slowed, for instance, interrupting global medical supply chains and delaying the delivery of HIV medications.
UNAIDS predicts that 500,000 people may unnecessarily die of AIDS-related illnesses in sub-Saharan Africa alone by the end of 2021 if global medical supply chains faced total disruption for six months.
Other factors, such as gendered violence, have contributed to the HIV/AIDS epidemic. The hundreds of millions of women who are sexually violated by an intimate partner each year are 1.5 times more likely to get HIV than women who do not experience this abuse, according to UNAIDS Executive Director Winnie Byanyima.
“Among marginalized groups, a high prevalence of violence is also linked with higher rates of HIV infection,” Byanyima wrote in the report. “Female sex workers have a 30-times greater risk of acquiring HIV than the general population.”
Gay and transgender people, migrants and people who use drugs also face heightened risk of HIV infection, Byanyima added. UNAIDS data from 46 sub-Saharan African nations also suggests a correlation between income inequality and HIV prevalence.
The Covid-19 crisis has only intensified these underlying, structural contributors, sometimes in surprising ways. School closures, for instance, make it more likely for young women to suffer gendered violence, teenage pregnancy and other forms of exploitation that are risk factors for HIV infection.
UNAIDS found that overwhelmed health systems, reduced condom production and distribution, strained HIV testing and treatment facilities, and other factors have combined to negatively affect the global HIV/AIDS response.
The risks run the other way too. People with HIV are more likely to face Covid-19’s deadliest complications, regardless of viral suppression, according to the report.
Governments have reduced funding for HIV responses since 2017, resulting in 3.5 million more HIV infections and 820,000 more AIDS-related deaths between 2015 and 2020 than UNAIDS had aimed for.
One of the goals for 2020 was to ensure that 90% of people living with HIV knew their status, that 90% of those who knew their status received treatments, and that 90% of those on treatment saw their viral loads — the amount of HIV cells in a milliliter of blood — suppressed to low levels. Fourteen countries had reached this target at 2019’s end.
Though the world has fallen short of UNAIDS’ goals for 2020, the report contained silver linings. It found a 23% global reduction in new HIV infections since 2010, primarily driven by a 38% decrease in new infections in eastern and southern Africa. AIDS-related deaths are down 39% since 2010.
Further, an estimated 81% of people living with HIV know their status, and more than two-thirds are on antiretroviral therapy — which is estimated to have saved 12.1 million people from dying of AIDS since 2010. Rates of viral load suppression rose since 2015 to the point that almost 60% of all people with HIV in 2019 had a suppressed viral load.
Robert Gallo, the University of Maryland School of Medicine Institute of Human Virology scientist who co-discovered HIV and pioneered the blood test used to diagnose it, remains largely optimistic about treating the virus.
“If the virus is really contained, you certainly can live a normal life with this virus — if it’s really contained. That doesn’t mean perfection, but damn well close to it,” Gallo said. “That incremental improvement, getting to the point where you won’t have to be taking medicines all the time … we’d like it so there’s really no replicating virus.”
Still, progress remains uneven: over the last decade, HIV infections increased by just over 20% in Latin America, the Middle East and North Africa, and a whopping 72% in eastern Europe and central Asia.
Gallo, who also co-founded an international coalition of virologists known as the Global Virus Network, notes that the Covid-19 pandemic has slowed many researchers’ work on HIV and AIDS.
“Very few people are Archimedes,” Gallo said, referencing the Syracusan mathematician who is said to have died during a Roman invasion because he refused to stop working on a problem. “Very few people are going to stay with their work when great danger threatens. The Roman with the sword was the pandemic; Archimedes was doing AIDS research. Of course HIV research will suffer as a consequence, of course, as will all research.”
He said he and other scientists have had to slow their work in order to tackle Covid-19. He also suggested that social distancing has posed a challenge to scientific innovation.
“What supply are we short of? Being with my colleagues in reality, rather than over telephone,” Gallo said. “Being able to periodically have those conversations where you’re thinking together, where you’re having more speculative discussions about science.”
These encounters are where conceptual progress is made, he said.
According to the UNAIDS report, 12.6 million people living with HIV remain untreated. The international NGO is calling for universal health coverage, increased protections for migrants, decriminalizing sex work and destigmatizing homosexuality and drug use as big-picture improvements to the AIDS epidemic.
Other policy proposals include integrating HIV services with those for tuberculosis — the most common reason people with HIV die prematurely every year — and coordinating HIV medicine and medical supply donations between governments and suppliers to prevent stock-outs in case of continued supply chain interruptions.
“We cannot rewrite the past,” the report’s conclusion states. “But as more and more people refuse to accept the inequalities of that past, the international community can seize this moment, imagine a better future and re-energize efforts to achieve global health, sustainable development and the end of the AIDS epidemic.”
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