UNAIDS has issued a sharp warning about the consequences of one pandemic on another: COVID-19 has significantly disrupted the global fight against HIV/AIDS. Yet that is not the sole reason why we are falling behind in combating the HIV/AIDS crisis – already we were off-track.
“The global aggregate of country data reported to UNAIDS shows that the world has invested too few resources, provided too few people with services and failed to bend the curves of new HIV infections and AIDS-related deaths as significantly as was envisioned in the UNAIDS Fast-Track Strategy,” a report by UNAIDS notes. This is what UNAIDS calls the “sad truth”, one belied by the “significant progress [that] has been achieved” in combating HIV/AIDS since its zenith in the late 20th century.
Put simply, despite the progress we’ve made, we are still failing. “All global targets for 2020 will be missed,” the report warns, four years after a large-scale consensus was achieved at the United Nations of the need to scale up “HIV services alongside rights-affirming and enabling environments for those services.” This is not to take away from the progress we’ve made. Increased access to antiretroviral therapy (ART), for example, is estimated to have averted 12.1 million AIDS-related deaths since 2010. Yet, on the downside, the report observes that the 39 percent reduction in AIDS-related mortality since 2010 still translates to “far too many people dying unnecessarily.”
India has much to gain in accelerating the fight against HIV/AIDS – and the country has made ambitious commitments, with the Union Ministry of Health and Family Welfare last year unveiling targets to achieve a significant reduction in HIV infections in 2019 and 2020. The Union Government, in 2016, committed to making HIV/AIDS a thing of the past by 2030 in line with the global target of ending the AIDS epidemic by that year.
Yet, as of 2017, India shoulders the third-largest HIV epidemic in the world. That year, India was home to 2.1 million people living with HIV and lost 69,000 lives to AIDS. Undoubtedly, India has made strides as one of the “dozens of countries from a diverse range of geographic, economic and epidemic settings” identified by UNAIDS. As previously reported by Health Issues India
“Since the start of the decade, India has witnessed significant reductions in its HIV/AIDS burden. New HIV infections 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.”
Nonetheless, the country still has much to do. The COVID-19 pandemic has compounded the challenge. Earlier this week, the World Health Organization (WHO) warned of impaired access to HIV/AIDS medications as a consequence of the pandemic. UNAIDS has been vocal about the challenge.
In India, adapting to the new circumstances engendered by the COVID-19 crisis has been a challenge – but not an insurmountable one. I spoke by phone with medical epidemiologist Dr Bilali Camara, UNAIDS Country Director for India, who told me “when COVID came up, we looked at two major issues: how do we continue services to people with HIV/AIDS and ensure they can access treatment and how do we address the needs of key populations like drug users, men who have sex with men, and transgender people?”
One advancement made in February, Dr Camara said, was the introduction of more simple treatments of lower toxicity, with fewer side effects, and better-tolerated (Dolutegravir-based regimens). This would ensure greater adherence to treatment regimens by patients – something that, for a number of commentators, was a concern as a result of the pandemic.
“Three major policy changes have been achieved,” Dr Camara told me. “The first was changing to provide ART e.g. every three months instead of every month (Multi-months dispensing of drugs (MMD). The second was mobilising communities (Community-Based Dispensing of drugs (CBD) to provide antiretroviral drugs so, instead of going to health facilities, people could get the drugs they need from those who came together – in Gujarat, Delhi, Karnataka, Tamil Nadu, Uttar Pradesh Maharashtra etc.. The third was to adapt so people continue their Opioid Substitution Therapy by introducing a policy to allow take home doses of OST.
“Another key point has been engaging with key populations – using targeted interventions to provide testing, contraceptives, addressing comorbidities, which have remained open despite the lockdown. Using these mitigating factors has been a success. These are important strategies and they are working.”
Adapting, has not translated to the pace of treatment slowing down. “We have civil society movements keeping our work afloat,” said Dr Camara. “We are making sure that the needs of people with HIV/AIDS and key populations continue to be met. The work is ongoing and the process has changed, but we are continually working and it is working very, very well. We have not reduced the intensity of our efforts or the intensity of our programmes. We have just come up with new ways to address HIV/AIDS in India.”
Such adaptations include “implementing networks using virtual discussions, training workshops and meetings of technical working groups to discuss issues of transgender people, men who have sex with men, drug users, and other key populations.” This is vital in not regressing in the work being done to combat HIV/AIDS – an area that, Dr Camara said, “has been strong” in India with reductions in HIV/AIDS mortality and a robust strategy of the National AIDS Control Programme.
Yet it is undeniable that COVID-19 has hit the response to a number of diseases, including India. As I previously wrote for this publication
“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.”
The adaptations highlighted by Dr Camara are undoubtedly positive steps. Sustaining the HIV/AIDS response is an imperative – both in India and at the global level.
“2020 Global AIDS Update — Seizing the moment — Tackling entrenched inequalities to end epidemics” can be accessed here.