Guyanese author launches COVID-19 children’s book

Guyanese author Ashley Anthony has launched a new children’s book on COVID-19 titled “Lia and Ellie talk about Coronavirus”.

Ashley is currently a sophomore student at Yale University, New Haven, Connecticut, USA, studying Biomedical Engineering and the History of Science, Public Health and Medicine.

The book was launched at the recently held PANCAP Youth Town Hall Meeting July 2020 and is available for free download on PANCAP.org.

Discussing her inspiration for writing the book with the Editor of the PANCAP Newsletter, she stated “I wrote this book as a final project for one of my classes last semester.  COVID-19 has been difficult on all of us, but it can be particularly challenging for children, especially if they don’t understand what’s happening. Having a discussion about COVID-19 can be difficult, but it is my hope that this book makes those conversations a little easier”.

Ashley is an avid writer with numerous published blogs and articles, most notably she wrote a weekly column in the Guyana Times on issues related to Global Warming, Adolescent Health and Rights, LGBT rights and the importance of valuing the contributions of youth.  She has also published a Science-Fiction book, “Mysterious Association and the VirtuGems”.

In addition, Ashley is a guest writer for the Yale Daily News and President of the Yale Boola Magazine.

Click here to read “Lia and Ellie talk about Coronavirus” on PANCAP.org.

Caribbean Vulnerable Communities Coalition is the recipient of the Robert Carr Research Award

To be named as one of the 2020 winners of the prestigious Robert Carr Research Award is an incredible recognition of the work of the team at Caribbean Vulnerable Communities Coalition (CVC).

It demonstrates the critical role communities, and key populations can play in policy and research. It also validates the importance of collaboration between community groups and Academia. Such partnerships can only help to better serve the groups most affected by HIV and advance the regional HIV response.

The award is even more significant, given that it honours one of CVC’s founders, whose vision was for national programmes to have the relevant data to better understand the needs of our communities and design meaningful and targeted interventions.

The research, for which the award was presented will certainly provide important baseline data against which the success of any future interventions can be adequately measured.

Continue reading “Caribbean Vulnerable Communities Coalition is the recipient of the Robert Carr Research Award”

CRN+ implementing strategies to support People Living with HIV during COVID-19

As COVID-19 continues to affect the Region, the Caribbean Regional Network of Persons Living with HIV and AIDS (CRN+) has collaborated with the UNAIDS Caribbean Sub-regional Office and PANCAP to address the challenges and advocate for People Living with HIV (PLHIV).

COVID-19 has severely affected CRN+, its country networks and partners. The organisation is particularly concerned about the lasting impact of COVID-19 on the Region and delayed projects intended to provide critical services for PLHIV. The delays have also affected proposed collaborations with National AIDS Programmes to address PLHIV at country-level.

Regular access to essential care and treatment for PLHIV has been challenged as health facilities have answered the call to respond to COVID-19.  Establishment and maintenance of alternative models for delivery of healthcare and medication for PLHIV must continue.

CRN+ has developed advocacy, communication and capacity building strategies to ensure the network of PLHIV organisations in the Region have the information and technical support needed to protect the health, wellbeing and rights of PLHIV at country-level.  CRN+ is receiving technical support from the UNAIDS Caribbean Sub-regional Office and PANCAP for this initiative.

With the development and implementation of these strategies, CRN+ intends to strengthen access for PLHIV to healthcare and human rights advocacy. The organisation will also seek to address alternative models for delivery of healthcare and medication by utilising a strategy titled – “How do we continue to work from a distance”.

The strategy would include social media messages and other approaches to reach PLHIV communities with limited or no Internet access through traditional means of communication such as newspapers, TV and radio.

There will be a particular focus on women and girls, which will encompass collaboration with the International Community of Women Living with HIV (ICW) Caribbean.  The approach will involve the provision of technical support for Women Living with HIV, adolescent girls and young women; work has commenced with the Republic of Trinidad and Tobago and Guyana ICW Groups.

CRN+ will continue to advocate for alternative models for healthcare and access to medication including appointment spacing, multi-month medication filling, courier delivery or uplifting medication at HIV Network or CSOs.

