The term pandemic is virtually ubiquitous in the public consciousness right now. The world is arrested in the grip of COVID-19, the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) – more popularly known simply as the coronavirus. Yet COVID-19 is one of two pandemics the world is grappling with – as a recent Lancet article reminds us.
Titled “When Pandemics Collide”, the article underscores that “one pandemic virus has been a major topic in global health for almost forty years, the other was discovered just four months ago.” The other pandemic, of course, is HIV – the human immunodeficiency viruses that cause the disease AIDS [acute immunodeficiency syndrome]. In 2018, HIV-related deaths numbered at 770,000 with 37.9 million people living with HIV that year according to the World Health Organization (WHO).
The two pandemics coinciding pose real challenges for continuity of HIV treatment. As the Lancet article outlines, “although we have learned a remarkable amount about SARS-CoV-2 in a short time, its potential impact on people living with HIV and on health systems in settings with high HIV burdens is becoming a major concern.”
Indeed, the challenges facing managing the HIV/AIDS crises in a time of dual pandemics is heightened. The Lancet article notes “that the response to SARS-CoV-2 is compromising HIV programmes. As global travel and transport are disrupted, drug supply chains are jeopardised.”
An earlier Lancet commentary – “Maintaining HIV care during the COVID-19 pandemic” – explained the challenges in-depth. The authors write “implementation of quarantine, social distancing, and community containment measures have reduced access to routine HIV testing.” Testing for HIV, it notes, “is the vital first step towards initiation into the HIV care continuum.”
For those tested positive for HIV, the article adds that similar issues of quarantine and lockdown may also present a challenge to continuing with antiretroviral therapy (ART) – a vital treatment credited with saving 1.2 million lives in 2016, extending life expectancy for those living with HIV, and preventing infections.
Another challenge of COVID-19 is the strain on health systems. “People living with HIV who should have initiated antiretroviral therapy (ART) in hospital might be deterred or delayed because hospitals are busy treating patients with COVID-19,” the commentary notes. “Furthermore, because many public health authorities globally are focused on COVID-19 control, allocation of resources for HIV care could be diminished, and circumstances surrounding the HIV care continuum could worsen.”
The gravity of the COVID-19 crisis is lost on few, but the argument can still be made (including by this publication) that it belies the manifold other health concerns nations face. COVID-19 stands to jeopardise hard-won progress against many diseases – be it through the provision of life-saving treatments such as ART or acting as a roadblock to immunisation campaigns (potentially risking a comeback of vaccine-preventable diseases such as measles).
HIV and COVID-19 are global pandemics – both of which affect India in significant ways. At the time of writing, India has confirmed 31,787 SARS-CoV-2 infections and 1,008 people have lost their lives to COVID-19. Meanwhile, as of 2017, the country is home to 2.1 million people living with HIV – translating to the third-largest HIV epidemic in the world. Every year, the country reports 80,000 new infections and 69,000 HIV/AIDS-related deaths.
To counter COVID-19, India imposed a wholescale 21-day lockdown late March which has since been extended to May 3rd. By the end of March, Al Jazeera reported that the restrictions were making availing HIV medication difficult for those who needed them.
Community activist efforts have been underway to ensure those in need of ART medications can access them. For example, the National Coalition of People Living with HIV has been able to deliver ART to more than 45,000 people in their dwellings. Yet difficulties remain for many.
There may seem to be a heightened urgency for dealing with COVID, but it cannot be forgotten that a diverse population carries with it a diverse burden of disease – as is the case in India. Public health emergencies require preparedness and planning, with contingencies to be in place for those affected by chronic and critical diseases. This is true of HIV. What is imperative also is the need to tackle the long-standing issues of prejudice and stigmatisation levelled at the HIV-positive community. In a time of crisis, such stigma poses to exacerbate the difficulties many are already facing to access the vital medicines they require.
Between 2010 and 2017, new HIV infections in India fell from 120,000 in 2010 to 88,000 in 2017; AIDS-related deaths decreased from 160,000 to 90,000; and there were 2.1 million people living with HIV in India 2017, compared to 2.3 million in 2010. This signifies real progress. Last year, the Union Ministry of Health and Family Welfare sought to capitalise on this by unveiling ambitious targets to further reduce the country’s HIV/AIDS burden. Yet COVID-19 could undermine these targets unless it is ensured that – even as we treat one pandemic – we do not neglect another.