Archives: Media Releases

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

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

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.

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.

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.

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.”

• UNAIDS 2020 Databook

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

• Core Epidemiology Slides

• Fact sheet