Editor’s note: The Caribbean Regional Network of People Living with HIV and AIDS (CRN+) is the regional umbrella organisation with a mandate of advocating for and on behalf of PLHIV. As a full and equal partner in the collaborative fight against HIV and AIDS, CRN+ is driven by PLHIV, making a meaningful difference to their lives. For more information visit www.crnplus.com

UNAIDS report on the AIDS epidemic shows that 2020 targets will not be met in the Caribbean

KINGSTON, 10 July 2020—A new report by UNAIDS shows that despite individual country successes, overall progress in the Caribbean to expand access to HIV services has slowed. Because of this, HIV targets set for 2020 will not be reached. The report, Seizing the moment, urges countries to act with greater resolve to reach those still left behind.

Caribbean 2019 data

There were an estimated 330,000 People Living with HIV (PLHIV) in the region at the end of 2019. Overall Caribbean adult HIV prevalence was 1.1%.

In 2019 77% of PLHIV in the Caribbean knew their status. This compares to the worldwide average of 81%. Eighty-one percent (81%) of diagnosed Caribbean people were on treatment last year. Eighty percent (80%) of those on antiretroviral therapy were virally suppressed. The global average was significantly higher at 88%.

Some countries have achieved elements of the 90–90–90 targets (90% of PLHIV aware of their HIV status, 90% of diagnosed people on antiretroviral treatment and 90% of those on treatment virally suppressed). Barbados has reached the target for testing while Guyana has exceeded it with 94% of PLHIV diagnosed. Haiti has gotten 98% of diagnosed people on treatment. Suriname and Trinidad and Tobago have achieved viral suppression among at least 90% of PLHIV who are on treatment.

“This shows that within the region there is the capacity to deploy the people, policies and programmes to end AIDS,” said UNAIDS Caribbean Sub-regional Office Director, Dr James Guwani. He was speaking at a virtual launch event hosted by UNAIDS Caribbean.

Last year there were 6,900 AIDS-related deaths in the region. Deaths due to AIDS decreased by 37% since 2010. Total antiretroviral treatment coverage for the region was 63%–71% for women and 56% for men.

New HIV infections decreased by 29% in the region since 2010. One-third of new HIV infections in the Caribbean in 2019 were among young people ages 15 – 24. Males ages 15 – 49 accounted for 57% of new infections.

“Year after year the data tell the story of Caribbean men’s inadequate access to HIV services. It is time for a comprehensive strategy to meet men where they are, increase demand and adapt service delivery to meet their needs,” Dr Guwani said.

Chair of the Spouses of Caribbean Leaders Action Network (SCLAN), Kim Simplis Barrow encouraged the region to increase access to education and sexual and reproductive health services for young people.

Great strides continue to be made in the Caribbean towards the Elimination of Mother-to-child HIV transmission, with seven countries and territories achieving World Health Organization revalidation. Mother-to-child HIV transmission reduced by nearly half since 2010.

Social inequalities and exclusion are key barriers

Sixty per cent of new infections in the region were among members of key population communities and their sexual partners in 2019. This includes 26% among men who have sex with men, 6% among sex workers, 5% among transgender people and 3% among people who use drugs.

“Access to care in most of our countries is hindered by several factors including criminalisation of same-sex relationships, hostile communities, homophobic discrimination, violence internal stigma, and limited health education,” said Dr Rosmond Adams, Director of the Pan Caribbean Partnership against HIV and AIDS (PANCAP).

Prejudice against PLHIV is still commonplace. The most recent data show that while discriminatory attitudes towards PLHIV are declining consistently in some countries like Belize and Guyana, they are rebounding in others.

“We have to engage people consistently around ending discrimination. We must also improve accountability and redress mechanisms when people’s rights are violated,” Dr Guwani said.

The COVID-19 pandemic could seriously disrupt the AIDS response

UNAIDS is urging countries to increase investments in both diseases. The 2020 Global AIDS Update notes that even before COVID-19, Caribbean state health systems were struggling to cover programmes traditionally funded by international donors, including HIV prevention and key population-focused initiatives.

Between 2010 and 2019 there was a 30% decline in disbursements by the Global Fund and a 19% decline in investments by the United States Government. HIV resource availability from domestic sources increased by 38% from 2010 to 2019. At present funding is 42% short of the level needed to effectively respond to HIV in the region during 2020.

Caribbean Regional Network of People Living with HIV (CRN+) Vice-Chair, Renatta Langlais, pointed to the strain COVID-19 placed on community organizations. She said despite funding cuts, they are being forced to do more work to serve clients whose incomes and healthcare access have been impacted by the COVID-19 response.

