Speaking at the launch of the 2020 UNAIDS Global AIDS Update on Monday, executive director Winnie Byanyima said the agency’s modelling shows that a continuation of severe disruptions from Covid-19 response measures has the potential to push up the AIDS death rate by devastating numbers. It’s a scenario that would amount to a 72% increase on the estimated 690,000 HIV-related deaths globally in 2019.

The “alarming figures” from the UN’s monitoring and modelling, Byanyima said, are as a result of access to treatment and prevention programmes for HIV/AIDS falling through the cracks, as the world’s attention has this year been almost singularly focused on fighting the coronavirus pandemic.

“If disruptions remain so severe for another six months, we could also see a reversal in mother-to-child transmission that will take us back to 10 years ago,” she said.

“Our report shows that Covid is a disease that is threatening to throw us more off-course, it is claiming resources like labs, scientists, healthcare workers away from HIV work – we are saying that we need to find creative ways to fight both of these diseases at the same time,” she said, speaking on a webinar in Geneva. 

Key UNAIDS targets will be missed

The executive director confirmed that the world will fall short of the 2020 target to have 90% of all people living with HIV know their status; 90% of people with diagnosed HIV infection to be on antiretroviral (ARV) therapy; and for 90% of all people receiving ARV therapy to have achieved viral suppression.

The missed 2020 target comes against the backdrop of more intersecting crises brought on by the coronavirus. 

“We know that girls were not safe at home with the lockdown, violence increased… and we know that violence is linked to higher infections among women and girls,” Byanyima said.

Covid-19 has also impacted drug manufacturing and distribution. The world has witnessed what Byanyima slammed as a “profit over lives” agenda, as some companies have looked to cash in on the global crisis by diverting manufacturing capabilities and resources to the Covid emergency, only to maximise returns.

“Any epidemic thrives on inequalities and unless you target these inequalities, you only will make the situation worse for the most vulnerable groups,” she said.

Byanyima pointed to some solutions and strategies to bring the world back on track for the target of eradicating HIV by 2030.

A starting point, she said, is for the HIV/AIDS epidemic to be seen not as a health issue, but a human rights issue.

“Rights matter; we need to stop stigmatising and criminalising. Some of the world’s vulnerable groups of gay men, sex workers, people who use drugs, transgender people, those in prisons and migrants, cannot be left behind without access to services and then end up continuing to transmit the disease,” she said.

Communities also need to be at the centre of the fight, she said, as grassroots campaigns can drive behavioural change. She said longer-term debt relief for developing countries is essential too, as is better tax compliance from companies that should pay their dues to ensure there is money for health responses.

“We need to keep fighting the inequalities between girls and boys and men and women. We know there are millions of girl children who will not return to school after this pandemic, and this is one of the structural barriers in society that need resolution,” she said.

Treatment gap of over 12 million

The UNAIDS report, titled, “Seizing the Moment – tackling entrenched inequalities to end epidemics”, contained updated epidemiological estimates for the world, various regions and countries.

There were an estimated 1.7 million new HIV infections around the world in 2019. “Not acceptable”, is what Byanyima called this number, as it is three times higher than the target of no more than 500,000 new cases per year.

An estimated 38 million people around the world are estimated to have been living with HIV in 2019. Of these, 25.4 million are on antiretroviral therapy and 12.6 million are not. Antiretroviral therapy is recommended for all people living with HIV.

The report acknowledges that the introduction of dolutegravir-based treatment combinations as first-line treatment in some countries is a significant advance. Dolutegravir is a still relatively new antiretroviral medicine that has very few side effects, and resistance to it is very rare.

Annual HIV-related deaths have dropped from about 770,000 in 2018 to 690,000 in 2019, but 95,000 of these deaths are of children and teens, and the total is still 190,000 more deaths than the UNAIDS 2020 target of no more than 500,000 deaths. It is also estimated that only 53% of children in the world living with HIV receive treatment.  

Progress in Africa

In Africa, it is estimated that there are still 4,500 girls or young women who become infected with HIV every week. This, even as sub-Saharan Africa, which has the highest HIV burden, reflected the best progress with new infection rates down by 38% over 10 years.

South Africa’s neighbour, Eswatini, has reportedly surpassed the 2020 goal as of the end of 2019, achieving a 95-95-95 milestone. Also on track on the continent are Namibia, Botswana, Rwanda, Uganda, Zambia and Zimbabwe, according to the report.

While infection rates are coming down in sub-Saharan Africa, they are going up in Eastern Europe and Central Asia, and to a lesser degree in the Middle East and North Africa.

Another key concern has been a drop in funding and investment to the HIV/AIDS-response. Byanyima said there is currently a $7.6-billion gap in funding globally, and a 7% drop between 2017 and 2019.

That South Africa is almost self-sufficient in funding its national AIDS response programme is a resource allocation that Byanyima lauded. She warned that the temptation to divert funding from a priority like HIV/AIDS to Covid-19 would invite dire future consequences for any country.

Byanyima said despite the setbacks reflected in this year’s report, there is progress to build on. 

“There is much to do to remove the structural barriers, but we have made huge progress globally. We have treatments that make HIV a manageable disease, we also have prevention programmes. And with innovation and more technology we can bring the science to meet people where they are, so we can start to reach everyone and so that those with the weakest rights do not remain our most silent.”

*The 23rd International AIDS Conference (AIDS2020 virtual) is taking place this week. DM/MC

This article was produced by SPOTLIGHT – health journalism in the public interest. SIGN UP for our newsletter.