International AIDS Conference
International AIDS Conference
Source/Disclosures
Source: Press Conference
Disclosures: Byanyima and Tedros report no relevant financial disclosures. Krakower reports being a consultant to Fenway Health for research funded by Gilead Sciences, and developing content for Medscape, MED-IQ, DKBMed and UpToDate. Healio could not confirm relevant financial disclosures for Lamontagne at the time of publication.
July 06, 2020
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COVID-19 knocks HIV goals ‘completely off track’

Source/Disclosures
Source: Press Conference
Disclosures: Byanyima and Tedros report no relevant financial disclosures. Krakower reports being a consultant to Fenway Health for research funded by Gilead Sciences, and developing content for Medscape, MED-IQ, DKBMed and UpToDate. Healio could not confirm relevant financial disclosures for Lamontagne at the time of publication.
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COVID-19 will set back the goal to end AIDS by 2030, stalling an already off-track goal even further, according to a presentation from the opening session of the AIDS 2020 virtual meeting.

“We were already off track to achieving our HIV goals, but the coronavirus is really blowing us completely off track,” UNAIDS Executive Director Winnie Byanyima said during the AIDS 2020 opening press conference. “One disease cannot be sacrificed for another. That’s a poor solution.”

UNAIDS estimates

Byanyima presented findings from the UNAIDS 2020 Global AIDS Update, which show “remarkable but highly unequal progress around the world.”

Byanyima outlined the success of efforts in sub-Saharan Africa, where infections have been reduced by 38%, while also noting that the rate of new HIV infections have been increasing in other parts of the world.

Globally, there were 1.7 million new HIV infections in 2019 three times higher than the UNAIDS goal of 500,000. According to Byanyima, most of these new infections were among men who have sex with men, prisoners and people who inject drugs.

“These are people who have their rights taken away,” she said. “We need political will to remove those barriers.”

Additionally, the report found that women and girls in Africa continue to be affected the most, accounting for 59% of all new infections in that region.
We can do more for women and girls in Africa,” Byanyima said. “We can keep girls in school; we can fight gender disparities; we can equalize opportunities for boys and girls, men and women.”

A “modest reduction” in overall HIV-related deaths occurred; there were 730,000 deaths in 2018 compared with 690,000 in 2019.

“There is progress, but it is not enough,” Byanyima said.

WHO survey

WHO Director-General Tedros Adhanom Ghebreyesus, PhD, MSc, announced results of a recent survey conducted by WHO during the opening session that examined the impact of COVID-19 on the global HIV response.

“Much like early years of HIV epidemic, the COVID-19 pandemic has impacted our daily lives in so many ways,” he said. “The world has 11.3 million cases and 531,000 lives have been lost. This is just the tip of the iceberg.”

As with HIV, the impact of the pandemic “has been felt politically, economically, culturally and socially,” Tedros continued.

Access to HIV services has been “severely curtailed” by COVID-19, according to the survey findings, with 24 countries reporting either a critically low stock of ART or disruptions in the supply of these medicines.

WHO recently provided updated recommendations to limit disruptions in access to HIV treatment through “multi-month dispensing” that would allow medicines to be prescribed for up to 6 months at a time. To date, 129 countries have adopted this policy, according to Tedros.

“These disruptions highlight the need for robust and flexible health systems that are able to cope with outbreaks while ensuring the delivery of essential health services such as HIV [care],” he said. “The disruptions to access come at a critical moment as progress in the global fight against HIV stalls.”

Effect of COVID-19 on LGBTQ community

Another presentation during the opening remarks focused on the effect COVID-19 has had on the LGBTQ community and their access to HIV prevention and care.

“We aimed to understand the impact of COVID-19 on one of the most stigmatized communities that is also disproportionately affected by HIV,” Erik Lamontagne, a senior economist at UNAIDS, said during the session.

A survey of 13,562 people in 138 countries was conducted from mid-April until mid-May. The results demonstrated that COVID-19 is having “a devastating impact” on the LGBTQ community around the world.

The data showed that 12% of people included in the study were living with HIV. Of these individuals, 72% maintained access to treatment, whereas 21% reported that, because of lockdown and movement restrictions, they were experiencing limited access to ART and other care, and 7% were at risk of running out of treatment.

The survey also found that 13% of individuals had lost their jobs and 20% of people were at greater risk of losing their jobs. Because of this, 25% of individuals said they had started to cut down the size of their meals or skip them entirely because of lack of income. Additionally, 1% of respondents reported that the sudden change in income led to engaging in sex work. For this group, the COVID-19 pandemic limited their ability to negotiate safer sex practices, potentially increasing their risk for acquiring HIV.

“The take-home message is that COVID-19 increases the susceptibility of groups that are already disproportionately affected by HIV and exacerbates the inequality,” Lamontagne said.

COVID-19 and PrEP

In the final presentation of the opening session, researchers from a community health center in Boston that specializes in sexual health found that the COVID-19 pandemic caused “major disruptions” in pre-exposure prophylaxis (PrEP) care, particularly among vulnerable populations.

According to Douglas Krakower, MD, a Harvard Medical faculty physician in the division of infectious diseases at Beth Israel Deaconess Medical Center and assistant professor of medicine at Harvard Medical School, despite the high use of telehealth, PrEP initiation fell by 72% between January and April, and refill lapses increased by 278%. The lapses in PrEP refills were associated with being aged younger than 27 years, “non-white,” Latinx or publicly insured.

The study also showed that testing for HIV, gonorrhea and chlamydia decreased by 85%, whereas rates of positive gonorrhea and chlamydia tests increased slightly.
“COVID-19 was associated with major disruptions in PrEP health care despite a very successful [and rapid] pivot to telehealth,” Krakower said during the session. “We believe that these data suggest that we need additional studies to assess changes in adherence to prevention strategies, with particular attention to vulnerable subpopulations.”

References:

  • Krakower D, et al. Impact of COVID-19 on HIV pre-exposure prophylaxis care at a Boston community health center. Presented at: International AIDS Conference; July 6-10, 2020 (virtual meeting).
  • Lamontagne E, et al. UNAIDS: COVID-19 pandemic increases socioeconomic vulnerability of LGBTI+ communities and their susceptibility to HIV. Presented at: International AIDS Conference; July 6-10, 2020 (virtual meeting).
  • Byanyima W. Seizing the moment: Tackling entrenched inequalities to end epidemics. Presented at: International AIDS Conference; July 6-10, 2020 (virtual meeting).
  • Tedros AG. WHO: access to HIV medicines severely impacted by COVID-19 as AIDS response stalls. Presented at: International AIDS Conference; July 6-10, 2020 (virtual meeting).