Executive Director of the Caribbean Public Health Agency (CARPHA), Dr Joy St. John, urged health authorities to adopt measures to assure the health of people living with HIV and those with non-communicable diseases.

“Continuous monitoring and re-evaluation of considerations for vulnerable populations at risk from COVID-19 are critical, as the demographics for COVID-19 are quickly changing,” she said.

CONTACT

UNAIDS Caribbean | Cedriann Martin | martinc@unaids.org

Remarks by Dr Rosmond Adams, Director, PANCAP on the occasion of the UNAIDS Global AIDS Report 2020 launch

It gives me great pleasure to present these brief remarks on next steps on behalf of the Pan Caribbean Partnership against HIV and AIDS (PANCAP) at this virtual launch of the UNAIDS Global AIDS Update 2020.

As COVID-19 rapidly spreads, the global HIV community is increasingly concerned about the potential impact of COVID-19 on the 37.9 million People Living with HIV globally. Indeed, the Caribbean Region is aware of the potential threat that COVID-19 will have on advancing progress towards ending AIDS in the region.

This report comes at an important time when we are faced with so many uncertainties in this very vulnerable corner of the globe. In addition to COVID-19, the region is faced by slow economic growth, which will present a challenge for financing and sustaining national and regional HIV/AIDS response. Additionally, other health sector challenges such as the rising burden of non-communicable diseases, the impact of climate change on health and the ever-looming threat from natural disasters are just a few examples.

The theme of this year’s report is, “Seizing the Moment: Tackling entrenched inequalities to end epidemics”. As we continue to maneuver the challenges of COVID-19, this theme is very fitting for us to look for the opportunities that the pandemic has presented and to seize the moment to accelerate action in filling gaps that exist in the regional response to ending the epidemic.

While the report highlighted that the Caribbean region has made progress in reducing new HIV infections and AIDS-related deaths and great strides have been made towards the Elimination of Mother-to-child HIV transmission, progress across the testing and treatment cascade has slowed. Awareness of HIV status is the first step in accessing care but is also a potential prevention tool and a way to normalise and destigmatise HIV. Therefore, any action on HIV must start with testing and awareness of one’s status.

Likewise, we have to focus on interventions aimed at improving linkage to and retention in HIV care to achieve the greatest reductions in HIV incidence especially among Key Populations as they are the drivers of the epidemic in the region accounting for 60% of new infections.

It is important to note that if we are to end AIDS and even eliminate a number of communicable diseases especially those referenced by the SDG-3, we must tackle the entrenched inequalities that stand in the way of progress. The HIV epidemic, as we know has been unusual in the extent to which discourse about its epidemiology has been linked to poverty and inequalities. This virus thrives on inequality.

Adolescents and young people, particularly girls and young women, must be the focus of any meaningful response. They are subjected to poor access to healthcare and education, limited empowerment, representation and opportunities to contribute to decision making with partners, family members and communities. Issues such as gender-based violence, harmful cultural norms, stigma and discrimination put them at increased risks.

Addressing the needs of Key Population is also critically important. Access to care in most of our countries is hindered by several factors including criminalisation of same-sex relationships, hostile communities, homophobic discrimination and violence, external and internal stigma, and limited health education.

We must also not forget men. There are many cultural and social norms that are proving to be obstacles to prevention and control among Caribbean men. Partially to blame is the “macho” culture that influences Caribbean men to suppress awareness of their bodies and not to show emotions or vulnerabilities. This puts them at increased risk and can result in not accessing care, not testing and loss to follow up.

We must continue our ongoing efforts to accelerate equitable HIV incidence decline.

Finally, I want to touch briefly on the 90-90-90 Targets. The region is lagging in these targets. According to the report, 77% of People Living with HIV (PLHIV) know their status, 81% of people who know their status are on treatment and 80% of PLHIV on treatment are virally suppressed with only 50% of all PLHIV are virally suppressed. These gaps must be filled. We must get these bars rising.

Another worrying challenge is that of data to guide strategic interventions. Significant data challenges exist in the region ranging from data quality and the timeliness of data. Go down to the granular level. 90-90-90 at the site level.

Supply chain management must be strengthened to ensure continued access to ARVs and other commodities.

Ending AIDS and addressing STIs requires a coordinated multisectoral regional response as articulated in the Caribbean Regional Strategic Framework (CRSF) – 2019-2025.  The CRSF is our blueprint towards ending AIDS, and it highlights policies and programmes to accelerate progress for achieving the UNAIDS 90-90-90 Targets to Test, Treat and Defeat AIDS, to which the region has committed.

We also hold strong to our Justice for All programme that was launched in 2015 to promote activities consistent with the UN Universal Declaration of Human Rights to which all countries are committed. It is intended to achieve one of the goals of the United Nations High-Level Meeting Political Declaration (2011) to eliminate stigma and discrimination against PLHIV by 2015 and to uphold the human rights and dignity of all.

PANCAP will continue to support the regional response by working with National Programmes, Key Partners and Civil Society Organizations, FBO etc.  We will address these challenges and work to break down the inequality barriers and other barriers that can hinder our move towards ending AIDS in the region.

Address ‘unprecedented’ impact of Coronavirus on Latin America and the Caribbean, urges Guterres

As COVID-19 continues to spread throughout the world, Latin America and the Caribbean have become a “hotspot of the pandemic”, the UN chief said on Thursday, releasing a new policy initiative on how best to recover in a region already embroiled in poverty, hunger, unemployment and inequality.

The UN brief reveals that several countries in the region, are now among those with the highest per capita infection rates worldwide and shines a light on how the crisis is impacting vulnerable groups, including indigenous communities and women.

“The most vulnerable populations and individuals are once again being hit the hardest,” Secretary-General António Guterres said in a video message on the pandemic’s effect throughout a zone grappling with fragmented health services – even before the coronavirus.

‘Unprecedented’ impacts

The UN chief emphasized the impact of the coronavirus on women across the region, who make up the majority of the workforce and now bear the brunt of additional caregiving. He highlighted the plight of older persons and individuals with disabilities, who are at greater risk; and indigenous peoples, those of African descent, migrants and refugees, who suffer disproportionately.

It is projected that there will be a 9.1 per cent contraction in the gross domestic product (GDP), which will be the largest in a century.

While stressing the need to “do everything possible to limit the spread of the virus and tackle the health effects of the pandemic”, Mr Guterres noted that “we must also address the unprecedented social and economic impacts.”

Steps towards a better recovery

The policy brief underlines an array of urgent and longer-term steps for better recovery, including the prioritization of distance learning and continued child-centred services to mitigate education interruptions.

Governments within the region are also being asked to do more to reduce poverty, food insecurity and malnutrition, such as by providing basic emergency income and anti-hunger grants.

Mr Guterres also flagged the urgent need for greater international support.

“I have called for a rescue and recovery package equivalent to more than 10 per cent of the global economy”, reminded the UN chief, underscoring the need of the international community to provide liquidity, financial assistance and debt relief for Latin America and the Caribbean.

“Latin American and Caribbean countries – and in particular small island developing States – should not be excluded from global assistance”, he asserted. “The international multilateral response needs to be extended to middle-income countries”.

Structural change

Broader structural challenges must be addressed to build back better and transform the region’s development model.

Against the backdrop of pervasive inequality, accessible and comprehensive welfare systems must be developed, fair taxation systems created, decent jobs promoted, environmental sustainability strengthened, and social protection mechanisms reinforced, according to the UN chief.

Moreover, regional economic integration is required, with “women participating fully and safely in public and economic life”, he stressed.

“Building back better demands strengthening democratic governance, human rights protection and the rule of law, in line with the 2030 Agenda for Sustainable Development”, Mr Guterres spelt out.

Address root causes

The Secretary-General maintained that the root causes of inequality, political instability and displacement must be addressed, while underscoring that at a time when too many citizens feel excluded, “greater accountability and transparency are crucial”.

He expressed his full solidarity with the people of Latin America and the Caribbean as they face these challenges, saying that “solidarity and compassion should be their guide”.

“Together, we can overcome this crisis and build inclusive and sustainable societies for all”, concluded the UN chief.

Key numbers

•    Unemployment will surge from 8.1 per cent in 2019 to 13.5 per cent this year – yielding over 44 million people out of work, an increase of more than 18 million from last year.•    Poverty is expected to jump by 7.0 per cent to 37.2 per cent in 2020 – leaving 230 million poverty-stricken people.

•    Extreme poverty is forecast to rise by 4.5 per cent to 15.5 per cent –representing 28 million people more people in dire straits (96 million in total).

Image: World Bank/Charlotte Kesl | A seasonal worker at a store in Buga, Colombia.

UN warns of COVID-19’s effect on HIV treatment

In March 2020, the Jamaica Observer reported Dr Jennifer Brown Tomlinson, medical director at Jamaica AIDS Support for Life (JASL), urging people living with HIV to ensure that they take their medication daily.

A compromised immune system, Dr Tomlinson cautioned, may not be able to function at its optimum to fight against the coronavirus.

Said Dr Tomlinson: “People living with HIV who are on their antiretroviral medication have the same risk [of contracting the novel coronavirus] as the normal population. All of the precautions that are being advised for the general population also apply to people living with HIV who are adherent to their antiretrovirals.

That very sound advice takes on more relevance now as we are being told by health experts that COVID-19 could cause an additional half a million AIDS deaths if treatment is disrupted long term.

That chilling projection was made Monday at the start of the virtual International AIDS Conference at which it was noted that the COVID-19 pandemic was jeopardising years of progress against HIV.

The United Nations (UN), in its annual report, pointed out that the world was already way off course in its plan to end the HIV/AIDS threat before the COVID-19 outbreak.

According to the UN, despite the fact that AIDS-related deaths have fallen by 60 per cent since the peak of the HIV epidemic in 2004, approximately 690,000 people still died from the virus and 1.7 million people were infected last year.

There are now almost 40 million people living with HIV worldwide.

The emergence and spread of the novel coronavirus now means that the UN’s target of reducing AIDS-related deaths and new HIV infections to fewer than 500,000 this year will now be missed.

A key contributor to that danger is that the pandemic is impacting access to preventative medicine among communities at risk because of lockdowns and distribution difficulties.

A report from the UN conference tells us that one model run in conjunction with the World Health Organization (WHO) showed that if COVID-19 measures disrupted HIV treatment programmes for six months it could leave an additional 500,000 people dead.

Indeed, WHO Director-General Dr Tedros Adhanom Ghebreyesus is reported as saying: “We cannot let the COVID-19 pandemic undo the hard-won gains in the global response to this disease.”

The information coming out of the UN conferences should not be lost on the just over 32,000 people living with HIV in Jamaica. Those who are not compliant with their medication need to heed Dr Tomlinson’s advice. In fact, anyone living with HIV should not, in the first place, be in a position of non-compliance.

As it now stands, our health authorities, and indeed the Government, need to ensure that the COVID-19 pandemic does not result in a shortage of antiretroviral medicines here.

For, while, as we have already stated, we are disappointed that Jamaica will not meet the Joint United Nations Programme on HIV/AIDS 90-90-90 target, which was set to be attained this year, we are encouraged that JASL has already achieved one of the targets and is close to the 2020 goal of having 90 per cent of its more than 730 HIV-positive clients virally suppressed.

WHO to issue new brief on airborne transmission, following ‘active engagement’ with scientists

Epidemiologist Dr. Maria van Kerkhove, WHO technical lead on COVID-19, was responding to a journalist’s question about an open letter signed by hundreds of scientists urging the UN agency to update its recommendations on airborne transmission.

Dr. van Kerkhove said WHO welcomes interaction with the scientific community.

She reported that the group first wrote to the UN agency on 1 April and there has been “active engagement” since then.

“Many of the signatories are engineers, which is a wonderful area of expertise, which adds to growing knowledge about the importance of ventilation which we feel also is very important”, she said.

WHO has been studying the various potential modes of coronavirus transmission, including by airborne or aerosol droplets, but also other channels such as from mother-to-child, and from animal-to-human.

The agency is producing a scientific brief that consolidates the growing knowledge around this subject, which will be issued in the coming days.

Accelerate global solidarity

The WHO chief has repeated his longstanding appeal for global solidarity to overcome the COVID-19 crisis.

Tedros Adhanom Ghebreyesus warned that although cases are accelerating globally, the peak of the pandemic has yet to be reached.

“While the number of deaths appears to have levelled off globally, in reality some countries have made significant progress in reducing the number of deaths, while in other countries, deaths are still on the rise”, he said.

“Where there has been progress in reducing deaths, countries have implemented targeted actions toward the most vulnerable groups, for example those people living in long-term care facilities.”

As of Tuesday, there were 11.4 million cases of COVID-19, and more than 535,000 deaths.

Tedros said while it took 12 weeks to reach 400,000 cases worldwide, this same number was recorded over the past weekend alone.

“I will say it again. National unity and global solidarity are more important than ever to defeat a common enemy, a virus that has taken the world hostage”, he told journalists.

“This is our only road out of this pandemic. I repeat national unity and global solidarity.”

Maintain access to HIV drugs

WHO is concerned about how the pandemic is having an impact on efforts to tackle HIV, as some 73 countries are at risk of running out of antiretroviral medicines (ARVs).

To address difficulties in accessing treatment during the crisis, WHO recommends prescribing these treatments for longer periods of time, up to six months.

The UN agency also urged countries to ensure uninterrupted prevention, treatment and services for HIV amid the pandemic.

While more than 25 million people worldwide have access to ARVs,  WHO said progress has stalled in the areas of prevention, testing and treatment because services are not reaching those who most need them.

A virus that affects all

The confirmation on Tuesday that Brazil’s President has tested positive for COVID-19 shows that the disease can affect anyone, according to UN health officials.

Jair Bolsonaro, who has repeatedly downplayed the pandemic threat, made the announcement on Brazilian television.

He joins other world leaders, senior government officials and politicians who have contracted the virus, including United Kingdom Prime Minister Boris Johnson.

“I think it brings home for us all the reality of this virus. No one is special in that regard. We are all potentially exposed to this virus”, said Dr. Michael Ryan, WHO Executive Director.

“The virus does not really know who we are. Whether we are prince or pauper, we are equally vulnerable.”

Both Dr. Ryan and the WHO chief wished Mr. Bolsonaro a speedy recovery.

Tedros also highlighted how the new coronavirus is “public enemy number one”, an expression he has used throughout the pandemic.

“It’s very important to understand the seriousness of this virus and to be really serious. No country is immune, and no country is safe. And no individual can be safe”, he said.

Solving the COVID-19 ‘detective story’

WHO experts will be travelling to China this weekend to prepare scientific plans with their local counterparts for identifying the zoonotic source of COVID-19.

The team will develop the scope and terms of reference for a WHO-led international mission to advance understanding of animal hosts for the coronavirus and ascertain how the disease jumped between animals and humans.

Dr. Ryan described this as “quite a detective story”, noting that it took “decades” to unravel the source of Ebola.

“There is the wild animal kingdom, there is the farmed animal kingdom, then there are interfaces with humans. Those interfaces with humans can occur with wild animals, they can occur on farms, they can occur in markets, and we don’t know where that species barrier was actually breached”, he said.

The new coronavirus first emerged in Wuhan, China, late last year.

Tedros explained that the WHO team will not be “starting from scratch” as Chinese researchers have already been studying this issue.

WHO: access to HIV medicines severely impacted by COVID-19 as AIDS response stalls

Seventy-three countries have warned that they are at risk of stock-outs of antiretroviral (ARV) medicines as a result of the COVID-19 pandemic, according to a new WHO survey conducted ahead of the International AIDS Society’s biannual conference. Twenty-four countries reported having either a critically low stock of ARVs or disruptions in the supply of these life-saving medicines.

The survey follows a modelling exercise convened by WHO and UNAIDS in May which forecasted that a six-month disruption in access to ARVs could lead to a doubling in AIDS-related deaths in sub-Saharan Africa in 2020 alone.

In 2019, an estimated 8.3 million people were benefiting from ARVs in the 24 countries now experiencing supply shortages. This represents about one third (33%) of all people taking HIV treatment globally.  While there is no cure for HIV, ARVs can control the virus and prevent onward sexual transmission to other people.

A failure of suppliers to deliver ARVs on time and a shut-down of land and air transport services, coupled with limited access to health services within countries as a result of the pandemic, were among the causes cited for the disruptions in the survey.

The findings of this survey are deeply concerning,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Countries and their development partners must do all they can to ensure that people who need HIV treatment continue to access it. We cannot let the COVID-19 pandemic undo the hard-won gains in the global response to this disease.

Stalled progress

According to data released today from UNAIDS and WHO, new HIV infections fell by 39% between 2000 and 2019. HIV-related deaths fell by 51% over the same time period, and some 15 million lives were saved through the use of antiretroviral therapy.

However, progress towards global targets is stalling. Over the last two years, the annual number of new HIV infections has plateaued at 1.7 million and there was only a modest reduction in HIV-related death, from 730 000 in 2018 to 690 000 in 2019.  Despite steady advances in scaling up treatment coverage – with more than 25 million people in need of ARVs receiving them in 2019 – key 2020 global targets will be missed.

HIV prevention and testing services are not reaching the groups that need them most. Improved targeting of proven prevention and testing services will be critical to reinvigorating the global response to HIV.

WHO guidance and country action

COVID-19 risks exacerbating the situation. WHO recently developed guidance for countries on how to safely maintain access to essential health services during the pandemic, including for all people living with or affected by HIV. The guidance encourages countries to limit disruptions in access to HIV treatment through “multi-month dispensing,” a policy whereby medicines are prescribed for longer periods of time – up to six months. To date, 129 countries have adopted this policy.

Countries are also mitigating the impact of the disruptions by working to maintain flights and supply chains, engaging communities in the delivery of HIV medicines, and working with manufacturers to overcome logistics challenges.

New opportunities to treat HIV in young children

At the IAS conference, WHO will highlight how global progress in reducing HIV-related deaths can be accelerated by stepping up support and services for populations disproportionately impacted by the epidemic, including young children. In 2019, there were an estimated 95 000 HIV-related deaths and 150 000 new infections among children. Only about half (53%) of children in need of antiretroviral therapy were receiving it.  A lack of optimal medicines with suitable pediatric formulations has been a longstanding barrier to improving health outcomes for children living with HIV.

Last month, WHO welcomed a decision by the U.S. Food and Drug Administration to approve a new 5mg formulation of dolutegravir (DTG) for infants and children older than 4 weeks and weighing more than 3 kg. This decision will ensure that all children have rapid access to an optimal drug that, to date, has only been available for adults, adolescents and older children. WHO is committed to fast-tracking the prequalification of DTG as a generic drug so that it can be used as soon as possible by countries to save lives.

Through a collaboration of multiple partners, we are likely to see generic versions of dolutegravir for children by early 2021, allowing for a rapid reduction in the cost of this medicine,” said Dr Meg Doherty, Director of the Department of Global HIV, Hepatitis and STI Programmes at WHO. “This will give us another new tool to reach children living with HIV and keep them alive and healthy.”

Tackling opportunistic infections

Many HIV-related deaths result from infections that take advantage of an individual’s weakened immune system. These include bacterial infections, such as tuberculosis, viral infections like hepatitis and COVID-19, parasitic infections such as toxoplasmosis and fungal infections, including histoplasmosis.

Today, WHO is releasing new guidelines for the diagnosis and management of histoplasmosis, among people living with HIV. Histoplasmosis is highly prevalent in the WHO Region of the Americas, whereas many as 15 600 new cases and 4500 deaths are reported each year among people living with HIV. Many of these deaths could be prevented through timely diagnosis and treatment of the disease.

In recent years, the development of highly sensitive diagnostic tests has allowed for rapid and accurate confirmation of histoplasmosis and earlier initiation of treatment. However, innovative diagnostics and optimal treatments for this disease are not yet widely available in resource-limited settings.

UNAIDS Launches Global AIDS Update 2020

Missed targets have resulted in 3.5 million more HIV infections and 820 000 more AIDS-related deaths since 2015 than if the world was on track to meet the 2020 targets. In addition, the response could be set back further, by ten years or more, if the COVID-19 pandemic results in severe disruptions to HIV services.

GENEVA, 7 July 2020 — A new report by UNAIDS shows remarkable, but highly unequal, progress, notably in expanding access to antiretroviral therapy. Because the achievements have not been shared equally within and between countries, the global HIV targets set for 2020 will not be reached. The report, Seizing the moment, warns that even the gains made could be lost and progress further stalled if we fail to act. It highlights just how urgent it is for countries to double down and act with greater urgency to reach the millions still left behind.

“Every day in the next decade decisive action is needed to get the world back on track to end the AIDS epidemic by 2030,” said Winnie Byanyima, the Executive Director of UNAIDS. “Millions of lives have been saved, particularly the lives of women in Africa. The progress made by many needs to be shared by all communities in all countries. Stigma and discrimination and widespread inequalities are major barriers to ending AIDS. Countries need to listen to the evidence and step up to their human rights responsibilities.”

Fourteen countries have achieved the 90–90–90 HIV treatment targets (90% of people living with HIV know their HIV status, of whom 90% are on antiretroviral treatment and of whom 90% are virally suppressed), including Eswatini, which has one of the highest HIV prevalence rates in the world, at 27% in 2019, and which has now surpassed the targets to achieve 95–95–95.

The scale-up of antiretroviral therapy has saved millions of lives and new infections. However, 690 000 people died of AIDS-related illnesses last year, and 12.6 million of the 38 million people living with HIV were not accessing the life-saving treatment.

“We cannot rest on our successes, nor be discouraged by setbacks. We must ensure that no one is left behind. We must close the gaps. We are aiming for 100–100–100,” said Ambrose Dlamini, the Prime Minister of Eswatini.

The world is far behind in preventing new HIV infections. Some 1.7 million people were newly infected with the virus, more than three times the global target. There has been progress in eastern and southern Africa, where new HIV infections have reduced by 38% since 2010. This is in stark contrast to eastern Europe and central Asia, which has seen a staggering 72% rise in new HIV infections since 2010. New HIV infections have also risen in the Middle East and North Africa, by 22%, and by 21% in Latin America.

Seizing the moment shows unequal progress, with too many vulnerable people and populations left behind. Around 62% of new HIV infections occurred among key populations and their sexual partners, including gay men and other men who have sex with men, sex workers, people who inject drugs and people in prison, despite them constituting a very small proportion of the general population.

Stigma and discrimination, together with other social inequalities and exclusion, are proving to be key barriers. Marginalised populations who fear judgement, violence or arrest struggle to access sexual and reproductive health services, especially those related to contraception and HIV prevention. Stigma against people living with HIV is still commonplace. At least 82 countries criminalise some form of HIV transmission, exposure or non-disclosure, sex work is criminalised in at least 103 countries, and at least 108 countries criminalise the consumption or possession of drugs for personal use.

Women and girls in sub-Saharan Africa continue to be the most affected and accounted for 59% of all new HIV infections in the region in 2019, with 4500 adolescent girls and young women between 15 and 24 years old becoming infected with HIV every week. Young women accounted for 24% of new HIV infections in 2019, despite making up only 10% of the population in sub-Saharan Africa.

However, where HIV services are comprehensively provided, HIV transmission levels are reduced significantly. In Eswatini, Lesotho and South Africa, high coverage of combination prevention options, including social and economic support for young women and high levels of treatment coverage and viral suppression for previously unreached populations, have narrowed inequality gaps and driven down the incidence of new HIV infections.

The COVID-19 pandemic has severely impacted the AIDS response and could disrupt it more. A six-month complete disruption in HIV treatment could cause more than 500 000 additional deaths in sub-Saharan Africa over the next year (2020–2021), bringing the region back to 2008 AIDS mortality levels. Even a 20% disruption could cause an additional 110 000 deaths.

“Those of us who survived HIV and fought for life and access to treatment and care cannot afford to lose the gains that took so much effort to win. In some Latin American countries we are seeing how HIV resources, medicines, medical staff and equipment are being moved to the fight against COVID-19,” said Gracia Violeta Ross, President of the Bolivian Network of People Living with HIV. “Some good lessons and practices of the HIV response, such as meaningful participation and accountability, are being ignored. We will not allow HIV to be left behind.”

To fight the colliding epidemics of HIV and COVID-19, UNAIDS and partners are leading a global call for a People’s Vaccine for COVID-19, which has been signed by more than 150 world leaders and experts demanding that all vaccines, treatments and tests be patent-free, mass produced and distributed fairly and free for all.

UNAIDS is also urging countries to increase investments in both diseases. In 2019, funding for HIV fell by 7% from 2017 to US$ 18.6 billion. This setback means that funding is 30% short of the US$ 26.2 billion needed to effectively respond to HIV in 2020.

“We cannot have poor countries at the back of the queue. It should not depend on the money in your pocket or the colour of your skin to be protected against these deadly viruses,” said Ms Byanyima. “We cannot take money from one disease to treat another. Both HIV and COVID-19 must be fully funded if we are to avoid massive loss of life.”

 Helpful links:
  • UNAIDS 2020 Databook

https://www.unaids.org/en/resources/documents/2020/unaids-data 

  • Core Epidemiology Slides
  • Fact sheet